Abstract
Background
There is a wide range of surgical procedures available to treat rectal prolapse that differ in approach as well as in principle. The current perineal approaches available involve mucosal or full thickness resection. There are currently no accepted procedures combining rectal fixation without resection using the perineal approach. We present our initial report of transvaginal sacrospinous rectopexy for the treatment of rectal prolapse.
Methods
A longitudinal incision was made in the posterior wall of the vagina. The rectum and sacrospinous ligament were identified. Two sutures were placed in the sacrospinous ligament and brought through a piece of Surgisis® mesh previously anchored to the anterior surface of the rectum. This was performed bilaterally. These sutures were tied to complete the rectal suspension, and the posterior wall of the vagina was closed.
Results
Transvaginal sacrospinous rectopexy was performed in all seven cases. In the first two cases, a Delorme procedure was performed concurrently. Two patients had rubber band ligation for symptomatic internal hemorrhoids, one patient had a sphincter plication, and one patient had an anal encirclement procedure with Surgisis®. Six of the seven patients had concomitant urologic procedures. The average operative time was 163 min, and the average blood loss was 107 mL. None of the cases required conversion to an open procedure. There was one full thickness recurrence at 18 weeks.
Conclusion
Transvaginal sacrospinous rectopexy is a safe, minimally invasive, technically feasible technique for the treatment of rectal prolapse.
Similar content being viewed by others
References
Deen KI, Grant E, Billingham C, Keighley MR (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81:302–304
Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39
Kuijpers HC (1992) Treatment of complete rectal prolapse: to narrow, to wrap, to suspend, to fix, to encircle, to plicate or to resect? World J Surg 16:826–830
Aigmueller T, Riss P, Dungl A, Bauer H (2008) Long-term follow-up after vaginal sacrospinous fixation: patient satisfaction, anatomical results and quality of life. Int Urogynecol J Pelvic Floor Dysfunct 19:965–969
Byrne CM, Smith SR, Solomon MJ, Young JM, Eyers AA, Young CJ (2008) Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum 51:1597–1604
Darai E, Coutant C, Rouzier R, Ballester M, David-Montefiore E, Apfelbaum D (2009) Genital prolapse repair using porcine skin implant and bilateral sacrospinous fixation: midterm functional outcome and quality-of-life assessment. Urology 73:245–250
Ellis CN (2008) Outcomes after repair of rectovaginal fistulas using bioprosthetics. Dis Colon Rectum 51:1084–1088
Williams NS, Giordano P, Dvorkin LS, Huang A, Hetzer FH, Scott SM (2005) External pelvic rectal suspension (the express procedure) for full-thickness rectal prolapse: evolution of a new technique. Dis Colon Rectum 48:307–316
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gurland, B., Garrett, K.A., Firoozi, F. et al. Transvaginal sacrospinous rectopexy: initial clinical experience. Tech Coloproctol 14, 169–173 (2010). https://doi.org/10.1007/s10151-010-0567-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-010-0567-2