Context
Dissection of the lateral ligaments during rectopexy has been a source of
contention. The purpose of this study was to determine the effect of complete
rectal mobilization and lateral ligament division on anorectal functioning after
laparoscopic suture rectopexy.
Aims
Evaluation of anorectal functions in patients with complete and internal rectal
prolapse after laparoscopic suture rectopexy with complete division of lateral
rectal ligaments.
Methods, material, and study design
Twenty-five patients with complete and internal rectal prolapse were enrolled in this
prospective cohort study between March 2018 and January 2021, including followup
period. Comparison between pre- and postoperative course included obstructed
defecation score, need for laxatives, anorectal manometry pressures, anorectal
sensations, and recurrence. Mean follow-up period was 12 months.
Statistical analysis
Data management and statistical analysis were done using SPSS vs. 25 (IBM,
Armonk, NY). Quantitative data were assessed for normality using the
Shapiro–Wilk test and direct data visualization methods. Then, quantitative data
were summarized as mean and SD or medians and ranges. Categorical data were
summarized as numbers and percentages. Longo score and anorectal manometry
were compared at different times using repeated-measures ANOVA. Post hoc AQ4
analyses were done using the Bonferroni method. Quality of life aspects were
compared pre- and postprocedure using paired t-test. McNemar test was used to
compare laxative use at different times. All statistical tests were two-sided. P values
less than 0.05 were considered significant.
Results
Preoperatively, 25 patients showed obstructed defecation symptoms.
Postoperatively, 23 (92%) patients have significant improvement in Obstructed
Defecation Syndrome (ODS) score; however, 40% of them are still depending on
laxatives. The remaining two patients (8%) with ODS have no significant
improvement in ODS score. Regarding anorectal manometry after surgery,
mean squeeze pressure showed significant increase, whereas all rectal
sensation showed significant decrease. Patient Assessment of Constipation
Quality of Life questionnaire score, total physical discomfort score, total
psychosocial discomfort score, and total worries and concerns score were
significantly lower postoperatively, whereas the total satisfaction score was
significantly higher postoperatively. No recurrences were found.
Conclusions
Complete mobilization of the rectum during laparoscopic suture rectopexy
associated with recovery of anorectal sensation and also improvement in ODS
with low recurrence rate reaches 0%. |
