Laparoscopic Mesh Posterior Rectopexy for the Treatment of Full Thickness Rectal Prolapse

Hitoshi Idani, MD, Satoshi Komoto, MD, Kanyu Nakano, MD, Shinichiro Kubo, MD, Yohei Kurose, MD, Shinya Asami, MD, Tetsushi Kubota, MD, Yasushi Ohmura, MD, Hiroshi Sasaki, MD, Katsuyoshi Hioki, MD, Hiroki Nojima, MD, Takashi Yoshioka, MD, Masahiko Muro, MD, Hitoshi Kin, MD, Norihisa Takakura, MD. Department of Surgery, Fukuyama City Hospital, Department of Gastrointestinal surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences

Background: The best surgical procedure for the management of full thickness rectum prolapse remains unknown. It has been reported that abdominal procedures have a lower recurrence rate than perineal ones, however, those are associated with larger surgical stress and higher rates of morbidity. Laparoscopic rectopexy has been introduced in these past ten years offering lower recurrence rate with less invasion and lower morbidity. We report our surgical procedure and outcome of laparoscopic posterior mesh rectopexy.
Surgical procedure: Under 10mmHg pneumoperitoneum, the sigmoid colon and the rectum were fully mobilized. 10X6cm polypropylene mesh or Parietex mesh was fixed to the presacral fascia with absorbable tacks. The rectum was wrapped 4/5 around with the mesh and fixed with 4-0 absorbable suture materials. Peritoneum was repaired by 3-0 absorbable suture materials.
Patients and Methods: From January 2004 to June 2011, 10 patients with full thickness rectal prolapse underwent laparoscopic posterior mesh rectopexy in our hospital. Operative time, blood loss, length of hospital stay, morbidity and recurrence rate were evaluated.
Result: Patients consisted of 7 women and 3 men with a mean age of 74 +/- 11.7 years. ASA score was 2.2 +/- 0.75. Polypropylene Mesh was used on 6 patients and Parietex Mesh was used on 4 patients. Operative time was 137 +/- 49.8 min and the amount of blood loss was negligible. Mean length of hospital stay was 6.8 +/- 2.4 POD. Constipation occurred in 3 patients, and diarrhea in 1 patient. No perioperative complication was marked. During the median follow up period of 46 months, there has been no sign of recurrence.
Conclusions: Laparoscopic mesh posterior rectopexy is safe and effective procedure for the treatment of full thickness rectal prolapse.
 

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