Laparoscopic ventral rectopexy for fecal incontinence associated with high-grade internal rectal prolapse.

Gosselink, Martijn P; Adusumilli, S; Gorissen, Kim J; Fourie, Simona; Tuynman, Jurriaan B; Jones, Oliver M; Cunningham, Chris; Lindsey, Ian

BACKGROUND The role of internal rectal prolapse in the origin of fecal incontinence remains to be defined. In our institution, laparoscopic ventral rectopexy is offered to patients with high-grade internal prolapse and fecal incontinence. OBJECTIVE The present study was designed to evaluate the functional outcome after laparoscopic ventral rectopexy in patients with fecal incontinence associated with high-grade internal rectal prolapse. DESIGN This study was designed as a prospective observational study. SETTINGS The study took place in a university hospital. PATIENTS Between 2009 and 2011, 72 patients with fecal incontinence not responding to maximum medical treatment (including biofeedback) were included. All patients had a grade III or grade IV rectal prolapse. INTERVENTION Laparoscopic ventral rectopexy was performed. MAIN OUTCOME MEASURES Preoperative endoanal ultrasonography and anorectal manometry were performed. Fecal continence was evaluated by using the Rockwood Fecal Incontinence Severity Index score before and 1 year after surgery. RESULTS The median fecal incontinence severity index score 1 year after surgery was lower than the median score before surgery (15 versus 31; p < 0.01), representing an improvement in fecal continence. LIMITATIONS This was a preliminary observational study with no control group, no postoperative proctography, and no postoperative anal physiology. CONCLUSION Laparoscopic ventral rectopexy can improve symptoms of fecal incontinence in patients with a high-grade internal rectal prolapse. Internal rectal prolapse contributes to the multifactorial origin of fecal incontinence.