Laparoscopic-assisted vs. open resection. Rectopexy offers excellent results.

PURPOSE: Anterior resection +/- rectopexy effectively manages full-thickness rectal prolapse; however, morbidity is approximately 15 percent mainly because of the laparotomy wound. There has been no comparison of laparoscopic with laparotomy approaches to the repair of this disorder. The purpose of this paper is to compare an age/sex-matched series of laparoscopic-assisted (n = 8) with laparotomy (n = 10) resections/rectopexies.

METHODS

A retrospective case review of laparoscopic-assisted (n = 8) vs. laparotomy (n = 10) resections/rectopexies from May 1989 to September 1993 was performed. Data collected included age, gender, technique, operative blood loss, operative time, length of bowel resected, length of hospital stay, return of bowel function, oral intake, and postoperative complications.

RESULTS

No significant difference was noted in age, sex, length of bowel resected, mortality, significant morbidity, or recurrence (mean follow-up, 27.1 +/- 4.4 months) in either group. Estimated blood loss for the laparotomy group was greater than for the laparoscopic group (285.0 +/- 35.0 vs. 184.4 +/- 31.0 ml). Operative time was greater for the laparoscopic group (177.1 +/- 23.0 vs. 86.5 +/- 8.6 min). Length of stay (95.0 +/- 16.7 vs. 183.5 +/- 8.9 hours), time to passage of flatus (3.9 +/- 1.1 vs. 2.8 +/- 1.9 days), and resumption of oral intake (4.5 +/- 0.7 vs. 2.8 +/- 1.9 days) occurred earlier for the laparoscopic group.

CONCLUSION

Therefore, laparoscopic-assisted resection/rectopexy effectively treats rectal prolapse without the morbidity of the laparotomy wound and significantly shortens hospitalization for this benign disease.