Evaluation of anorectal functions after laparoscopic suture rectopexy with complete division of lateral rectal ligaments

Context
Dissection of the lateral ligaments during rectopexy has been a source of contention. The purpose of this study was to determine the effect of complete rectal mobilization and lateral ligament division on anorectal functioning after laparoscopic suture rectopexy.
Aims
Evaluation of anorectal functions in patients with complete and internal rectal prolapse after laparoscopic suture rectopexy with complete division of lateral rectal ligaments.
Methods, material, and study design
Twenty-five patients with complete and internal rectal prolapse were enrolled in this prospective cohort study between March 2018 and January 2021, including follow-up period. Comparison between pre- and postoperative course included obstructed defecation score, need for laxatives, anorectal manometry pressures, anorectal sensations, and recurrence. Mean follow-up period was 12 months.
Statistical analysis
Data management and statistical analysis were done using SPSS vs. 25 (IBM, Armonk, NY). Quantitative data were assessed for normality using the Shapiro–Wilk test and direct data visualization methods. Then, quantitative data were summarized as mean and SD or medians and ranges. Categorical data were summarized as numbers and percentages. Longo score and anorectal manometry were compared at different times using repeated-measures analysis of variance. Post hoc analyses were done using the Bonferroni method. Quality of life aspects were compared pre- and postprocedure using paired -test. McNemar test was used to compare laxative use at different times. All statistical tests were two-sided. values less than 0.05 were considered significant.
Results
Preoperatively, 25 patients showed obstructed defecation symptoms. Postoperatively, 23 (92%) patients have significant improvement in Obstructed Defecation Syndrome (ODS) score; however, 40% of them are still depending on laxatives. The remaining two patients (8%) with ODS have no significant improvement in ODS score. Regarding anorectal manometry after surgery, mean squeeze pressure showed significant increase, whereas all rectal sensation showed significant decrease. Patient Assessment of Constipation Quality of Life questionnaire score, total physical discomfort score, total psychosocial discomfort score, and total worries and concerns score were significantly lower postoperatively, whereas the total satisfaction score was significantly higher postoperatively. No recurrences were found.
Conclusions
Complete mobilization of the rectum during laparoscopic suture rectopexy associated with recovery of anorectal sensation and also improvement in ODS with low recurrence rate reaches 0%.