80 - Freie Mitteilung
3. Juni 2022, 08:30 - 10:00, Panorama 1
Robotic versus laparoscopic ventral mesh rectopexy
S. Christen, F. V. Angehrn, F. Nocera, M. Von Strauss und Torney, M. von Flüe, V. Geissbühler, D. C. Steinemann, Presenter: S. Christen (Basel)
Ventral mesh rectopexy (VMR) is increasingly common used to correct rectal prolapse and for outlet obstruction. Colposacropexy may be added to treat multicompartment prolapse. We aim at comparing VMR in laparoscopic (LVMR) and robotic (RVMR) technique.
The follow-up included all VMR between 2016 and June 2021. The proportions of complex and multicompartment repair were analyzed. Age, Body Mass Index (BMI), American Society of Anesthesiology (ASA) score, operation time, conversion rate, intra- and postoperative complications, hospital length, Cleveland Constipation Index (CCI), Vaizey Wexner score of fecal incontinence (FI), overall satisfaction and need for further therapy in LVMR and RVMR were compared.
We performed in total 109 VMR: 81 LVMR and 28 RVMR. The median follow-up was 42 (6-60) and 17 (5-26) months (p>0.001). 53% of LVMR and all RVMR were considered complex (p<0.001). Multicompartment repair was performed in 25 of 81 LVMR and 17 of 28 RVMR (p=0.06). Median Age was 73 (29-97) and 70 (46-87) years and (p=0.337). Median BMI was 22 (15-36.2) and 25 (20-33.6) kg/m^2 (p<0.001). Median ASA was in LVMR 2 (1-4) and 2 (1-3) (p=0.249). Median operation time was 100 (70-210) and 110 (90-210) minutes (p=0.013), for multicompartment repair 150 (90-300) and 180 (140-270) minutes (p=0.048). Conversion occurred in one case in LVMR and twice in RVMR (p=0.101). There were no intraoperative complications. Postoperative complications occurred in LVMR in 7 of 81 cases (7 Clavien-Dindo II) and in RVMR in 3 of 28 cases (2 Clavien-Dindo II and 1 Clavien-Dindo I) (p=0.775). Median hospital length was 6 (3-19) and 6 (3-16) days (p=0.735). Median Vaizey Wexner Score as end of follow-up was 6 (0-18) and 4 (0-19) (p=0.238). The median CCI was 5 (0-20) and 7 (1-17) (p=0.998). Median overall satisfaction with the therapy (1 = not satisfied and 10 = highest overall satisfaction) in LVMR was 8 (1-10) and in RVMR 7 (1-10) (p=0.330). Further therapy was necessary in 17 cases (16 pelvic floor therapy and 1 operation) and 8 cases (7 pelvic floor therapy and 1 operation) (p=0.894).
The results indicate that both techniques were equally safe and equally effective. More complex procedures were selected for RVMR compared to LVMR. Long-term results concerning the quality of life will be investigated in further studies.