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Techniques in Coloproctology
Published in: Techniques in Coloproctology 6/2012

01-12-2012 | Multimedia Article

Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results

Authors: A. Lauretta, R. E. Bellomo, F. Galanti, C. A. Tonizzo, A. Infantino

Published in: Techniques in Coloproctology | Issue 6/2012

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Abstract

Background

Laparoscopic ventral rectopexy limits the risk of autonomic nerve damage, and the colpopexy allows correction of a concomitant prolapse of the middle compartment. The aim of this study is to describe a modified laparoscopic ventral rectocolpopexy procedure with a low approach to the sacral hollow (laparoscopic low ventral rectocolpopexy: LLVR). We propose this technique to manage combined rectogenital prolapse.

Methods

Between November 2006 and June 2009, all patients with symptomatic rectal prolapse associated with genital prolapse and/or enterocele underwent LLVR. Demographics, results of imaging studies, mortality, morbidity, and functional outcome were retrospectively analyzed.

Results

Thirty patients underwent LLVR: two patients suffered from a full-thickness rectal prolapse while 28 had symptomatic recto-anal intussusception. The mean operating time was 94 ± 39 minutes. Conversion to laparotomy was never needed. Hospital stay ranged between 2 and 14 days (mean of 5 ± 2.5 days). No mortality was recorded and only two complications occurred (6.6 %): one trocar site incisional hernia and one vaginal suture erosion in a patient who had concomitant hysterectomy. After a mean follow-up of 13.9 months, constipation was completely resolved or improved in 92.8 % patients. Significant reduction in the mean Altomare obstructed defecation score (14.7–5.6; p < 0.05) was recorded. Preoperative incontinence improved after the procedure in all patients affected. No new cases of postoperative constipation or fecal incontinence were registered. Only one case of recurrence in a patient with recto-anal intussusception was recorded (3.4 %), after 19 months.

Conclusions

Laparoscopic low ventral rectocolpopexy is safe and associated with very low morbidity. In the medium term, it provides good result for prolapse and associated symptoms.
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Literature
1.
Lim M, Sagar PM, Gonsalves S, Thekkinkattil D, Landon C (2007) Surgical management of pelvic organ prolapse in females: functional outcome of mesh sacrocolpopexy and rectopexy as a combined procedure. Dis Colon Rectum 50:1412–1421PubMedCrossRef
2.
Mellgren A, Johansson C, Dolk A et al (1994) Enterocoele demonstrated by defecography is associated with other pelvic floor disorders. Int J Colorectal Dis 9:121–124PubMedCrossRef
3.
Mellgren A, Bremmer S, Johansson C et al (1994) Defecography: results of investigations in 2,816 patients. Dis Colon Rectum 37:1133–1141PubMedCrossRef
4.
Hausammann R, Steffen T, Wishaupt D, Beutner U, Hetzer FH (2009) Rectocele and intussusception: is there any coherence in symptoms or additional pelvic floor disorders? Tech Coloproctol 13:17–26PubMedCrossRef
5.
D’Hoore A, Cadoni R, Penninckx F (2004) Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg 91:1500–1505PubMedCrossRef
6.
Slawik S, Soulsby R, Carter H, Payne H, Dixon AR (2008) Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Colorectal Dis 10:138–143PubMed
7.
Baden WF, Walker TA, Lindsay HJ (1968) The vaginal profile. Tex Med J 64:56–58
8.
Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implication. Gut 30:1737–1749PubMedCrossRef
9.
Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88PubMed
10.
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef
11.
Moschowitz AW (1912) The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gynecol Obstet 15:7–21
12.
Cadeddu F, Sileri P, Grande M, De Luca E, Franceschilli L, Milito G (2012) Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature. Tech Coloproctol 16:37–53PubMedCrossRef
13.
Eu KW, Seow-Choen F (1997) Functional problems in adult rectal prolapse and controversies in surgical management. Br J Surg 84:904–911PubMedCrossRef
14.
Mollen RM, Kuipers JH, Van Hoek F (2000) Effects of rectal mobilization and lateral ligaments division on colonic anorectal function. Dis Colon Rectum 43:1283–1287PubMedCrossRef
15.
Scaglia M, Fasth S, Hallgren T, Nordgren S, Oresland T, Hulten L (1994) Abdominal rectopexy for rectal prolapse: influence of surgical technique on functional outcome. Dis Colon Rectum 37:805–813PubMedCrossRef
16.
Speakman CTM, Madden MV, Nicholls RJ, Kamm MA (1991) Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. Br J Surg 78:1431–1433PubMedCrossRef
17.
Broden B, Snellman B (1968) Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum 11:330–347PubMedCrossRef
18.
Infantino A, Bellomo R, Del Ciampo D (2008) Rectopexy with mesh: the Orr-Loygue technique. In: Altomare DF, Pucciani F (eds) Rectal prolapse. Diagnosis and clinical management. Springer-Verlag, Milan, pp 131–137
19.
DeLancey JO (1999) Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstet Gynecol 180:815–823PubMedCrossRef
20.
D’Hoore A, Penninckx F (2006) Laparoscopic ventral rectocolpopexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20:1919–1923PubMedCrossRef
21.
Collinson R, Wijffels N, Cunningham C, Lindsey I (2010) Laparoscopic ventral rectopexy for internal rectal prolapse: short term functional result. Colorectal Dis 12:97–104PubMedCrossRef
Metadata
Title
Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results
Authors
A. Lauretta
R. E. Bellomo
F. Galanti
C. A. Tonizzo
A. Infantino
Publication date
01-12-2012
Publisher
Springer Milan
Published in
Techniques in Coloproctology / Issue 6/2012
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-012-0918-2

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