Nathalie Deferm, MD, Vicky Dhooghe, MD, Gabriele Bislenghi, MD, André D’hoore, MD, PhD, Albert Wolthuis, MD, PhD. UZ Leuven
Introduction: Laparoscopic ventral mesh rectopexy has been widely used for rectal prolapse. In case of posterior prolapse, this technique could be insufficient. The purpose of this multimedia abstract is to present a technique of combined laparoscopic anterior and posterior rectopexy with levatorplasty for posterior rectocele.
Case Report: We report a case of a 26 year-old male with a history of incomplete defecation. RX-defecography showed a posterior rectocele due to pelvic floor insufficiency. Anterior and posterior rectopexy with levatorplasty was performed by a four port technique. The first step was the dissection of the posterior rectal plane with bilateral dissection up to the pelvic floor where a central gap was observed. Levatorplasty was performed by approximating sutures (Ethibond). Secondly a J-shaped incision was performed over the peritoneum with the development of the anterior plane up to the pelvic floor. Afterwards, the peritoneum was opened over the promontory and 2 marlex meshes were introduced anterior and posterior to the rectum and secured with Vicryl and glue to the mesorectum. Finally, the meshes were fixed to the promontory with endo-tackers avoiding the hypogastric nerves. Operative time was 124 minutes. Postoperative course was uneventful with a hospital stay of 2 days. Possible complications are bleeding, mesh erosion and pelvic pain.
Conclusion: In case of posterior rectocele, laparoscopic anterior and posterior rectopexy combined with a levatorplasty is feasible and offers a complete repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94149
Program Number: V202
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop