Laparoscopic ventral rectopexy with sacrocolpopexy for coexisting pelvic organ prolapse and external rectal prolapse
From the Gastroenterological Surgery, Department of Kameda Medical Center, Chiba, Japan
Abstract:
Objectives: Pelvic organ prolapse (POP) POP is defined as the protrusion of pelvic organs from the vaginal canal. POP often coexists with internal rectal prolapse or external rectal prolapse (ERP). A series of patients with coexisting POP and ERP who underwent laparoscopic ventral rectopexy (LVR) combined with laparoscopic sacrocolpopexy (LSC) are reported here. Methods: Seven patients underwent LVR and LSC together. Fecal incontinence was assessed by the Fecal Incontinence Severity Index (FISI), constipation was assessed by the Constipation Scoring System (CSS), and urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Anatomical disorders were assessed by Pelvic Organ Prolapse Quantification (POP-Q) and defecography. Results: The patients' median age was 81 (60-88) years. The median operative time was 380 (282-430) minutes. The median postoperative hospital stay was 3 (1-5) days. There were no postoperative complications. The FISI, CSS, POP-Q, and defecography findings improved postoperatively; however, the ICIQ-SF deteriorated in 2 of 5 patients. Conclusions: LVR combined with LSC for coexisting POP and ERP is feasible.
Supplement
Video S1 (laparoscopic ventral rectopexy)
A peritoneal incision was made from just above the sacral promontory. The incision was extended along the right side of the rectum and over the bottom of the pouch of Douglas, in an inverted J-shape. Denonvillier’s fascia was incised, and the rectovaginal septum was broadly opened. A strip of polypropylene mesh was introduced and sutured as distally as possible on the rectal wall with six sutures. The mesh was settled tension-free on the sacral promontory with a stapler.
Video S2 (Laparoscopic sacrocolpopexy)
After laparoscopic ventral rectopexy, laparoscopic sacrocolpopexy was performed. The bilateral round ligaments, ovarian ligaments, and ascending branches of the uterine arteries were coagulated and dissected. Subtotal hysterectomy was then performed. Following dissection between the bladder and the vagina, a second mesh was fixed on the anterior vaginal wall and uterine cervix. The first and the second meshes were sutured on the cut end of the uterus. The second mesh was also fixed to the sacral promontory. Finally, the mesh was peritonealized by suturing the uterosacral ligament and the free edge of the divided peritoneum.
