Risk Factors for Recurrence After Laparoscopic Ventral Rectopexy

Abstract

BACKGROUND: Laparoscopic ventral rectopexy effectively treats posterior compartment prolapse. However, recurrence after laparoscopic ventral rectopexy is poorly understood. OBJECTIVE: This study aimed to evaluate factors contributing to recurrence after laparoscopic ventral rectopexy. DESIGN: A retrospective cohort analysis was performed of patients who underwent laparoscopic ventral rectopexy between June 2008 and June 2014. Patients presenting with full-thickness rectal prolapse were compared against the rest. Cox proportional hazards regression was used to determine predictors for recurrence. Operative findings of redo cases were evaluated. SETTINGS: This study was conducted under the supervision of a single pelvic floor surgeon. PATIENTS: A total of 231 patients with a median follow-up of 47 months were included. MAIN OUTCOME MEASURES: Clinicopathological risk factors and technical failures contributing to recurrence were analyzed. RESULTS: The overall recurrence rate was 11.7% (n = 27). Twenty-five recurrences occurred in patients with full-thickness rectal prolapse, of which 16 were full-thickness recurrences (14.2% (16/113)). Multivariate analyses showed predictors for recurrence to be prolonged pudendal nerve terminal motor latency (HR = 5.57 (95% CI, 1.13 - 27.42); p = 0.04) and the use of synthetic mesh as compared with biologic grafts (HR = 4.24 (95% CI, 1.27-14.20); p = 0.02). Age >70 years and poorer preoperative continence were also associated with recurrence on univariate analysis. Technical failures contributing to recurrence included mesh detachment from the sacral promontory and inadequate midrectal mesh fixation. LIMITATIONS: Modifications to the operative technique were made throughout the study period. A postoperative defecating proctogram was not routinely performed. CONCLUSIONS: Recurrence after laparoscopic ventral rectopexy is multifactorial, and risk factors are both clinical and technical. The use of biologic grafts was associated with lower recurrence as compared with synthetic mesh. Patients with full-thickness rectal prolapse who are elderly, have poorer baseline continence, and have prolonged pudendal nerve terminal motor latency are at increased risk of recurrence.