Laparoscopic ventral rectopexy using the transanal vacuum test for complete rectal prolapse
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Laparoscopic ventral rectopexy using the transanal vacuum test for complete rectal prolapse Takeyoshi Yumiba1 · Yoshihito Souma1 · Jun Yasuda1 · Junji Ieda1 · Tomojiro Ono1 · Riichiro Nezu1 · Toru Saito1 Received: 7 July 2020 / Accepted: 22 September 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Laparoscopic ventral rectopexy was performed in 84 patients with complete rectal prolapse from January 2016 to December 2019. In the initial 27 cases, three cases had recurrence, especially in cases of a long rectal prolapse measuring over 10 cm. In order to avoid recurrence, the transanal vacuum test was performed following the dissection of the rectovaginal septum towards the pelvic floor. The disappearance of rectal prolapse is confirmed by the intraoperative transanal vacuum test. When the posterior wall of the rectum showed the presence of prolapse according to the transanal vacuum test, then laparoscopic ventral rectopexy was converted to laparoscopic posterior rectopexy. In 94 cases in which laparoscopic ventral rectopexy was attempted, laparoscopic ventral rectopexy was completed in 57 cases, while the procedure was converted to laparoscopic posterior rectopexy in 37 cases. The recurrence rate following laparoscopic ventral rectopexy decreased from 11.1% (3/27) to 1.7% (1/57) after beginning to use the transanal vacuum test. Laparoscopic ventral rectopexy using the transanal vacuum test is therefore considered to be a useful technique to reduce postoperative recurrence. Keywords Laparoscopic ventral rectopexy · Complete rectal prolapse · Transanal vacuum test
Introduction Complete rectal prolapse is a disease that causes discomfort, pain, and bleeding as well as defecation dysfunction due to full-thickness prolapse of the rectum beyond the anal canal and it significantly impairs the quality of life. Since laparoscopic rectopexy for complete rectal prolapse was first reported in 1992 [1], laparoscopic rectopexy has become the treatment of choice since it is radical and less invasive surgery. Laparoscopic rectopexy has been reported in various studies to date for various surgical procedures and good surgical results have been obtained. However, postoperative new constipation (de novo constipation) due to damage to the autonomic plexus around the rectum has been pointed out [2]. D’Hoore et al. proposed a new technique called laparoscopic ventral rectopexy (LVR) in which only the ventral rectum was dissected, while the autonomic plexus around the rectum was preserved [2]. This procedure is a method for suspending the anterior wall of the rectum with a mesh and * Takeyoshi Yumiba yumiba@osaka‑centralhp.jp 1
Department of Surgery, Osaka Central Hospital, 3‑3‑30 Umeda, Kita‑ku, Osaka 530‑0001, Japan
fixing it to the sacral promontory. The recurrence rate is as low as for other types of rectopexy, and the incidence of de novo constipation has been reported to decrease [3]. In our hospital, we adopted laparoscopic posterior rectopexy (LPR) (modified Wells method [4]) for complete rectal prolap
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