Laparoscopic Ventral Mesh Rectopexy for Obstructive Defecation Syndrome: Functional Outcomes after Surgery

Obstructive defecation syndrome (ODS) is a widespread but poorly understood complex multifactorial illness that is initially treated with dietary changes, pelvic floor exercises and biofeedback. Surgical care can be administered in patients with anatomical anomalies who do not respond to conservative treatment. Laparoscopic ventral mesh rectopexy (LVMR) is a relatively new surgical method that has gained acceptance for the treatment of ODS with long-term success. The objective of this study was to find out the outcome of laparoscopic ventral mesh rectopexy in patients with obstructive defecation syndrome. This longitudinal descriptive study was carried out in the Department of Colorectal Surgery, Rajshahi Medical College Hospital, Rajshahi among 40 patients having ODS for a period of 3 years from July 2021 to June 2024. The study was conducted after obtaining ethical clearance from the Ethical Review Committee (ERC) of Rajshahi Medical College and consent from the patients. Based on predefined eligibility criteria, a total number of 40 patients of obstructive defecation syndrome due to rectocele and rectorectal intussusception were included in the study by purposive sampling technique. Patients were followed up at the end of two weeks, three and six months of performing laparoscopic ventral mesh rectopexy. Data were analyzed by SPSS software, version-24 and p value < 0.05 was considered statistically significant for all tests. Out of 40 patients, 16 (40.00%) were within the age group of 35-45 years with mean age of the patients 41.97±9.99 years. Majority 32 (80.00%) of the patients were female with female male ratio 4:1. Half 20 (50.00%) of the patients had class VI-X level of education and 23 (57.50%) were housewives. Mean BMI of the patients was 23.73±3.62 kg/m2. Only 7 (17.50%) of the patients had history of smoking and 11 (27.50%) had history of OCP intake. Before operation, 22 (55.00%) of the patients had rectorectal intussusception with rectocele, 12 (30.00%) had rectorectal intussusception alone and 6 (15.00%) had rectocele alone. Mean Modified Longo ODS Score was 21.97±1.07 before operation followed by 7.77±1.61, 4.23±2.03 and 2.87±1.80 after two weeks, three and six months of laparoscopic ventral mesh rectopexy, respectively. Modified Longo ODS Score was significantly reduced after six months of laparoscopic ventral mesh rectopexy in comparison to preoperative period (p <0.001). The mean modified Longo ODS score decreased significantly by 87.05% after six months of the procedure. None of the patient had rectocele, rectorectal intussusception and urinary stress incontinence after laparoscopic ventral mesh rectopexy but only one patient experienced loose stool incontinence and another patient experienced having persistence of ODS symptoms. Laparoscopic ventral mesh rectopexy is a safe surgical procedure with minimal complications and good functional results for ODS patients with rectal anatomical abnormalities.