Laparoscopic ventral pouch pexy with acellular dermal matrix (ADM)—a novel technique for the treatment of full-thickness pouch prolapse after restorative proctocolectomy and j-pouch
- 41 Downloads
Ileal pouch prolapse is a rare complication after j-pouch formation with an incidence of about 0.3%. However, if a pouch prolapse occurs, it can be a debilitating complication for the patient. Full-thickness pouch prolapse usually warrants surgical repair as reported by Sagar and Pemberton (Br J Surg 99(4):454–468, 2012) and Sherman et al. (Inflamm Bowel Dis 20(9):1678–1685, 2014). This report presents our first experience with laparoscopic ventral pouch pexy with acellular dermal matrix (ADM).
With the patient in the French position, four trocars were positioned: a camera port at the level of the umbilicus, two 5-mm trocars in the right lower quadrant, and a third 5-mm trocar in the left lower quadrant. The j-pouch was mobilized ventrally and laterally to the level of the sphincter. A 4 × 16-cm piece of ADM (EPIFLEX®, POLYTECH Health & Aesthetics, Dieburg, Germany) was sutured to the levators on both sides and to the ventral pouch directly cranial of the sphincter. In the next step, the ADM was attached to the promontory. Subsequently, further sutures were placed to attach the pouch to the ADM. Finally, the ADM was sewn to the cranial vaginal pole.
Operating time was 249 min. The postoperative course was uneventful except for a higher stool frequency which could be managed conservatively. The patient was discharged on POD 9. At the latest follow-up (12 months after surgery), the patient was still symptom free without any sign of recurrence.
Laparoscopic ventral pouch pexy with ADM performed by a surgeon experienced in laparoscopic pouch surgery is a safe and effective treatment option in patients with pouch prolapse.
KeywordsIleal pouch prolapse Pouch pexy Pouch salvage Acellular dermal matrix
Authorship and contributions
Study conception and design: J. Hardt, P. Kienle; acquisition of data: J. Hardt, P. Kienle; Analysis and interpretation of data: J. Hardt, P. Kienle; writing manuscript: J. Hardt, P. Kienle. All authors gave final approval of the version to be published.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Joyce MR, Fazio VW, Hull TT, Church J, Kiran RP, Mor I, Lian L, Shen B, Remzi FH (2010) Ileal pouch prolapse: prevalence, management, and outcomes. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 14(6):993–997. https://doi.org/10.1007/s11605-010-1194-y CrossRefGoogle Scholar
- 8.Williams NS, Giordano P, Dvorkin LS, Huang A, Scott SM (2004) Full-thickness pouch prolapse after restorative proctocolectomy: a potential future problem treated by the new technique of external pelvic neorectal suspension (the express procedure). Dis Colon Rectum 47(8):1415–1419CrossRefGoogle Scholar