Does laparoscopic rectopexy for total rectal prolapse treat anal incontinence?
Seance of wednesday 14 may 2025 (Chirurgie proctologique)
DOI number : 10.26299/jf54-sn05/2025.18.04
Abstract
Introduction. First assessment of a patient with anal incontinence includes a search for the etiology such as diarrhoeal syndrome, sphincter rupture, neuropathy, full-thickness rectal prolapse (FRP), and multiple cause. Confirmation of a FRP should lead to surgical treatment, ideally by rectopexy to the promontory, which is recognized as the gold standard treatment (1). It is likely that the incontinence induced by the exteriorization of the rectum is due to anal distension (hence the resting hypotonia in manometry), stretching of the nerves and weakness of the perineal musculature as demonstrated by our published video (2).
Methods. Among 710 patients (mean age 61 years [15-99], 8% men) treated with rectopexy from 1995 to 2024 in our center, we identified 601 patients operated on for FRP (96% through laparoscopy). Twenty of them operated on in year 2023 answered a questionnaire with an anal incontinence score for the purposes of this presentation.
Results. The mean incontinence score was 14/20 [8-20] before surgery and 4/20 [0-14] at a 14 months mean follow-up [6-27]. This result is consistent with the literature (3-5), which also shows that this improvement is sustainable (6), as is the improvement in dyschesia.
Conclusion. Rectopexy for FRP improves anal incontinence in the long term.
1. Reche F, Faucheron JL. Laparoscopic ventral rectopexy is the gold standard treatment for rectal prolapse. Tech Coloproctol 2015;19:565-6
2. Faucheron JL, Mancini A, Reche F. Hedrocele Associated With Full-Thickness Rectal Prolapse: A Very Rare Condition Treated by Ambulatory Laparoscopic Anterior Rectopexy. Dis Colon Rectum 2017;60:992-3
3. Samaranayake CB, Luo C, Plank AW, Merrie AEH, Plank LD, Bissett IP. Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 2010;12:504-14
4. Faucheron JL, Voirin D, Riboud R, Waroquet PA, Noel J. Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients: short and long-term follow-up. Dis Colon Rectum 2012;55:660-5
5. Faucheron JL, Trilling B, Girard E, Sage PY, Barbois S, Reche F. Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results. World J Gastroenterol 2015;21:5049-5
6. Barra M, Trilling B, Mastronicola G, Sage PY, Roudier A, Foote A, Tidadini F, Fournier J, Faucheron JL. Long-term outcome of laparoscopic ventral rectopexy for full-thickness rectal prolapse: the PEXITY study. Tech Coloproctol 2025;29:68. doi: 10.1007/s10151-024-03104-0.
Pr Jean-Luc Faucheron, Pr Bertrand Trilling, Dr Pierre-Yves Sage, Dr Nicolas Depas, Mr Fatah Tidadini, Dr Jean-Louis Quesada
Grenoble Alpes University Hospital
Methods. Among 710 patients (mean age 61 years [15-99], 8% men) treated with rectopexy from 1995 to 2024 in our center, we identified 601 patients operated on for FRP (96% through laparoscopy). Twenty of them operated on in year 2023 answered a questionnaire with an anal incontinence score for the purposes of this presentation.
Results. The mean incontinence score was 14/20 [8-20] before surgery and 4/20 [0-14] at a 14 months mean follow-up [6-27]. This result is consistent with the literature (3-5), which also shows that this improvement is sustainable (6), as is the improvement in dyschesia.
Conclusion. Rectopexy for FRP improves anal incontinence in the long term.
1. Reche F, Faucheron JL. Laparoscopic ventral rectopexy is the gold standard treatment for rectal prolapse. Tech Coloproctol 2015;19:565-6
2. Faucheron JL, Mancini A, Reche F. Hedrocele Associated With Full-Thickness Rectal Prolapse: A Very Rare Condition Treated by Ambulatory Laparoscopic Anterior Rectopexy. Dis Colon Rectum 2017;60:992-3
3. Samaranayake CB, Luo C, Plank AW, Merrie AEH, Plank LD, Bissett IP. Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis 2010;12:504-14
4. Faucheron JL, Voirin D, Riboud R, Waroquet PA, Noel J. Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients: short and long-term follow-up. Dis Colon Rectum 2012;55:660-5
5. Faucheron JL, Trilling B, Girard E, Sage PY, Barbois S, Reche F. Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results. World J Gastroenterol 2015;21:5049-5
6. Barra M, Trilling B, Mastronicola G, Sage PY, Roudier A, Foote A, Tidadini F, Fournier J, Faucheron JL. Long-term outcome of laparoscopic ventral rectopexy for full-thickness rectal prolapse: the PEXITY study. Tech Coloproctol 2025;29:68. doi: 10.1007/s10151-024-03104-0.
Pr Jean-Luc Faucheron, Pr Bertrand Trilling, Dr Pierre-Yves Sage, Dr Nicolas Depas, Mr Fatah Tidadini, Dr Jean-Louis Quesada
Grenoble Alpes University Hospital