Laparoscopic-Total Extraperitoneal Anterior Rectopexy (L-TEAR)-A preliminary report

Background Rectal prolapse, associated incontinence and obstruction significantly impair quality of life. Minimally invasive ventral mesh rectopexy, the current standard, being transperitoneal entails risks of vascular, bowel injury, adhesions, besides mesh and tac fixation issues. This study evaluates the feasibility, safety, and short-term outcomes of a novel total extraperitoneal anterior rectopexy that avoids peritoneal transgression and sacral fixation. Methods In this prospective single-center study conducted from July 2024 till date, 20 patients (11 males, 9 females; mean age 34.6 ± 14.2 years) with complete rectal prolapse, body mass index < 28 kg/m², without prior abdominal surgery underwent this procedure which involved transfascial rectal fixation to the abdominal wall with preperitoneal mesh placement. Operative variables, complications, recurrence, functional outcomes [St. Mark’s Incontinence Score (SMIS), Obstructed Defecation Syndrome (ODS) score, quality-of-life questionnaires] sigmoidoscopy, manometry, and defecography were assessed. Results Mean operative time was 181.2 ± 41.6 minutes, blood loss 70.6 ± 30.6 mL, and hospital stay 4.1 ± 2.7 days. During median 8-month follow-up, two patients (10%) experienced partial recurrence. There was no mortality or major complications. Four patients developed transient hematuria, resolving conservatively. Significant improvements were observed in SMIS (18.6 ± 2.4 to 15.4 ± 2.8; p  = 0.036) and ODS scores (16.3 ± 3.2 to 8.1 ± 3.9; p  < 0.0001). Quality-of-life improved, while manometric and defecographic parameters were not significantly altered. Conclusions Total extraperitoneal anterior rectopexy is feasible and safe, avoiding peritoneal entry and sacral fixation while achieving favorable early outcomes. Larger, long-term validation is needed.