Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct;41(5):453-461.
doi: 10.3393/ac.2025.00080.0011. Epub 2025 Oct 28.

Laparoscopic ventral mesh rectopexy with and without transverse perineal support using biological mesh for rectal prolapse and perineal descent: postoperative course and functional outcomes

Maria Clelia Gervasi  1 , Giorgio Brancato  1 , Lorenzo Crepaz  1 , Ahmad Tfaily  2 , Alberto Di Leo  1
Affiliations

Laparoscopic ventral mesh rectopexy with and without transverse perineal support using biological mesh for rectal prolapse and perineal descent: postoperative course and functional outcomes

Maria Clelia Gervasi et al. Ann Coloproctol. 2025 Oct.

Abstract

Purpose: Laparoscopic ventral mesh rectopexy (LVMR) is effective for the treatment of rectal prolapse. However, descending perineal syndrome may impair the outcomes of LVMR. The aim of this study was to assess the safety and functional outcomes of LVMR performed with and without transverse perineal support (TPS).

Methods: This was a retrospective study of 143 consecutive female patients treated with LVMR with or without TPS between 2018 and 2022. Patients with rectal prolapse and perineal descent who underwent surgery were included. Obstructed defecation syndrome and fecal incontinence were evaluated using the Cleveland Constipation Score (Wexner score) and St. Mark's Incontinence Score, respectively. Perineal descent was defined using defecography. Biological meshes were utilized in all cases.

Results: No significant differences were recorded between with- and without-TPS groups at baseline. TPS was performed in 110 patients (76.9%). Surgical morbidity was higher in the with-TPS group (12.7% vs. 0%, P=0.047), primarily due to seroma formation. Almost all complications were mild (Clavien-Dindo grades I-II). In both groups, digital aid for defecation (P<0.001), prolonged straining (P=0.004), and hematochezia (P<0.001) nearly disappeared postoperatively, though constipation and laxative/enema use persisted in 22.4%. Fecal incontinence significantly decreased from 43.4% to 11.2% (P<0.001). TPS appears to have a potentially favorable effect in reducing the constipation score. Both constipation and incontinence scores remained low up to 24 months after surgery. Operative time was significantly longer in the LVMR with-TPS group (P<0.001).

Conclusion: LVMR with TPS appears safe and feasible. TPS may provide better surgical outcomes compared to LVMR alone for patients with symptomatic rectoceles and descending perineum syndrome.

Keywords: Defecation; Laparoscopy; Perineum; Rectal prolapse; Surgical mesh.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Surgical procedure. (A) Two nonabsorbable stitches are fixed to the periosteum membrane of the ascending branches of the pubis. (B) A blunt dissection of the subcutaneous adipose tissue is performed with fingers between the 2 incisions to create a tunnel. In the image, a surgical instrument is placed in the tunnel. Above, a previously shaped porcine dermal implant, which was positioned for illustrative purposes. (C) The dermal porcine implant is placed in the tunnel and fixed with the 2 stitches bilaterally to the periosteum membrane of the ascending branches of the pubis. (D) Skin incisions are sutured with separate stitches.
Fig. 2.
Fig. 2.
Time trend in constipation scores, as a function of transverse perineal support (TPS) placement.
Fig. 3.
Fig. 3.
Constipation scores over time. (A) Without transverse perineal support. (B) With transverse perineal support.
Fig. 4.
Fig. 4.
Incontinence scores over time.
See this image and copyright information in PMC

References

    1. D'Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004;91:1500–5. doi: 10.1002/bjs.4779. - DOI - PubMed
    1. Parks AG, Porter NH, Hardcastle J. The syndrome of the descending perineum. Proc R Soc Med. 1966;59:477–82. doi: 10.1177/003591576605900601. - DOI - PMC - PubMed
    1. Brillantino A, Iacobellis F, Maglio M, Grillo M, Vicenzo L, Monaco L, et al. The relevance of the excessive perineal descent in the obstructed defecation syndrome: a prospective study of 141 patients. Dis Colon Rectum. 2023;66:1508–15. doi: 10.1097/dcr.0000000000002526. - DOI - PubMed
    1. van Iersel JJ, Consten EC. Ventral mesh rectopexy for rectal prolapse: level-I evidence. Lancet Gastroenterol Hepatol. 2016;1:264–5. doi: 10.1016/s2468-1253(16)30114-5. - DOI - PubMed
    1. D'Hoore A. Fine-tuning indications for laparoscopic ventral mesh rectopexy. Tech Coloproctol. 2017;21:593–4. doi: 10.1007/s10151-017-1678-9. - DOI - PubMed

LinkOut - more resources