Endoscopic fixation of the rectum for rectal prolapse: a feasibility and survival experimental study
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In recent years, there has been considerable interest in developing technology as well as techniques that could widen the therapeutic horizons of endoscopy. Rectal prolapse, a benign localized condition causing considerable morbidity, could be an excellent focus for new endoscopic therapies. The aim of this study was to assess the feasibility and safety of endoluminal fixation of the rectum to the anterior abdominal wall, after pushing it up inside the body, using an in vivo animal model.
We performed an in vivo comparative surgical study in a porcine model, including laparoscopic mobilization of the rectum and posterior rectopexy (standard surgical method) or endoluminal tacking of the rectum. After proving feasibility in ex vivo and acute studies, we performed a survival study to evaluate the safety of endoluminal tacking of the mobilized rectum to the anterior abdominal wall. The main outcome measures were successful completion of the tasks, maintenance of the fixation, complications associated with the methods, and survival studies including histopathological examinations of the fixation sites.
There were two groups: laparoscopic rectopexy (8 animals) and endoluminal fixation of the rectum to the anterior abdominal wall (10 animals). There were no differences between these two groups in their postoperative recovery. The group with the endoluminal fixation was found to have adequate attachment of the rectum to the anterior abdominal wall (measured attachment pressure in the endoluminal group = 6.06 ± 0.52 ft-lb, in the control group = 4.86 ± 2.00 ft-lb) on both gross and microscopic evaluation.
Endoscopic fixation of the mobilized rectum is feasible and safe in this model and in the future may provide an effective alternative to current treatment options for rectal prolapse.
KeywordsRectal fixation Endoluminal surgery Rectopexy Rectal prolapse
The authors acknowledge and express sincere gratitude to Olympus for the financial support of this project. They also thank Yuko Tonohira, medical illustrator in the Colon and Rectal Surgery Section, Weill Medical College of Cornell University, for providing illustrations for the project and this article.
This particular study was investigator-initiated and was funded by Olympus. Dr. J. W. Milsom received course support from Olympus, Covidien, and Applied Medical and research support from Olympus. Dr. T. Sonoda received course support from Olympus, Covidien, and Applied Medical and research support from Adolor. K. Trencheva and Drs. R. Pavoor, J. DiRocco, P. Shukla, and J. Kawamura have no conflicts of interest or financial ties to disclose.
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