Laparoscopic + proctopexy.
Giordano P, Nduka C, Darzi A. Minerva Chir. 1998 Jul- Aug;53(7-8):675-9.
Although not common, rectal prolapse in adults can often be a debilitating conditions. Its only effective treatment is surgical. Among the many procedures described for the treatment of rectal prolapse, abdominal rectopexy is one of the preferred. It consists of fixation of the rectum to the sacrum and does not require any intestinal resection or anastomosis. However, like all open abdominal surgery associated with a large incision this operation may result in significant morbidity which is exacerbated by the advanced age of the patient.
An abdominal rectopexy carried out completely laparoscopically is described. The rectum is fully mobilised down to the pelvic floor and then fixed to the sacrum employing a polypropylene mesh. The mesh is first stapled to the sacral hollow and then sutured on both sides of the rectum. Thus the mesh is wrapped around the lateral aspects of the rectum, but the anterior rectal wall is left free. Laparoscopic techniques have been applied to a wide range of benign and malignant colorectal procedures.
However most of colorectal laparoscopic techniques involving bowel resection, are technically demanding and require often an abdominal incision to deliver the specimen and fashion the anastomosis.
Without the need for bowel resection, the laparoscopic rectopexy may constitute an optimal application of laparoscopic colorectal techniques and may soon become the gold standard for the treatment of rectal prolapse.