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A step-by-step approach to endorectal proctopexy (ERPP): how we do it

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Abstract

There are many surgical treatments aimed at correcting internal mucosal prolapse and rectocele associated with obstructed defecation syndrome (ODS). Perineal procedures can be considered as first options in young men in whom an abdominal approach poses risks of sexual dysfunction and in selected women with isolated posterior compartment prolapse who failed conservative treatment. About 20 years ago, we described endorectal proctopexy (ERPP) also known as internal Delorme procedure. The aim of the present study was to describe, with attention to technical details and the aid of a video, the different steps of ERPP for the treatment of ODS. A retrospective analysis of our last 100 cases confirms our initial good results. Complications included suture line dehiscence with consequent stricture in four patients (4%). Bleeding occurred in four (4%) patients and was conservatively treated. Transient anal continence impairment consisting of urgency and soiling occurred in 12 (12%) and 6 (6%) patients, respectively. At 6-month follow-up the Cleveland Clinic Constipation Score and ODS score improved from a median preoperative value of 18.9 and 18.5 to 5 and 5, respectively (p < 0.0001). The mean follow-up was 36.05 ± 13.3 (range 12–58) months and anatomical recurrence rate was 6 (%). Due to its excellent safety profile and the ability to tailor the procedure to different disease presentations, we think that ERPP should be part of the basic armamentarium of all colorectal surgeons operating on the pelvic floor.

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Authors and Affiliations

  1. Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy

    G. Gallo, G. Clerico, A. Realis Luc & M. Trompetto

  2. Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy

    G. Gallo

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  1. G. Gallo
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  2. G. Clerico
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  3. A. Realis Luc
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  4. M. Trompetto
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Correspondence to G. Gallo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Gallo, G., Clerico, G., Realis Luc, A. et al. A step-by-step approach to endorectal proctopexy (ERPP): how we do it. Tech Coloproctol 25, 879–886 (2021). https://doi.org/10.1007/s10151-021-02467-y

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  • DOI: https://doi.org/10.1007/s10151-021-02467-y

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