Robotic vs. laparoscopic ventral mesh rectopexy for external rectal prolapse and rectal intussusception: a systematic review.

BACKGROUND: Laparoscopic ventral mesh rectopexy (LVR) is a treatment with promising results in external rectal prolapse, rectal intussusception, and rectocele. Because of the emergence of robotic-assisted surgery and the technical advantage it provides, we examined the potential role and place of robotic surgery in ventral rectopexy. METHODS: MEDLINE, PubMed, and other databases were searched, by two independent reviewers, to identify studies comparing robotic to laparoscopic ventral mesh rectopexy. The primary outcome was the rate of unplanned conversion to open. The secondary outcomes were morbidity, length of hospital stay and recurrence rate. RESULTS: Five studies (4% male, n = 259) met the inclusion criteria. All 5 studies reported on conversion rate and showed no significant difference between the conversion rate of robotic and laparoscopic groups [OR 0.58 (95% CI 0.09-3.77)]. Robotic surgery was also similar to laparoscopic surgery for both morbidity [OR 0.71 (95% CI 0.34-1.48)] and recurrence rate [OR 0.56 (95% CI 0.18-1.75)]. Operative time was longer in the robotic group with a MWD of 22.88 minutes (CI 5.73-40.04, p < 0.0007). There was a statistically significant reduction in length of stay with robotic surgery [mean difference - 0.36 days (95% CI - 0.66 to - 0.07)]. CONCLUSIONS: This systematic review shows that robotic-assisted ventral rectopexy requires longer operative time with no significant added benefit over laparoscopic ventral rectopexy. The conversion rate was low in both groups and the trends to benefit did not reach statistical significance. More studies are required to clarify whether the potential technical advantage of robotic surgery in ventral rectopexy translates to an improvement in clinical outcome.

Laparoscopic ventral rectopexy for rectal prolapse and rectal intussusception using a biological mesh.

AIM: Laparoscopic ventral rectopexy (LVR) is a nerve-sparing technique for the treatment of rectal prolapse. Concerns about the use of synthetic meshes in the pelvis and the associated risk of erosion have led to the recent use of biological meshes in some colorectal units. This retrospective study aims to assess the outcomes of patients undergoing LVR using a noncross-linked nondermal biological mesh. METHOD: The medical notes of all patients who underwent LVR between 1 December 2011 and 31 May 2014 were reviewed. The rate of obstructed defaecation before surgery was retrospectively determined from medical records using the Rome III criteria. The rates of obstructed defaecation and faecal incontinence following surgery were determined using a self-reported questionnaire. RESULTS: A total of 51 patients had LVR between 1 December 2011 and 31 May 2014. Their mean age was 57.3 ± 2.5 years and the mean follow-up was 23 ± 1 months. There were seven (13.7%) postoperative complications. In total, 45 (88%) patients completed the functional outcome questionnaires. Before surgery, 33 (73.3%) patients complained of symptoms of obstructed defaecation. At the end of follow-up, 22 (48.8%, P = 0.001) patients continued to have some symptoms of obstructed defaecation. Before surgery, 12 (26.7%) patients complained of faecal incontinence. At the end of follow-up, only three (6.7%, P = 0.004) patients reported faecal incontinence. At the end of follow-up, recurrence of symptoms had occurred in six (13.3%) patients. CONCLUSION: LVR using a biological mesh is safe and results in significant reduction in symptoms associated with external rectal prolapse and rectal intussusception.