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Long-term outcomes of robotic ventral mesh rectopexy for external rectal prolapse

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Abstract

Introduction

Nowadays in Europe, laparoscopic ventral mesh rectopexy is the gold standard treatment of external rectal prolapse (ERP). The benefits of robot ventral mesh rectopexy (RVMR) are not clearly defined. The primary objective of the study was to evaluate the long-term results of RVMR. The secondary objective was to determine predictive factors of recurrence.

Design

Monocentric, retrospective study. Data, both pre-operative and peri-operative, were collected, and follow-up data were assessed prospectively by a telephone questionnaire. The study was performed in a tertiary referral center.

Methods

Between August 2007 and August 2017, we evaluate all consecutive patients who underwent RVMR for ERP by three different surgeons. The primary outcome was the recurrence rate perceived by patients. Secondary outcome were functional results based on Knowles–Eccersley–Scott-Symptom score for constipation and Wexner score for incontinence, compared before and after surgery.

Results

During the study period 96 patients (86 women) underwent RVMR. The mean age was 62.3 years (range 16–90). Twelve patients had a history of ERP repair. Sixty-nine patients were analyzed for long-term outcomes with a mean follow-up of 37 months (range 2.3–92 months). Recurrence rate was 12.5%. After surgery, constipation was significantly reduced: 44 patients were constipated before surgery versus 23 after surgery. Six patients described de novo constipation (6.25%). Fecal incontinence was significantly reduced: 59 patients were incontinent before surgery versus 14 after surgery. No predictive factor for recurrence was identified after multivariate analysis. No mesh related complications were related.

Conclusions

In conclusion, RVMR presents good long-term functional result and a recurrence rate similar to LVMR as published in the literature. The rate of mesh related complications seems lower.

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Author information

Agathe Postillon substantial contributions to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; and drafting the work and revising it critically for important intellectual content; and final approval of the version to be published; and Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved. Cyril Perrenot drafting the work and revising it critically for important intellectual content. Adeline Germain substantial contributions to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; and drafting the work and revising it critically for important intellectual content. Marie-Lorraine Scherrer substantial contributions to the conception and design of the work; and the acquisition of data for the work. Cyrille Buisset substantial contributions to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; and drafting the work and revising it critically for important intellectual content; and final approval of the version to be published. Laurent Brunaud final approval of the version to be published. Ahmet Ayav final approval of the version to be published. Laurent Bresler substantial contributions to the conception and design of the work; and the acquisition, analysis, and interpretation of data for the work; and drafting the work and revising it critically for important intellectual content; and final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved.

Correspondence to Agathe Postillon.

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Disclosures

Laurent Bresler, MD, PhD has financial disclosure; he is Proctor for Intuitive Surgical (Sunnyvale, CA). Agathe Postillon, Cyrille Perrenot, MD, Adeline Germain, MD, PhD, Marie-Lorraine Scherrer, MD, Cyrille Buisset, MD, Laurent Brunaud, MD, PhD, and Ahmet Ayav, MD, PhD have no conflicts of interest or financial ties to disclose.

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Postillon, A., Perrenot, C., Germain, A. et al. Long-term outcomes of robotic ventral mesh rectopexy for external rectal prolapse. Surg Endosc 34, 930–939 (2020) doi:10.1007/s00464-019-06851-6

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Keywords

  • Constipation
  • Fecal incontinence
  • Rectal prolapse
  • Rectopexy
  • Recurrence
  • Robotics