Our Summary

This research paper looks at a specific kind of pelvic floor disorder called Posterior Compartment Pelvic Floor Prolapse (PCPFP), which can cause discomfort and functional issues in the body. The main way to treat this is through surgery, specifically a type called Ventral Mesh Rectopexy (VMR), which has become more popular in Western countries.

The researchers wanted to see how effective and safe this surgery is for people in Asia, as there isn’t much information available. They looked at all the cases of PCPFP surgery done at Singapore General Hospital between 2014 and 2019.

They found that 83 patients had this surgery, most of them in the last 3 years. The patients were mostly women, with an average age of 63. The main reasons for needing the surgery were issues with passing stool, fecal incontinence, rectal bleeding, or discomfort in the anal area.

Most patients (66%) underwent a type of surgery called abdominal rectopexy, while others had a procedure known as Delorme’s. Almost all of the VMR procedures were minimally invasive, meaning they used small incisions rather than large ones.

Patients stayed in the hospital for about 3 days on average. Some had complications after surgery, but most (93%) were initially satisfied with the results. However, 11 patients did experience a recurrence of their symptoms after about 9 months.

There was no significant difference in results between the different surgical approaches, or between using laparoscopic (small incision) or robotic VMR.

In conclusion, the researchers found that surgery for PCPFP was generally accepted and effective in their Asian hospital, with good symptom improvement and low rates of complications and recurrence.

FAQs

  1. What is Ventral Mesh Rectopexy (VMR) and why is it gaining popularity in the West?
  2. What were the most common symptoms observed in patients who underwent PCPFP surgery?
  3. How effective is surgery for PCPFP in terms of symptom improvement and recurrence?

Doctor’s Tip

A helpful tip a doctor might tell a patient about rectal prolapse surgery is to follow post-operative care instructions carefully, including avoiding heavy lifting and straining during bowel movements to prevent recurrence of the prolapse. It is also important to attend follow-up appointments to monitor healing and address any concerns promptly.

Suitable For

Patients who are typically recommended rectal prolapse surgery are those who have posterior compartment pelvic floor prolapse (PCPFP) leading to anatomical distortion and functional impairment. These patients may present with symptoms such as obstructive defecation, fecal incontinence, rectal bleeding, or anal discomfort. The main anatomical indication for surgery is external rectal prolapse, although rectocele and rectal intussusception may also be indications.

In the study mentioned, the majority of patients undergoing surgery for PCPFP were female, with a median age of 63 years. The most common surgical approach was abdominal rectopexy, with some patients also undergoing Delorme’s procedure. Ventral mesh rectopexy (VMR) was performed in a significant number of cases, with the majority being minimally invasive.

Overall, surgery for PCPFP was found to be effective in improving symptoms, with low morbidity and recurrence rates. Patients generally reported satisfaction with their symptoms after surgery, although some did experience anatomical recurrence over time. There were no significant differences in outcomes between different surgical approaches or techniques.

Timeline

Before rectal prolapse surgery:

  • Patient experiences symptoms such as obstructive defecation, fecal incontinence, rectal bleeding, or anal discomfort.
  • Anatomical indications for surgery may include external rectal prolapse, rectocele, and/or rectal intussusception.
  • Various surgical options are considered, including abdominal rectopexy or Delorme’s procedure.
  • Pre-operative assessments and consultations are conducted to determine the best course of action.

After rectal prolapse surgery:

  • Patient undergoes surgery, with the majority opting for ventral mesh rectopexy (VMR) or other minimally invasive procedures.
  • Post-operative complications such as ileus may occur in some patients.
  • Patients typically have a short hospital stay of around 3 days.
  • Follow-up appointments are scheduled to monitor progress and address any concerns.
  • Most patients experience symptom improvement and are satisfied with the outcome of the surgery.
  • Some patients may experience anatomical recurrence, typically within 9 months to a year after surgery.

What to Ask Your Doctor

  1. What are the different surgical options for rectal prolapse and which one do you recommend for my specific case?
  2. What are the potential risks and complications associated with rectal prolapse surgery?
  3. What is the expected recovery time after surgery and when can I resume normal activities?
  4. Will I need to make any changes to my diet or lifestyle after the surgery?
  5. How successful is rectal prolapse surgery in terms of long-term symptom improvement?
  6. Are there any alternative treatments or non-surgical options that I should consider?
  7. How experienced are you in performing rectal prolapse surgery and what is the success rate of the procedures you perform?
  8. Will I need to undergo any additional tests or evaluations before the surgery?
  9. What can I expect in terms of post-operative pain management and follow-up care?
  10. Are there any specific warning signs or symptoms that I should watch out for after the surgery that would require immediate medical attention?

Reference

Authors: Ng YY, Tan EJKW, Fu CWP. Journal: Asian J Endosc Surg. 2022 Jan;15(1):110-120. doi: 10.1111/ases.12978. Epub 2021 Aug 27. PMID: 34448361