Laparoscopic Ventral Rectopexy for Fecal Incontinence Associated with High-grade Internal Rectal Prolapse

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.