Clinical Effect Of Laparoscopic Rectal Left Side Wall Suspension With Pelvic Floor Elevation Combined With The PPH For Rectal Internal Prolapse

Background Rectal internal prolapse is one of the most common types of outlet obstruction constipation.About 30% ~ 40% of patients with abnormal defecate using defecation imaging can be found rectal internal prolapse.The pathogenesis of rectal prolapse is complex,although there are several surgical treatment reports,but the postoperative high recurrence rate,poor curative effect,difficult operation,trauma and much complication has been plagued by surgeons.It is generally believed that the perineum surgery has shorter hospital stay,less complication and pain in perioperative period,but the recurrence rate is 4times of abdominal surgery.And it has poor function after rectum resection.These factors to some extent,affect the selection of the perineal operation.Abdominal surgery in general has better curative effect,but higher complication and mortality.Main problems existing in the prolapse of rectum are the prolapse mucosa,weak pelvic support tissue,pelvic floor hernia and anal canal down.The abdominal surgery can repair the weak structure of the pelvic floor,and solves pelvic floor hernia very well,but not for prolapse of mucous membrane and anal canal down.While the perineum surgery emphasizes on solving the problem such as prolapse of mucous membrane and anal canal down,but can do nothing for weak structure of pelvic floor.It is an urgent need to clinical research subject that how to combine the advantages of the abdominal and perineum surgery in solving the prolapse of mucous membrane,anal canal down,the pelvic floor hernia,at the same time,restoring the normal pelvic floor anatomy.Objective To analyze clinical efficacy of laparoscopic rectal left side wall suspension with pelvic floor elevation combined with the PPH for rectal internal prolapse.Methods From March 2011 to November 2012,94 cases of patients who had internal rectal prolapse were treated.Patients were divided into two groups in terms of different surgical techniques.Groups A(n=48)received laparoscopic rectal left side wall suspension with pelvic floor elevation combined with the PPH,Group B(n=46)received PPH.Longo Scores and Wexner Scores,postoperative effect,relapse and postoperative complications in the two groups were assessed respectively before surgery and 24 months after surgery.Results1.Mean Longo scores,preoperatively compared with 24 months post operation improved from 15.39 to 5.37 in group A,14.87 to 7.84 in group B.The mean Wexner scores changed from 14.25 preoperatively to 4.84 in group A,and14.58 to7.52 in group B.2.24 months after surgery,effective rate of group A was 89.6%,effective rate of group B was 69.6%,two groups of efficient comparative difference was statistically significant(P<0.05).3.24 months after surgery,no recurrent cases in group A and group B in 5 cases recurrence,the recurrence between the two groups was statistically significant(P<0.05).4.In the Group A there are 8 patients with pain,4 patients with urinary retention,1 case with anastomotic bleeding;In the Group B there are 6 patients with pain,3 patients with urinary retention,1case with anastomotic bleeding,complication rates between the two groups has no statistical significance(P>0.05).Conclusion The study shows that the effect of laparoscopic rectal left side wall suspension with pelvic floor elevation combined with the PPH in treatment of internal rectal prolapse is better than PPH.The operation not only makes up for the limitations of PPH surgery,can restore the structure of the pelvic floor solid and original anatomical position,but also has the advantages of laparoscopic minimally invasive surgery,conforms to the concept of minimally invasive surgery.The operation is simple,safe and effective,It avoids the placement of allograft material.It is a better way in the treatment of internal rectal prolapse and is worthy of further promotion.But the study mode is less,postoperativ e observation is two years,the long-term curative effect remains to be further observation.