Redo ventral rectopexy: is it worthwhile?
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ORIGINAL ARTICLE
Redo ventral rectopexy: is it worthwhile? K. E. Laitakari1,2 · J. K. Mäkelä‑Kaikkonen1,2 · M. Kairaluoma3 · A. Junttila3 · J. Kössi4 · P. Ohtonen1,2 · T. T. Rautio1,2 Received: 27 May 2020 / Accepted: 24 October 2020 © The Author(s) 2020
Abstract Background Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). Methods This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At followup, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life. Results A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation. Conclusions Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates. Keywords Rectal prolapse · Ventral rectopexy · Mesh · Redo surgery
Introduction Due to a lack of sufficient evidence, there are no broadly adopted recommendations about the use of either perineal or transabdominal techniques or what kind of procedure is the most effective for rectopexy when treating primary rectal prolapse [1]. Despite this, laparoscopic ventral mesh rectopexy (LVMR) has become the treatment of choice for * K. E. Laitakari [email protected] 1
Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
2
Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
3
Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland
4
Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
external rectal prolapse (ERP) in Europe [2]. LVMR has also been offered to patients with internal rectal prolapse (IRP) and other pelvic anatomical disorders involving obstructed defecation symptoms (ODS) or incontinence, although there is only level 3 evidenc
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