Outcome of a Modified Laparoscopic Suture Rectopexy for Rectal Prolapse with the Use of a Single or Double Suture: A Case Series of 15 Patients

Abstract

BACKGROUND Surgery is considered to be a mainstay of therapy for full-thickness rectal prolapse (FTRP). Surgical procedures for FTRP have been described, but optimal treatment is still controversial. The aim of this report is to evaluate the safety and feasibility of a simplified laparoscopic suture rectopexy (LSR) in a case series of 15 patients who presented with FTRP and who had postoperative follow-up for six months. CASE REPORT Fifteen patients who underwent a modified LSR at our surgical unit from September 2010 were retrospectively evaluated. The mean age of the patients was 72.5±10.9 years. All 15 patients underwent general anesthesia, with rectal mobilization performed according to the plane of the total mesorectal excision. By lifting the mobilized and dissected rectum cranially to the promontorium, the optimal point for subsequent suture fixation of the rectum was marked. The seromuscular layer of the anterior right wall was then sutured to the presacral fascia using only one or two interrupted nonabsorbable polypropylene sutures. The mean operative time was 176.2±35.2 minutes, with minimal blood loss. No moderate or severe postoperative complications were observed, and there was no postoperative mortality. One patient (6.7%) developed recurrence of rectal prolapse one month following surgery. CONCLUSIONS The advantages of this LSR procedure for the management of patients with FTRP are its simplicity, safety, efficacy, and practicality and the potential for its use in patients who can tolerate general anesthesia.

Figure 1.

Laparoscopic suture rectopexy (LSR) for full-thickness rectal prolapse (FTRP). (A) Full-thickness rectal prolapse (FTRP) has a characteristic circular mucosal fold appearance. (B) The FTRP was resolved and a normalized anus was observed.

Figure 2.

Rectal dissection and mobilization were performed in the plane of total mesorectal excision. (A) Anterior rectal dissection was completed 10 to 20 mm caudal to the peritoneal reflection. (B) Posterior rectal dissection was accomplished until the levator muscles were exposed.

Figure 3.

Laparoscopic suture rectopexy (LSR) for full-thickness rectal prolapse (FTRP). (A) The mobilized rectum was cranially lifted to the promontorium (blue arrow). (B) The optimal point for suture fixation of the rectum was clearly marked.

Figure 4.

Laparoscopic suture rectopexy (LSR) for full-thickness rectal prolapse (FTRP). (A) The seromuscular layer of anterior right wall of the rectum was sutured to the presacral fascia. Only one or two non-absorbable polypropylene sutures were placed in an interrupted fashion. (B) The advantage of this laparoscopic suture rectopexy (LSR) is its simplicity.