Laparoscopic mesh rectopexy for the treatment of rectal prolapse (video)

Abstract

Introduction: There are many options for the surgical management of rectal prolapse, whether fixating, resection or combined procedures. Perineal approach avoids entering the peritoneal cavity, although higher recurrence rates are observed compared to abdominal access.

Description: 66 year-old female, with previous laparotomic hysterectomy, was referred with a history of 1 year of complete external rectal prolapse, in abscence of fecal incontinence or constipation. Preoperative endoscopy ruled out the presence of malignancy.

Patient was placed in Trendelenburg and right-sided position. As usual, a dolico-sigmoid and deep Douglas pouch is present, and previous hysterectomy scar is seen. The procedure starts with peritoneal opening at the level of the sacral promontory, with medial dissection and left ureter identification. Peritoneal reflection is then opened too and circumferential dissection is carried out up to the level of the vaginal vault. Mesh rectopexy is done with Orr-Loygue technique, fixating both ends of the prosthetic polypropylene mesh with 2-0 polypropylene sutures to the lateral rectal wall and to the sacral promontory at each side. Care must be taken not to injure iliac vessels and ureters. Finally, peritoneal reflection is closed with 2-0 poliglactine running sutures to avoid visceral contact with the mesh.

Patient was discharged on postoperative day 2 without complications.

Conclusion: Laparoscopic approach for rectal prolapse is safe and has the advantages of minimally invasive surgery. Mesh rectopexy is technically challenging but has better late outcomes.