Laparoscopic Resection Rectopexy with Transanal Specimen Extraction for Complete Rectal Prolapse: Retrospective Cohort Study of Functional Outcomes.

Background

Complete rectal prolapse (RP) is a debilitating pelvic floor disorder often accompanied by obstructed defecation syndrome (ODS), fecal incontinence, and LARS-like bowel dysfunction. Laparoscopic resection rectopexy (LRR) is an established abdominal approach; however, functional outcomes after LRR with transanal specimen extraction (LRR-TSE) are incompletely defined. Aim: To evaluate short- and long-term functional outcomes-ODS, Wexner incontinence score (WIS), and LARS-in patients undergoing LRR-TSE.

Methods

This single-center cohort included 53 consecutive patients who underwent LRR-TSE between January 2013 and December 2019. Variables were prospectively recorded and analyzed retrospectively. ODS, WIS, and LARS scores were assessed preoperatively and at 3, 6, and 12 months. Longitudinal changes were analyzed using repeated-measures ANOVA with Greenhouse-Geisser correction, polynomial contrasts when appropriate, and Bonferroni-adjusted pairwise comparisons.

Results

ODS improved significantly over time (p < 0.001), decreasing from 12.8 ± 3.2 preoperatively to 2.4 ± 2.1, 4.2 ± 2.2, and 5.2 ± 2.9 at 3, 6, and 12 months, respectively. LARS scores declined from 18.0 ± 12.7 at 3 months to 8.8 ± 6.8 at 6 months and 3.5 ± 4.2 at 12 months (p < 0.001). WIS showed a transient increase at 3 months (8.1 ± 5.2), followed by improvement at 6 and 12 months (3.2 ± 3.7 and 2.4 ± 3.0; p < 0.001). Sex and body mass index did not affect functional trajectories (p > 0.05), whereas patients aged ≥50 years had higher postoperative LARS and WIS scores (p < 0.05). Complications occurred in 5 patients (9.43%), including one anastomotic leak with a mortality rate of 1.85%. Full-thickness recurrence occurred in 2 patients (3.77%), and 3 developed mucosal prolapse managed with Delorme's procedure.

Conclusions

LRR-TSE is a safe and feasible minimally invasive technique that improves constipation, continence, and LARS-related bowel dysfunction. Early postoperative impairment may overestimate long-term functional severity, highlighting the need for follow-up beyond 12 months.