Natural Orifice Transanal Endoscopic Rectopexy for Complete Rectal Prolapse: Prospective Evolution of a New Technique and Short-term Outcomes

BACKGROUND: Endoluminal surgery for the management of rectal prolapse remains largely experimental. OBJECTIVE: To evaluate the evolution and short-term outcomes of a new endoluminal technique for the management of complete rectal prolapse. DESIGN: This was a prospective study. SETTINGS: This study was conducted at a single tertiary care teaching center. PATIENTS: A total of 29 patients were included. The first 12 patients underwent the procedure with our initial technique, and the last 17 patients were subjected to the new modified procedure. The follow-up duration was 3 years for the older technique and 26 months for the newer technique. INTERVENTION: This technique involves: 1) ventral "suture" rectopexy: rectum is fixed anteriorly to the anterior abdominal wall using percutaneously placed sutures. 2) Posterior rectum is fixed to the sacral promontory using tackers through a submucosal tunnel. MAIN OUTCOME MEASURES: Safety, recurrence, functional outcomes, morbidity, and mortality were the main outcome measures. RESULTS: There were improvements in constipation and incontinence scores, anal manometric pressures, anorectal angle, anorectal descent, and quality of life postoperatively in both groups. In patients undergoing the modified procedure, there was a significant decrease in duration of surgery (220 +/- 48.89 vs 110 +/- 12.51 min), shortened hospital stay (4.6 +/- 1.71 vs 2.6 +/- 0.65 d), decreased recurrence (25% vs 5.8%), and complications (surgical-site infection and retrorectal abscess). LIMITATIONS: Short follow-up, small sample size, and single-center study were the limitations. CONCLUSION: This is a novel endoluminal technique for treating rectal prolapse obviating perirectal dissection, abdominal incisions, or a mesh. This can now be performed under complete endoscopic and fluoroscopic vision. It avoids general anesthesia and therefore can be an alternative for patients with comorbid conditions in whom the standard abdominal procedure may not be well tolerated. Larger randomized multicentric studies with longer follow-ups are warranted. See Video Abstract at http://links.lww.com/DCR/C59.