Minimally invasive resection Rectopexy as a treatment method for obstructive defecation (ODS): functional outcome in ODS; constipation and fecal incontinence

Minimally invasive resection rectopexy is an effective treatment for obstructive defecation syndrome (ODS) in carefully selected patients, offering promising functional outcomes with potentially reduced surgical burden. As minimally invasive techniques gain traction in colorectal surgery, combining resection rectopexy with Natural Orifice Specimen Extraction (NOSE) or minilaparotomy specimen retrieval may enhance bowel function by reducing constipation and fecal incontinence. We hypothesize that outcomes are influenced by disease severity. Methods Minimally invasive resection rectopexy was performed on 85 ODS patients. Patient-specific characteristics were assessed using standardized questionnaires. Data were obtained from a prospectively maintained data registry. Surgical outcomes, complications, and patient satisfaction were evaluated 1, 3, and 6 months postoperatively. Symptom severity was measured with the Wexner Constipation Score (WCS), Wexner Incontinence Score (WIS), and Altomare Obstructive Defecation Syndrome (AOS) Score. Repeated measures ANOVA assessed the effect of surgery on the acquired outcome measures over time. Results All procedures were completed laparoscopically without conversion. The mean patient age was 58.5 years (SD: 16.5). Complications included Clavien-Dindo IIIa (n=3), IIIb (n=8), and IVa (n=1). Repeated measures ANOVA revealed significant improvements in WCS (p < 0.0001) and AOS (p < 0.0001), while WIS changes were nonsignificant but showed a gender effect (p = 0.011). Post hoc analyses by gender revealed no significant temporal effects for WIS. Conclusion Minimally invasive resection rectopexy provides significant symptom relief, particularly for constipation and obstructive defecation. While fecal incontinence outcomes remain variable, the procedure is feasible, and significantly improves quality of life in ODS patients.