Clinically based management of rectal prolapse: Comparison of the laparoscopic Wells procedure and laparoscopic resection with rectopexy

K. M. Madbouly, A. J. Senagore, C. P. Delaney, H. J. Duepree, K. M. Brady, V. W. Fazio

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Laparoscopic repair of rectal prolapse offers the potential of lower recurrence rates for transabdominal repair coupled with the advantages of minimally invasive colorectal surgery. There have been no direct comparisons of the laparoscopic Wells procedure (LWP) and laparoscopic resection with rectopexy (LRR). This study is the first to make a direct comparison of outcomes from laparoscopic LRR and LWP repairs using a selected, symptom-based choice of operative procedure. Methods: Consecutive patients presenting with complete rectal prolapse were evaluated by clinical history of the degree of constipation, diarrhea, or incontinence. Patients with a history of constipation or normal bowel habits with normal continence underwent LRR, whereas those with diarrhea or anal incontinence underwent LWP. The collected data included age, gender, operative time, length of hospital stay (LOS), operative blood loss, complications, and postoperative symptoms of constipation or diarrhea. Continence was scored using the Cleveland Clinic scoring system. Results: Of the 24 patients, 11 underwent LRR and 13 had LWP. The patients in both groups were predominantly, female (LRR, 9/1; LWP, 10/2). The LRR patients were significantly younger (48.6 vs 63.9 years p <0.001). Both operative time and LOS were significantly longer in the RR group (operative time, 128.5 ± 80.6 min vs 69.9 ± 13.4 min; LOS, 3.6 ± 3.1 days vs 2.2 ± 1.03 days). All patients in the LRR group had constipation preoperative, and no patients were incontinent clinically. Preoperatively, 7 of the 13 patients in the LWP group had preoperative diarrhea, and 1 patient had clinical constipation. A five patients experienced clinical symptoms of fecal incontinence, manifested in different degrees. Postoperative complications occurred only in the LRR group (1 case of abdominal wall hematoma and 2 cases of prolonged ileus). During a mean follow-up period of 18.1 months, there were no recurrences; 10 of the 11 LRR patients had correction of constipation; and 4 of 5 of the incontinent LWP patients had improvement in their symptoms. Constipation developed in one LWP patient. Conclusions: Clinical assessment of preoperative bowel function and continence allows accurate selection of the appropriate laparoscopic technique for repair of rectal prolapse without the added expense of anal physiologic testing. Although LRR may be associated greater morbidity than LWP, both procedures offer good functional outcome, with short LOS and low recurrence rates.

Original languageEnglish (US)
Pages (from-to)99-103
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume17
Issue number1
DOIs
StatePublished - Jan 2003
Externally publishedYes

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Rectal Prolapse
Constipation
Length of Stay
Diarrhea
Operative Time
Recurrence
Postoperative Hemorrhage
Fecal Incontinence
Colorectal Surgery
Minimally Invasive Surgical Procedures
Ileus
Operative Surgical Procedures
Abdominal Wall
Hematoma
Habits

Keywords

  • Laparoscopic rectopexy
  • Rectal prolapse
  • Wells procedure

ASJC Scopus subject areas

  • Surgery

Cite this

Clinically based management of rectal prolapse : Comparison of the laparoscopic Wells procedure and laparoscopic resection with rectopexy. / Madbouly, K. M.; Senagore, A. J.; Delaney, C. P.; Duepree, H. J.; Brady, K. M.; Fazio, V. W.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 17, No. 1, 01.2003, p. 99-103.

Research output: Contribution to journalArticle

Madbouly, K. M. ; Senagore, A. J. ; Delaney, C. P. ; Duepree, H. J. ; Brady, K. M. ; Fazio, V. W. / Clinically based management of rectal prolapse : Comparison of the laparoscopic Wells procedure and laparoscopic resection with rectopexy. In: Surgical Endoscopy and Other Interventional Techniques. 2003 ; Vol. 17, No. 1. pp. 99-103.
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T2 - Comparison of the laparoscopic Wells procedure and laparoscopic resection with rectopexy

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AU - Senagore, A. J.

AU - Delaney, C. P.

AU - Duepree, H. J.

AU - Brady, K. M.

AU - Fazio, V. W.

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N2 - Background: Laparoscopic repair of rectal prolapse offers the potential of lower recurrence rates for transabdominal repair coupled with the advantages of minimally invasive colorectal surgery. There have been no direct comparisons of the laparoscopic Wells procedure (LWP) and laparoscopic resection with rectopexy (LRR). This study is the first to make a direct comparison of outcomes from laparoscopic LRR and LWP repairs using a selected, symptom-based choice of operative procedure. Methods: Consecutive patients presenting with complete rectal prolapse were evaluated by clinical history of the degree of constipation, diarrhea, or incontinence. Patients with a history of constipation or normal bowel habits with normal continence underwent LRR, whereas those with diarrhea or anal incontinence underwent LWP. The collected data included age, gender, operative time, length of hospital stay (LOS), operative blood loss, complications, and postoperative symptoms of constipation or diarrhea. Continence was scored using the Cleveland Clinic scoring system. Results: Of the 24 patients, 11 underwent LRR and 13 had LWP. The patients in both groups were predominantly, female (LRR, 9/1; LWP, 10/2). The LRR patients were significantly younger (48.6 vs 63.9 years p <0.001). Both operative time and LOS were significantly longer in the RR group (operative time, 128.5 ± 80.6 min vs 69.9 ± 13.4 min; LOS, 3.6 ± 3.1 days vs 2.2 ± 1.03 days). All patients in the LRR group had constipation preoperative, and no patients were incontinent clinically. Preoperatively, 7 of the 13 patients in the LWP group had preoperative diarrhea, and 1 patient had clinical constipation. A five patients experienced clinical symptoms of fecal incontinence, manifested in different degrees. Postoperative complications occurred only in the LRR group (1 case of abdominal wall hematoma and 2 cases of prolonged ileus). During a mean follow-up period of 18.1 months, there were no recurrences; 10 of the 11 LRR patients had correction of constipation; and 4 of 5 of the incontinent LWP patients had improvement in their symptoms. Constipation developed in one LWP patient. Conclusions: Clinical assessment of preoperative bowel function and continence allows accurate selection of the appropriate laparoscopic technique for repair of rectal prolapse without the added expense of anal physiologic testing. Although LRR may be associated greater morbidity than LWP, both procedures offer good functional outcome, with short LOS and low recurrence rates.

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