CONCOMITANT SINGLE SHEETLAPAROSCOPIC VENTRAL MESH RECTOPEXY AND SACROCOLPOPEXY FOR COMBINEDFULL THICKNESS RECTAL PROLAPSE AND UTEROVAGINAL PROLAPSE
J. R. LOGANATHAN1, M.LIU 2, S. GURJAR 2, A. FAYYAD 3;
1Obstetrics and Gynaecology, Luton and Dunstable Univ.Hosp. NHS Trust, Luton, United Kingdom, 2ColorectalSurgery, Luton and Dunstable Univ. Hosp. NHS Trust, Luton, UnitedKingdom, 3Luton and Dunstable Univ. Hosp. NHS Trust,Luton, United Kingdom.
Objective: To demonstrate thetechnique of laparoscopic single sheet ventral mesh rectopexy andsacrocolpopexy for multiple compartment pelvic organprolapse.
Method: 12 women with combined vaginal and fullthickness rectal prolapse who underwent laparoscopic single sheetventral mesh rectopexy and sacrocolpopexy were retrospectivelyevaluated up to 4 years postoperatively. All women underwentpreoperative evaluation by the P-QOL questionnaire (1) and vaginalprolapse was anatomically evaluated using the POP-Q system (2). Thetechnique involved temporary suspension of the uterus to the anteriorabdominal wall with sutures to allow access to the rectovaginalspace. This was followed by opening the rectovaginal space towardsthe level of the rectum, where the perineal body and levator ani wereexposed bilaterally. A single sheet light weight type 1 polypropylenemesh was then sutured to the ventral aspect of the rectum with 8absorbable sutures followed by 4-6 non absorbable sutures to theposterior aspect of the cervix uteri. The presacral peritoneum wasthen opened to the level of the pelvic floor and the mesh fixed tothe sacrum with 4 non absorbable 5 mm protacks. The mesh wascompletely covered with peritoneum. All women reported complete cureof vaginal and rectal prolapse symptoms and reported feeling ‘muchbetter’ or ‘very much better’ on their global impression ofimprovement questionnaire (3) that persisted at 4 yearspostoperatively.
Clinical relevance: There is paucity ofdata on the best technique to manage women with combined fullthickness rectal prolapse and coexistent vaginal prolapse. In thisvideo we show the use of single mesh to address both compartmentsafter adequate dissection of the rectum and vagina. This techniquehas the advantages of the laparoscopic approach, treating multiplecompartment prolapse in a single setting and minimising the volume ofmesh used in the pelvis to address the multiple compartmentprolapse.
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