Comparison of Surgical Outcomes of Laparoscopic Ventral Mesh Rectopexy and Stapled Transanal Rectal Resection for Managing Obstructed Defecation Syndrome

Abstract

Abstract Background: Obstructed defecation syndrome has several underlying causes and is a prevalent but poorly understood condition. It is characterized by the inability to pass stool even when one experiences the urge to defecate. Initial therapy for ODS usually involves diet modifications, pelvic floor exercises, and biofeedback, which can considerably reduce symptoms. Surgical intervention may be recommended for individuals who present with certain anatomical anomalies and who do not respond to conservative therapies. Objectives: To assess and compare the surgical outcomes of laparoscopic ventral mesh rectopexy (LVMR) and stapled transanal rectal resection (STARR) for ODS management. Design: The study conducted a retrospective review of prospectively gathered data on the outcomes of 162 patients treated for ODS at our facility between January 2015 and January 2022 using either LVMR or STARR. Settings: The study was conducted at our facility between January 2015 and January 2022, evaluating 162 patients with ODS who underwent either LVMR (118 patients) or STARR (44 patients). Patient and Methods: The Modified Longo’s Scores (MLS) were used as the primary evaluation tool, determined preoperatively and postoperatively at 1 month, 6 months, and 12 months. Sample Size: A total of 162 patients were included in the study, with 118 patients who underwent LVMR and 44 patients who underwent STARR for the treatment of ODS at our facility between January 2015 and January 2022. Results: Preoperative MLS for LVMR patients averaged 23.41, which was similar to that of STARR patients (23.52), showing no statistically significant difference. After 1 month, the mean MLS showed a significant decrease of 93.3% among LVMR patients and that of 18.0% among STARR patients from the preoperative mean MLS, indicating a significantly greater change among LVMR patients than among STARR patients. Similarly, after 6 months, the preoperative mean MLS for LVMR patients and STARR patients revealed a substantial decline of 95.4% and 6.5%, respectively, with LVMR patients experiencing a considerably greater change than STARR patients. After 12 months, the mean MLS showed a significant decrease of 96.6% and 3.6% among LVMR and STARR patients from the preoperative mean MLS, respectively, with change being significantly more among LVMR patients than STARR patients. Conclusion: LVMR can be the preferred method because it outperforms STARR in terms of alleviating ODS symptoms. Limitations: This research involved a retrospective study using a small sample size and a short follow-up period. Conflicts of Interest: None.