Athula Tennakoon and Golam Farook
Introduction: Laparoscopic ventral mesh rectopexy (LVMR) is gaining wider acceptance. The aim of this study is to present that LVMR can be learnt and safely performed with short term results similar to that of establish centres.
Materials and Methods: All underwent anorectal physiology, defecation proctography, colon transit studies, colonoscopy or sigmoidoscopy as appropriate and pelvic floor MDT and biofeedback. Patients with high grade intussusception who did not respond to laxatives and biofeedback were offered LVMR. Surgical technique was as described by D’Hoore et al. and performed by both authors. Data are presented as median, range and proportions.
Results: Median age, ASA & BMI were 60.5 (34-78), 2 (1-3), 26.1 (20.4-33.1). Previous pelvic surgery included hysterectomy (35%), vaginal wall repair (15%) and rectal prolapse surgery (20%). 45% had Oxford prolapse grades 3/4 and rest were grade 5. Median operative time was 229 minutes (175-330). Synthetic mesh was used in 16 patients (Parietex 30%, TiLENE 50%) and Permacol in four (20%). 30 day mortality was zero. There were no conversions and overall complication rate was 10%.Sexual dysfunction was not reported. Median length of stay was 3 (2-6). 17 patients (85%) had 6 months or more follow up. Median patient reported outcome for satisfaction was 9.5 on a scale of 1 to 10 (2-10). Two patients developed recurrences of ODS at 6 and 12 months.
Discussion and Conclusions: We suggest that experienced laparoscopic surgeons can learn and safely perform laparoscopic ventral mesh rectopexy.
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