Clinical Outcome after Resection Rectopexy in patients with Constipation and Rectal Prolapse

Abstract

Introduction: Laparoscopic resection rectopexy (LRR) is an established procedure for the treatment of rectal prolapse. This study evaluated constipation and gastrointestinal quality of life in patients before and after LRR for rectal prolapse. Methods: 30 patients (24 females, 6 males) underwent laparoscopic anterior (n = 14), posterior (n = 8) and suture resection rectopexy (n = 8) for rectal prolapse during 2010 – 2020. 25 were retrospectively evaluated for constipation and gastrointestinal quality of life using validated Cleveland Clinic Constipation Score (CCCS) and Gastrointestinal Quality of Life Index (GIQLI). Results: Constipation score was significantly reduced from median 16.0 ± 6.4 to 6.0 ± 4.7 after 68.0 ± 42.8 months (p < 0.001). Constipation was improved in 20 patients (80.0%), unaltered in 2 patients and worse in 3 patients. Prior abdominal surgeries were associated with less improvement for constipation (p < 0,05). Significant improvement in GIQLI score was observed, with median total GIQLI score increasing from 95.0 ± 14.8 to 124.0 ± 18.2 (p < 0.001). Quality of life improved in 21 patients (84.0%). Positive changes were also observed in GIQLI subgroups of gastrointestinal symptoms, emotions, physical status, social dysfunction and effects of medical treatment (p < 0.001). There was no difference in outcome between the three procedures. Conclusion: Laparoscopic resection rectopexy for rectal prolapse is safe, feasible, and very effective regarding both perioperative results and long-term functional outcome. Our results suggest that LRR significantly improves constipation in patients with outlet obstruction and clearly contributes to a higher quality of life.

Keywords

• outlet obstruction
• laparoscopy
• colorectal surgery
• cleveland clinic constipation score
• gastrointestinal quality of life index