Skip to main content
SpringerLink
Log in

The optimal strategy for proximal mesh fixation during laparoscopic ventral rectopexy for rectal prolapse: an ex vivo study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic ventral rectopexy (LVR) is an established technique for the treatment of rectal prolapse. Several techniques and devices can be used for proximal mesh fixation on the sacral promontory during this procedure. The aim of this study was to compare the fixation strength of a recently introduced screw for mesh fixation on the promontory during LVR with two other frequently used techniques.

Methods

An ex vivo experimental model using a porcine spinal column was designed to measure the strength of proximal mesh fixation. In a laparoscopic box trainer, a polypropylene mesh was anchored on the spinal column using three different fixation methods, i.e., the Protack 5-mm tacker device, Ethibond Excel 2-0 stitches, and the Karl Storz screw. Subsequently, increasing traction was applied to the mesh. This traction was applied at a standardized angle as determined by measuring the mean angle between the site of distal mesh fixation on the rectum and a line straight through the sacral promontory on 12 random dynamic MR scans of the pelvic floor after the LVR procedure. The applied force was measured at the moment that the fixation broke, using a calibrated electronic Newton meter. All fixation methods were tested ten times.

Results

The mean angle, as measured on the MR scans, was 100°. The mean disruption force, which led to a break of the proximal mesh fixation, was 58 N for the three Protack tacks, 55 N for the two stitches, and 70 N for the new screw. The use of a screw therefore led to a significantly stronger fixation compared to the use of stitches (p ≤ 0.05). No significant difference was determined between the tacks and the screw fixation and between the tacks and the stitches fixation.

Conclusion

The new screw for proximal mesh fixation during LVR procedures offers similar fixation strength when compared to tacks. The use of one screw for proximal mesh fixation is therefore a reasonable alternative to the use of several tacks or sutures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wu JS (2009) Rectal prolapse: a historical perspective. Curr Probl Surg 46(8):602–716

    Article  PubMed  Google Scholar 

  2. Wijffels NA, Collinson R, Cunningham C, Lindsey I (2010) What is the natural history of internal rectal prolapse? Colorectal Dis 12(8):822–830

    Article  PubMed  CAS  Google Scholar 

  3. Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140(1):63–73

    Article  PubMed  Google Scholar 

  4. Boons P, Collinson R, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation. Colorectal Dis 12(6):526–532

    Article  PubMed  CAS  Google Scholar 

  5. Collinson R, Wijffels N, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results. Colorectal Dis 12(2):97–104

    Article  PubMed  CAS  Google Scholar 

  6. D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91(11):1500–1505

    Article  PubMed  Google Scholar 

  7. D’Hoore A, Penninckx F (2006) Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20(12):1919–1923

    Article  PubMed  Google Scholar 

  8. Slawik S, Soulsby R, Carter H, Payne H, Dixon AR (2008) Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Colorectal Dis 10(2):138–143

    PubMed  CAS  Google Scholar 

  9. van den Esschert JW, van Geloven AA, Vermulst N, Groenedijk AG, de Wit LT, Gerhards MF (2008) Laparoscopic ventral rectopexy for obstructed defecation syndrome. Surg Endosc 22(12):2728–2732

    Article  PubMed  Google Scholar 

  10. Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I (2011) Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis 13(5):561–566

    Article  PubMed  CAS  Google Scholar 

  11. Cobb WS, Burns JM, Kercher KW, Matthews BD, James NH, Todd HB (2005) Normal intra-abdominal pressure in healthy adults. J Surg Res 129(2):231–235

    Article  PubMed  Google Scholar 

Download references

Disclosure

Drs. Formijne Jonkers, Draaisma, Heggelman, Consten, and Broeders and Mr. Van de Haar have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands

    Hendrik A. Formijne Jonkers, Harm J. van de Haar, Werner A. Draaisma, Esther C. J. Consten & Ivo A. M. J. Broeders

  2. Department of Radiology, Meander Medical Centre, Amersfoort, The Netherlands

    Ben G. F. Heggelman

  3. Institute of Technical Medicine, University of Twente, Enschede, The Netherlands

    Ivo A. M. J. Broeders

Authors
  1. Hendrik A. Formijne Jonkers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harm J. van de Haar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Werner A. Draaisma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ben G. F. Heggelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Esther C. J. Consten
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ivo A. M. J. Broeders
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivo A. M. J. Broeders.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Formijne Jonkers, H.A., van de Haar, H.J., Draaisma, W.A. et al. The optimal strategy for proximal mesh fixation during laparoscopic ventral rectopexy for rectal prolapse: an ex vivo study. Surg Endosc 26, 2208–2212 (2012). https://doi.org/10.1007/s00464-012-2161-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2161-3

Keywords

Search

Navigation