Clinical Effectiveness of Laparoscopic Ventral Mesh Rectopexy in the Management of Internal Rectal Prolapse: A Randomized Controlled Trial

Abstract

Background: Internal rectal prolapse (IRP) is a common pelvic floor disorder characterised by intussusception of the rectum without external protrusion and frequently causes obstructed defecation syndrome (ODS) and faecal incontinence. Aim: This study aimed to evaluate whether laparoscopic ventral mesh rectopexy (LVMR) improves functional outcomes and quality of life in patients with symptomatic IRP refractory to conservative therapy. Methods: This double-blind randomised clinical trial included 120 adults with radiologically confirmed high-grade (Oxford III–IV) IRP and persistent ODS symptoms despite at least 6 months of conservative management. Patients were randomly allocated to LVMR (n = 60) or continued conservative management (n = 60). At 12 months, follow-up was completed by 114 participants (95.0%). Results: At 6 months, the mean ODS score improved from 21.0 ± 1.8 preoperatively to 10.37 ± 1.61 in the LVMR group, compared with 19.2 ± 2.1 in the control group (p < 0.001). The Wexner Constipation Score decreased from 14.37 to 7.23 at 6 months (p < 0.001). Significant improvements were also observed in Fecal Incontinence Severity Index scores (preoperative: 12; postoperative: 5; p < 0.001). The overall complication rate was 9.2%, with mesh-related complications in 1.4% of patients. The recurrence rate at 12 months was 5.0% in the LVMR group. The median hospital stay was 3 days (IQR, 2–4), and no mortality was observed. Conclusions: LVMR may be considered a surgical option for patients with symptomatic IRP refractory to conservative therapy.