Koji Masumori, Assistant ProfessorMD, Koutarou Maeda, Professor, Tsunekazu Hanai, Associate Professor, Haruyosihi Sato, Associate Professor, Hiroshi Matsuoka, Assistant Professor. Department of Surgery, School of Medicine, Fujita Health University
For full- thickness rectal prolapse,transanal and transabdominal procedure have been performed in our hospital, depending on the patient’s age and total condition. Currently, laparoscopic surgery with it radical and less invasive procedure has been for several diseases. We laparoscopically added pelvic peritonizatin repair to the fixation of the rectum to the sacrum with prothetic material by Nicolas and Bass.The procedure and outcomes of the laparoscopic surgery were described.
Patient and Methods)
All patients were assessed preoperatively by clinical examination, defecography, anal manometry and endoscopy, transit study with sitzmarks.
Dis indications for Laparoscopic surgery were in performance status 2 and above, were unable to have general anesthesia or have the last open surgery or severe mental sickness.
Laparoscopic operative technique:
A total of 5 port sites (using three 12mm ports and two 5mm ports) are placed at the umbilicus and the other lower abdomen. The sigmoid colon and the rectum are dissected posteriorly and laterally from the autonomic nerves with forceps and electric diathermy. The rectovaginal septum is dissected anteriorly. Using the rolling tape, the rectum is retracted, and the rectum is mobilized down to the levator muscles. A rectangular polypropylene mesh ( width; 3 quarters of the rectum, length; about 5cm) is inserted and fixed to the sacral concavity using a Endo-Hernia staplar. Reperitonization was performed by hand sewn method to shallow the peritoneal reflection.
This procedure was performed in twenty three patients from May 1996 to December 2010. Median Operating time and blood loss were 169 (range 89-248) min and 13 (range 2-57)g respectively. Postoperatively, slight soiling was observed in 5 patints with acceptable bowel moments.
Intraoperative complication was 1case (bleeding of the middle rectal artery). And postoperative complication was 1case with port site hernia.Median following time was 23 (range2- 145)months ,there were no recurrence case.
This laparoscopic procedure is feasible for full thickness rectal prolapse with favorable short term functional results.
Session Number: Poster – Poster Presentations
Program Number: P089