Laparoscopic pelvic organ prolapse suspension vs. ventral mesh rectopexy in rectal prolapse

摘要

Rectal prolapse is a debilitating condition characterized by protrusion of the rectal wall through the anus and is often associated with significant functional impairments such as incontinence, constipation, and obstructed defecation syndrome (ODS)[1]. It predominantly affects older women and is commonly associated with other pelvic floor disorders such as cystocele or uterine prolapse[2]. The primary objective of surgical intervention for rectal prolapse is to restore normal anatomy, alleviate symptoms, and minimize the risk of recurrence. Various surgical techniques have been developed, with laparoscopic procedures gaining favor owing to their minimal invasiveness and reduced recovery time. Laparoscopic ventral mesh rectopexy (LVMR) and laparoscopic pelvic organ prolapse suspension (POPS) aim to correct anatomical abnormalities while preserving bowel function. A recent study by Zeinalpour et al. compared the anatomical and functional outcomes of LVMR and POPS in 120 female patients with rectal prolapse[3]. Of these, 58 underwent LVMR and 62 underwent POPS. The study found that both techniques resulted in significant improvements in prolapse-related symptoms including obstructed defecation and constipation. LVMR demonstrated superior improvement in ODS scores postoperatively, whereas POPS was particularly effective in patients with concomitant pelvic organ prolapse. Both techniques exhibited similar recurrence rates (12.1% for LVMR and 8.1% for POPS), reinforcing their efficacy in long-term prolapse management. Laparoscopic techniques have revolutionized the management of rectal prolapse, providing surgeons with the ability to correct the prolapse using minimally invasive approaches. Compared to open surgery, laparoscopic procedures result in fewer complications, faster recovery times, and shorter hospital stays[4]. LVMR has become the preferred method in Europe, primarily due to its ability to address both anatomical restoration and functional outcomes. This procedure uses a mesh to suspend the rectum, thereby preventing further descent and alleviating symptoms related to rectal prolapse and ODS.[5-7] The effectiveness of LVMR in improving bowel function, particularly for patients suffering from constipation and ODS, has been well-documented.[8-10] By providing support to the anterior wall of the rectum and preserving the posterior rectal wall, LVMR minimizes the risk of nerve damage and bowel dysfunction, which are common complications in older, more invasive techniques such as posterior rectopexy[11]. As a result, LVMR offers a favorable balance between anatomical correction and preservation of bowel function, making it one of the most widely adopted procedures for rectal prolapse. In patients with concurrent pelvic organ prolapse, such as uterine or bladder prolapse, POPS offers a more comprehensive solution[12,13]. This technique not only corrects rectal prolapse, but also suspends other prolapsing organs, providing multi-compartment support. POPS involves the use of a mesh to elevate the pelvic organs, reduce the risk of further prolapse, and improve symptoms related to urinary incontinence and pelvic pressure. POPS is particularly effective for patients who present with both rectal and pelvic organ prolapse, offering a unified approach to correcting pelvic floor dysfunction[14]. By treating all affected compartments simultaneously, POPS reduces the need for additional surgeries and provides long-term relief from prolapse-related symptoms. This technique has gained popularity among surgeons who treat complex cases of pelvic organ prolapse as it addresses the underlying causes of pelvic floor dysfunction while minimizing recurrence rates. One of the primary challenges in rectal prolapse surgery is balancing the need for anatomical correction with the preservation of bowel and bladder function. While achieving anatomical restoration is essential for reducing the risk of recurrence, it is equally important to preserve the