Minimally invasive resection rectopexy as a treatment method for obstructive defecation (ODS): functional outcome in ODS; constipation and fecal incontinence.

BACKGROUND

Minimally invasive resection rectopexy is an effective treatment for obstructive defecation syndrome (ODS) in carefully selected patients, offering favorable functional outcomes with potentially reduced surgical trauma. As minimally invasive techniques continue to advance in colorectal surgery, integrating resection rectopexy with Natural Orifice Specimen Extraction (NOSE) or minilaparotomy retrieval may further enhance postoperative bowel function by minimizing constipation and fecal incontinence. We hypothesize that surgical outcomes are influenced by the severity of disease.

METHODS

Between January 2019 and June 2022, 85 patients with ODS underwent minimally invasive resection rectopexy. Patient characteristics were assessed using standardized questionnaires. Surgical outcomes, complications, and patient satisfaction were evaluated at 1, 3, and 6 months postoperatively. Symptom severity was quantified using the Wexner Constipation Score (WCS), Wexner Incontinence Score (WIS), and Altomare Obstructive Defecation Syndrome (AOS) Score. Repeated measures ANOVA was performed to assess longitudinal changes in these measures over time.

RESULTS

All procedures were successfully completed laparoscopically without conversion. The mean patient age was 58.5 years (SD = 16.5). Complications were classified as Clavien-Dindo grade IIIa (n = 3), IIIb (n = 8), and IVa (n = 1). Repeated measures ANOVA demonstrated significant postoperative improvements in WCS (p < 0.0001) and AOS (p < 0.0001). Although WIS changes were not statistically significant, a gender-specific effect was observed (p = 0.011). Post hoc analyses revealed no significant temporal effects for WIS across genders. Follow-up was limited to 6 months.

CONCLUSION

Minimally invasive resection rectopexy provides substantial symptom relief, particularly in reducing constipation and obstructive defecation. While outcomes for fecal incontinence remain variable, the procedure seems safe, feasible, and markedly improves the quality of life in patients with ODS. Long-term outcomes and recurrence rates require further study.