Systematic review doi:10.1111/j.1463-1318.2009.01934.x Systematic review on ventral rectopexy for rectal prolapse and intussusception C. B. Samaranayake*, C. Luo*, A. W. Plank†, A. E. H. Merrie*, L. D. Plank* and I. P. Bissett* *Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand and †Department of Mathematics and Computing, University of Southern Queensland, Toowoomba, Queensland, Australia Received 24 February 2009; accepted 9 March 2009; Accepted Article online 29 April 2009 Abstract Objective This systematic review assesses the effective- ness of ventral rectopexy (VR) surgery for treatment of rectal prolapse (RP) and rectal intussusception (RI) in adults. Method MEDLINE, EMBASE, Scopus and other rele- vant databases were searched to identify studies. Ran- domized controlled trials or nonrandomized studies with more than 10 patients receiving ventral mesh rectopexy surgery were considered for the review. Results Twelve nonrandomized case series studies with 728 patients in total are included in the review. Seven studies used the Orr-Loygue procedure (VR with pos- terior rectal mobilization to the pelvic floor) and five studies used VR without posterior rectal mobilization. Overall weighted mean percentage decrease in faecal incontinence (FI) rate was 45%. The weighted mean percentage decrease in constipation rate was 24%. Weighted mean recurrence rate was 3.4%. Conclusions There are limitations in published literature on VR. The available data indicate that VR has low recurrence and improves FI in patients suffering from these conditions. There is a greater reduction in postop- erative constipation if VR is used without posterior rectal mobilization. Keywords Ventral rectopexy, rectal prolapse, rectal intussusception, systematic review Introduction Complete rectal prolapse (RP) is the circumferential full- thickness protrusion of the rectal wall through the anal orifice [1]. This is a debilitating condition and greatly impairs the quality of life. The cause of RP is not known. But the risk of developing RP may be increased by having a straight rectal tube, defect of the anterior pelvic floor and supporting structures [2] or rectal intussusception (RI) [3] associated with straining. Anatomical abnormal- ities commonly found in RP patients are a deep pouch of Douglas, a patulous anus, a lax anal sphincter, a redun- dant rectosigmoid colon, insufficient pelvic floor or a lack of fascial support of the rectum against the sacrum [4]. RP may cause faecal incontinence (FI), mucus discharge, pain, ulceration, bleeding, incarceration and gangrene [5]. Many surgical interventions have been promoted for the treatment of RP but the optimum method is still unclear [5]. The traditional management of RP is with posterior rectopexy and although this may improve FI, the associated constipation tends to worsen postopera- tively [6]. Occult RP or RI is an intussusception of the rectal wall that does not protrude out through the anus [6]. This condition may be asymptomatic or symptoms can range from FI to obstructed defecation [7]. Defaecography, either with contrast or magnetic resonance imaging, is the most useful investigation for the diagnosis of this condition [6]. The treatment for RI is widely debated and ranges from no intervention to posterior rectopexy surgery [6]. Even though this treatment may improve FI [6], posterior rectopexy for obstructed defecation because of RI is controversial [8]. Ventral rectopexy (VR) involves mobilization of the anterior wall of the rectum and anterior placement of a mesh on the rectum with fixation to the sacrum. The initial description of VR was the Orr-Loygue procedure [9] which involves full rectal mobilization anteriorly and posteriorly to levator ani muscle level before suturing two Correspondence to: Ian P. Bissett, Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail: i.bissett@auckland.ac.nz 504 Ó 2010 The Authors. Journal Compilation Ó 2010 The Association of Coloproctology of Great Britain and Ireland. Colorectal Disease, 12, 504–514