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Laparoscopic rectopexy with posterior mesh fixation

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Abstract

Objective

The purpose of this multimedia article is to present a technique of laparoscopic rectopexy with fixation of the rectum to the sacrum using a short strip of mesh.

Methods

The technique is presented in a video clip.

Results

The laparoscopic rectopexy procedure is usually performed using four ports. First, the upper rectum is mobilized on its right side, and dissection posterior to the rectum is performed all the way down to the level of the pelvic floor. Anterior mobilization is performed next, and the rectovaginal septum is dissected all the way down to the level of the pelvic floor. A short strip of mesh, approximately 5 cm × 2 cm in diameter, is introduced through the right lower quadrant port. The mesh is placed vertically on the sacrum from the level of the sacral promontory downward, and secured to the sacrum using endo-tackers, which should be applied below the promontory and adjacent to the midline to avoid injury to the hypogastric nerves. The mesorectum is then secured to the mesh in four points using absorbable sutures. Applying adequate sutures directly to the presacral fascia using the relatively small needles that can go through the ports may be a difficult task. Suturing to the mesh, however, is very easy, and in our opinion may be considered the main advantage of the posterior mesh technique.

Ten female patients (age range, 26–84 years) underwent rectopexy using this technique. At a mean follow-up of 2.2 years, two had recurrent prolapse—one of which, the only patient in whom absorbable tackers were used—had in-house recurrence and refixation. Complications included one patient with mild pelvic pain, which spontaneously resolved in 3 weeks.

Conclusion

The presented technique may ease fixation of the rectum to the sacrum and potentially improve results.

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References

  1. Azimuddin K, Khubchandani IT, Rosen L, Stasik JJ, Riether RD, Reed JF 3rd (2001) Rectal prolapse: a search for the “best” operation. Am Surg 67:622–627

  2. Brown AJ, Anderson JH, McKee RF, Finlay IG (2004) Strategy for selection of type of operation for rectal prolapse based on clinical criteria. Dis Colon Rectum 47:103–107

  3. Carpelan-Holmstrom M, Kruuna O, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20(9):1353–1359

  4. Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J et al (2006) Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc 20(1): 35–42

  5. Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89(1):35–39

  6. Watts JD, Rothenberger DA, Buls JG, Goldberg SM, Nivatvongs S (1985) The management of procidentia: 30 years experience. Dis Colon Rectum 28:96–102

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Disclosure

Drs. Oded Zmora, Marat Khaikin, Alexander Lebeydev, Danny Rosin, Aviad Hoffman, Mordehai Gutman, and Amram Ayalon have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Oded Zmora.

Electronic supplementary material

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Supplementary material 1 (AVI 47097 kb)

Supplementary material 1 (AVI 47097 kb)

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Zmora, O., Khaikin, M., Lebeydev, A. et al. Laparoscopic rectopexy with posterior mesh fixation. Surg Endosc 25, 313–314 (2011). https://doi.org/10.1007/s00464-010-1170-3

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Keywords

  • Rectal prolapse/surgery
  • Laparoscopy
  • Surgical technique