Natural Orifice Transanal Endoscopic Rectopexy: A Novel Option for Rectal Prolapse

BACKGROUND: Endoluminal surgery for the management of rectal prolapse remains largely experimental. OBJECTIVE: To evaluate the evolution and short-term outcomes of a new endoluminal technique for the management of complete rectal prolapse. DESIGN: This was a prospective study. SETTINGS: This study was conducted at a single tertiary care teaching center. PATIENTS: A total of 29 patients were included. The first 12 patients underwent the procedure with our initial technique, and the last 17 patients were subjected to the new modified procedure. The follow-up duration was 3 years for the older technique and 26 months for the newer technique. INTERVENTION: This technique involves: 1) ventral “suture” rectopexy: rectum is fixed anteriorly to the anterior abdominal wall using percutaneously placed sutures. 2) Posterior rectum is fixed to the sacral promontory using tackers through a submucosal tunnel. MAIN OUTCOME MEASURES: Safety, recurrence, functional outcomes, morbidity, and mortality were the main outcome measures. RESULTS: There were improvements in constipation and incontinence scores, anal manometric pressures, anorectal angle, anorectal descent, and quality of life postoperatively in both groups. In patients undergoing the modified procedure, there was a significant decrease in duration of surgery (220 ± 48.89 vs 110 ± 12.51 min), shortened hospital stay (4.6 ± 1.71 vs 2.6 ± 0.65 d), decreased recurrence (25% vs 5.8%), and complications (surgical-site infection and retrorectal abscess). LIMITATIONS: Short follow-up, small sample size, and single-center study were the limitations. CONCLUSION: This is a novel endoluminal technique for treating rectal prolapse obviating perirectal dissection, abdominal incisions, or a mesh. This can now be performed under complete endoscopic and fluoroscopic vision. It avoids general anesthesia and therefore can be an alternative for patients with comorbid conditions in whom the standard abdominal procedure may not be well tolerated. Larger randomized multicentric studies with longer follow-ups are warranted. See Video Abstract at http://links.lww.com/DCR/C59. RECTOPEXIA ENDOSCÓPICA TRANSANAL POR ORIFICIO NATURAL PARA EL PROLAPSO RECTAL COMPLETO: EVOLUCIÓN PROSPECTIVA DE UNA NUEVA TÉCNICA Y RESULTADOS A CORTO PLAZO ANTECEDENTES: La cirugía endoluminal para el tratamiento del prolapso rectal ha permanecido en gran parte experimental. OBJETIVO: Este estudio tiene como objetivo evaluar la evolución y los resultados a corto plazo de una nueva técnica endoluminal para el manejo del prolapso rectal completo. DISEÑO: Estudio prospectivo. ÁMBITOS: Único centro docente de tercer nivel de atención. PACIENTES: Se incluyeron un total de 29 pacientes (19 hombres y 10 mujeres) con prolapso rectal completo. Los primeros 12 pacientes fueron sometidos al procedimiento con nuestra técnica anteriormente descrita y los últimos 17 pacientes fueron sometidos al nuevo procedimiento modificado. La duración del seguimiento es de 3 años para la técnica más antigua y de 26 meses para l...

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“…GelPOINT path and ReliaTack device were used for posterior fixation of the rectum to the sacral promontory as described by us earlier. 10…”

Section: Methodsmentioning

confidence: 99%

“…GelPOINT path and ReliaTack device were used for posterior fixation of the rectum to the sacral promontory as described by us earlier. 10 The entire procedure was completed under CO 2 insufflation and fluoroscopic assistance.…”

Section: Equipment Usedmentioning

confidence: 99%

Natural Orifice Transanal Endoscopic Rectopexy for Complete Rectal Prolapse: Prospective Evolution of a New Technique and Short-term Outcomes

Chandra

Rajan

Gupta

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…Significant improvement in resting and squeeze pressures and anorectal angle and descent were noted at 1 month as well as in obstructive defecation syndrome and St. Mark's incontinence scores at 6 months. 8 Overall, the authors should be commended for their stepwise and rigorous approach in developing and implementing this new technique. Through careful review of initial results, the technique was optimized to reduce actual and potential complications and reduce operative time and technical difficulties to achieve a reproducible result.…”

Section: Commentaries and Educational Contentmentioning

confidence: 99%

“…Significant improvement in resting and squeeze pressures and anorectal angle and descent were noted at 1 month as well as in obstructive defecation syndrome and St. Mark’s incontinence scores at 6 months. 8…”

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confidence: 99%

A Viable Option for Frail Patients? Natural Orifice Transluminal Endoscopic Surgery Rectopexy for Rectal Prolapse Using Transanal Fixation

Sylla

2022

Diseases of the Colon &Amp; Rectum

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“…We recently reported a novel minimally invasive transanal endoscopic fixation of complete rectal prolapse. 4,5 e185 Herein we describe a similar technique for simultaneous endoluminal lateral suspension of apical vaginal wall prolapse with ultrasound assistance.…”

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confidence: 99%

Natural Orifice Endosonographic Colposuspension With Rectopexy for Combined Pelvic Organ Prolapse: A Feasibility Study

Chandra

Rajan

Gupta

et al. 2022

Diseases of the Colon &Amp; Rectum

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See video on DCR YouTube Channel at https:// youtu.be/VKTNzGwA1ykBACKGROUND : We describe a natural orifice technique for simultaneous endoluminal lateral suspension of apical vaginal wall and rectal prolapse fixation with ultrasound and fluoroscopic assistance. IMPACT OF INNOVATION:The technique is minimally invasive, can be performed under regional anaesthesia, and avoids laparotomy or use of a mesh in addition to preserving the uterus. TECHNOLOGY MATERIALS AND METHODS:This technique involves suprapubic transvaginal ventral suture colposuspension, fixation of the anterior rectal wall to the undersurface of the anterior abdominal wall and tack fixation of the posterior rectal wall to the underlying sacral promontory through a submucosal tunnel performed endoscopically with fluoroscopic and ultrasound assistance.PRELIMINARY RESULTS: Seven patients with a mean age of 63 years were followed between 3 to 11 months.CONCLUSIONS: This is a novel minimally invasive transluminal procedure that repairs concomitant rectal and vaginal prolapse in the same sitting.Funding/Support: None reported.

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Natural Orifice Transanal Endoscopic Rectopexy: A Novel Option for Rectal Prolapse

Cited by 4 publications

References 13 publications

Natural Orifice Transanal Endoscopic Rectopexy for Complete Rectal Prolapse: Prospective Evolution of a New Technique and Short-term Outcomes

Natural Orifice Transanal Endoscopic Rectopexy for Complete Rectal Prolapse: Prospective Evolution of a New Technique and Short-term Outcomes

A Viable Option for Frail Patients? Natural Orifice Transluminal Endoscopic Surgery Rectopexy for Rectal Prolapse Using Transanal Fixation

Natural Orifice Endosonographic Colposuspension With Rectopexy for Combined Pelvic Organ Prolapse: A Feasibility Study

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