Rectal axis and enterocele on proctogram may predict laparoscopic ventral mesh rectopexy outcomes for rectal intussusception

Abstract

These data show that proctographic findings can help predict functional outcomes after LVMR. Presence of an enterocele and a vertical axis of the rectum at rest may be associated with a better resolution of symptoms.

Fine-tuning indications for laparoscopic ventral mesh rectopexy

“…Proctography is now an important part of the functional workup of a patient with fecal incontinence and obstructed defecation [3,4]. The pathophysiology of obstructed defecation is complex, and often prolapse is accompanied by pelvic floor dyssynergia.…”

Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma

“…Recently, Ris and co-authors even showed that patients with an enterocele had a greater resolution of faecal incontinence symptoms after LVR [4]. Another study from the same group found a greater improvement in incontinence scores after LVR in patients with a low preoperative anal squeeze increment (anal squeeze pressure minus anal resting pressure) [5].…”

“…They raise an interesting point regarding correlation of IMV diameter of whole-mount specimens with and without tumours, to validate the hypothesis [1]. Imaging correlation to histopathological specimens is a tried and tested method to correlate rectal cancer staging and subsequent tumour regression grade after neoadjuvant radiotherapy [3,4]; however, we have some apprehensions with the suggestion in this case. First, the measurement of the IMV ex vivo may not correlate with the measurement on CT because of lack of circulation, flow and venous pressure and potential changes in vessel elasticity ex vivo.…”

“…In patients with small rectal diameter, low squeeze pressure or excessive perineal descent, LVR probably has the advantage over STARR. However, these authors also suggested that in patients with a horizontal rectal axis, additional limited posterior rectal mobilization to LVR may be necessary [4].…”

Laparascopic Ventral Mesh Rectopexy Experience for Rectal Prolapse At Our Center

“…Amaç anatomiyi düzeltmek ve böylece tıkanıklık ve fekal inkontinans belirtilerini iyileştirmektir (13). Yapılan çalışmalarda laparoskopik ventral rektopeksi ile obstriktif defekasyon sendromu ve ileri derece rektal intusepsiyonu olan hastaların %70' de semptomların düzeldiği gösterilmiştir (14)(15). Ayrıca bu tedaviden fayda görme olasılığını arttırmak için hasta seçiminde dikkatli olunmalıdır.…”