Laparoscopic Ventral Rectopexy for Rectal Prolapse
Rectal prolapse is the circumferential, full-thickness intussusception of the rectal wall with protrusion beyond the anal canal. The principles for the surgical management of full-thickness external rectal prolapse can be distilled into four basic objectives: the restoration of anatomy with the aim of improving function, whilst minimising morbidity and avoiding the onset of new symptoms. The plethora of surgical procedures described to treat external rectal prolapse (via both perineal and abdominal approaches) attests to the difficulty of successfully satisfying all four of these goals with one procedure. In general, abdominal rectopexy is considered preferable to perineal procedures, having the advantage of lower recurrence rates and superior improvement of incontinence (Brazzelli et al., Database Syst Rev 2:CD001758, 2000). However, the abdominal approach is invasive and is associated with poor correction (and often induction) of constipation. The less invasive nature of perineal procedures has resulted in their wide use for elderly or medically unfit patients, but at the expense of high recurrence rates and unpredictable recovery of function, particularly incontinence. A laparoscopic approach has been shown to be superior to open rectopexy in a prospective, randomised controlled trial, with improved perioperative morbidity, decreased postoperative pain and reduced length of stay (Solomon et al., Br J Surg 89:35–39, 2002).
KeywordsExternal rectal prolapse Laparoscopic Rectopexy Laparoscopic ventral mesh rectopexy
- 1.Brazzelli M, Bachho P, Grant A. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. 2000;2:CD001758.Google Scholar
- 3.Moschowitz AV. The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gynecol Obstet. 1912;15:7–21.Google Scholar
- 8.Slawik S, Soulsby R, Carter H, Payne A, Dixon AR. Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Color Dis. 2007;10:138–43.Google Scholar