Trans-abdominal Combined Posterior, Lateral and Anterior Fixation of Rectum for Complete Prolapse: a Novel Procedure
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Rectal prolapse is not uncommon. There is no foolproof method to prevent recurrence. This novel method is likely to show new insight. Patients with completely prolapsed rectum and with normal colonic transit and those found fit in ASA grades I and II were included. A lower midline incision was used for open trans-abdominal rectopexy. Only posterior mobilisation was performed. A prolene mesh was placed on the dissected sacral surface. The rectal wall was fixed on either side of the sacral periosteum at promontory with a prolene suture along with the mesh. The lateral and anterior walls were plicated without any dissection obliterating the recto-vaginal/vesical pouch. There were 30 patients including 27 males studied from 2004 to 2012. The mean age was 32.35 years (SD 11.67). Two were paraplegics and three patients had recurrent case of prolapse. The median operation time and blood loss were 55 min and 50 ml respectively. There were no mortalities and one superficial wound sepsis by MRSA. Anal incontinence subsided and none of them were constipated after resumption of normal diet. One case, a paraplegic with recurrent prolapse had a recurrence of mucosal prolapse during the median follow-up of 66 months. Posterior rectal dissection with prolene mesh, anterior and lateral placating fixation without dissection in cases with normal colonic transit resulted in good control of prolapse without any constipation and reduction of the mucous discharge.
KeywordsProlapse rectum Recurrent prolapse Posterior mesh rectopexy Anterior and lateral rectal wall suture plication Correction of intussusception
Compliance with Ethical Standards
Conflict of Interest
The author declares that there is no conflict of interest.
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