Tokihito Nishida, PhD. Department of Surgery, Kasai City Hospital, Hyogo, Japan
Aim: Usually, the repair of rectal or uterine prolapse was undergone by separate method each other in respective department of surgery or gynecology. We devised a new technique of laparoscopic simultaneous united rectopexy and hysteropexy by our modified Ripstein method with single mesh for the both of rectal and uterine prolapse.We experienced two cases of them and operated by our new technique.
Methods: Case1 was 82-year-old female, who had treated with Myers ring for uterine prolapse from 56-year-old, came to our department with complete rectal prolapse of 5cm length. Case2 was 74-year-old female, who presented rectal prolapse one month ago, came to our department and showed both of rectal (4cm length) and uterine (4cm length) prolapse. Operative procedures were as follows; under general anesthesia of lithotomy position, under laparoscope, we exfoliated the rectum of RS, Ra and dorsal Rb from sacrum with TME technique, modified Ripsetin method, cut single BARD mesh into a T-shape (transverse 12-15cm, vertical 7.5-8cm, short side 5cm), attached the mesh to the pulled-up rectum, fixed the mesh to ventral rectum with Endo Universal Stapler, fixed the mesh to sacrum with AbsorbaTack ± Endo Universal Stapler, and at last fixed uterine neck to the internal angle of mesh and uterine body to the top of mesh with 3-0 nylon thread. In this way, laparoscopic simultaneous united rectopexy and hysteropeccy was performed.
Results: In each case, operative time were 147 and 178 min., blood loss were 3 and 4 grams, there was no morbidity, meals were started on POD1 and patients were discharged on POD7. In case1, prolapse of vaginal anterior wall occurred 4 months after, and only colpocystocele was diagnosed on abdominal CT 6 months after. A pessary ring was inserted at gynecology of our hospital. She has constipation sometimes, no fecal incontinence and no urinary incontinence 6 months after the operation. In case2, she has no recurrence, no constipation, fecal incontinence sometimes and no urinary incontinence 5 months after the operation.
Conclusions: Laparoscopic simultaneous united rectopexy and hysteropexy by our modified Ripstein method with single mesh was effective for the both of rectal and uterine prolapse. We show a video of the procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93720
Program Number: V200
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop