Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 10, 2015; 7(12): 1045-1054
Published online Sep 10, 2015. doi: 10.4253/wjge.v7.i12.1045
Laparoscopic surgery for rectal prolapse and pelvic floor disorders
Alexander Rickert, Peter Kienle
Alexander Rickert, Peter Kienle, Department of Surgery, University Medical Centre Mannheim, 68167 Mannheim, Germany
Author contributions: Rickert A and Kienle P designed the review, performed the literature search, interpreted the data, wrote the paper and finally approved the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter Kienle, MD, Professor, Department of Surgery, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. peter.kienle@umm.de
Telephone: +49-621-3832357 Fax: +49-621-3833809
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: June 2, 2015
Revised: June 22, 2015
Accepted: August 25, 2015
Article in press: August 31, 2015
Published online: September 10, 2015
Processing time: 136 Days and 0.7 Hours
Abstract

Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.

Keywords: Resection rectopexy, Pelvic floor disorders, Rectal prolapse, Laparoscopy, Mesh rectopexy, Suture rectopexy

Core tip: Pelvic floor disorders are dysfunctions of the pelvic organs which affect a substantial amount of people, predominantly women. Operative treatment is often necessary and laparoscopic procedures play a major role. Many different techniques are used but their functional and operative outcome is hardly evaluated in randomised studies. In this review we summarize the present status of laparoscopic surgery for pelvic floor disorders. The different techniques are described, compared and rated concerning their operative outcome, functional results and recurrence rates. Clinically important topics like management of complications and surgery in elderly people are highlighted.