Laparoscopic and robotic ventral rectopexy for posterior compartment disorders: a multicentric study in a gynecological setting

INTRODUCTION: This study aimed to evaluate postoperative outcomes of minimally invasive ventral rectopexy (VRP) performed for posterior compartment defects in a gynecological setting, according to laparoscopic (L-VRP) or robotic (R-VRP) approaches. METHODS: Women with symptomatic posterior compartment defects, including enterocele, rectal prolapse, and rectocele, who underwent L-VRP or R-VRP, were retrospectively analyzed. Primary outcome was the evaluation of functional outcomes at ≥ 6-month follow-up; secondary outcomes included anatomical results, peri- and postoperative complications, and predictors of recurrence, postoperative constipation, and anal incontinence. RESULTS: A total of 102 women were included, 60 in the L-VRP group and 42 in the R-VRP group. Anterior sacrocolpopexy was performed in 70.6% of women (72/102). At a mean of 18-month follow-up, anorectal symptoms rate, constipation [L-VRP (17.7 ± 5.5) versus (2.5 ± 3.6): p < 0.001; R-VRP (15.2 ± 5.4) versus (2.6 ± 4.6): p < 0.001], and incontinence [L-VRP (11.6 ± 4.6) versus (1.1 ± 3.1): p < 0.001; R-VRP (10.7 ± 5.1) versus (1.2 ± 2.2): p < 0.001] Wexner scores significantly improved without difference according to the surgical route (p > 0.05). Posterior prolapse relapse was 1.0% (1/101), without difference between groups [L-VRP (1.7%;1/60) versus R-VRP (0%;0/41); p = 0.99]. Other anatomical and functional outcomes did not significantly differ between groups. One woman in L-VRP group (1.0%; 1/101) required the resection of the mesh for infection of the implanted material. No predictive factors emerged at multivariate analysis. CONCLUSIONS: Minimally invasive VRP was associated with significant short- to mid-term anatomical and functional improvement and a low rate of perioperative complications. No statistically significant differences were observed between laparoscopic and robotic approaches; however, the study was not powered to demonstrate equivalence, and longer follow-up is required to assess durability and delayed mesh-related complications. TRIAL REGISTRATION: DIPUSVSP-27-07-2087 retrospectively registered.