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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 4/2013

01-04-2013 | Original Article

Resection rectopexy—laparoscopic neuromapping reveals neurogenic pathways to the lower segment of the rectum: preliminary results

Authors: Werner Kneist, Daniel W. Kauff, Gert Naumann, Hauke Lang

Published in: Langenbeck's Archives of Surgery | Issue 4/2013

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Abstract

Purpose

Nerve sparing in functional pelvic floor surgery is strongly recommended as intraoperative damage to the autonomic nerves may predispose to persistent or worsened anorectal and urogenital function. The aim of this study was to investigate the intraoperative neural topography above the pelvic floor in patients undergoing laparoscopic resection rectopexy in combination with electrophysiologic neuromapping.

Methods

Ten consecutive female patients underwent laparoscopic resection rectopexy for rectal prolapse. Intraoperative identification of pelvic autonomic nerves was carried out with a novel intraoperative neuromonitoring system based on electric stimulation under simultaneous electromyography of the internal anal sphincter and manometry of the bladder. Neuromonitoring results were compared to patients' preoperative anorectal and urogenital function and their functional results at the 3-month follow-up.

Results

Laparoscopy in combination with electrophysiologic neuromapping revealed neurogenic pathways to the lower segment of the rectum during surgical mobilization. In all procedures, intraoperative neuromonitoring finally confirmed functional nerve integrity to the internal anal sphincter and the bladder. Patients with preoperatively diagnosed fecal incontinence were continent at the 3-month follow-up. The Wexner score improved in median from preoperative 4 (range 1–18) to 1 (range 0–3) at follow-up (p = 0.012). Cleveland Clinical Constipation Score improved in median from 10 (range 5–17) to 3 (range 1–7; p = 0.005). In none of the investigated patients a new onset of urinary dysfunction did occur. No change in sexual function was observed.

Conclusions

Laparoscopy in combination with electrophysiologic neuromapping during nerve-sparing resection rectopexy identified and preserved neurogenic pathways heading to the lower segment of the rectum above the level of the pelvic floor.
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Metadata
Title
Resection rectopexy—laparoscopic neuromapping reveals neurogenic pathways to the lower segment of the rectum: preliminary results
Authors
Werner Kneist
Daniel W. Kauff
Gert Naumann
Hauke Lang
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Langenbeck's Archives of Surgery / Issue 4/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-013-1064-7

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