Ventral Rectopexy for Rectal Prolapse and Obstructed Defecation

Abstract

Objectives: On completion of this article, the reader should be able to describe the technique and benefit of anterior ventral rectopexy.Ventral rectopexy (VR) has gained momentum in recent years as an operation for both full-thickness and internal rectal prolapse. Dissection is performed anterior to the rectum and mesh is fixed to the rectal wall and suspended to the sacrum. The initial description of VR known as the OrrLoygue procedure involves full rectal mobilization anteriorly and posteriorly to the levator ani muscle level and suturing two meshes on to the anterolateral rectal wall. 1 D'Hoore described a modified VR performed laparoscopically. 2 Only the Denonvilliers fascia is dissected to expose anterior rectal wall and a single mesh is sutured onto the anterior aspect of the distal rectum. Posterior dissection is avoided and limited only to clearing the sacral promontory sufficiently for mesh fixation. Proponents of ventral rectopexy report low recurrence rates and functional improvements for both fecal incontinence and constipation.3-5 The aim of this review is to describe surgical technique and associated outcomes of VR. PrevalenceAlthough internal and external rectal prolapse are not lifethreatening conditions, these disorders can be extremely debilitating and have a negative impact on quality of life. Effected individuals may report discomfort or pain from prolapsing tissue, drainage of mucus or blood, and associated fecal incontinence or difficult evacuation. Women aged 50 and older are 6 times as likely as men to present with rectal prolapse. 6,7 Two thirds of women are multiparous and 15 to 30% report associated urinary dysfunction and vaginal prolapse. 8 Pathophysiology of Posterior Compartment ProlapseThe pelvic floor is often considered in terms of three compartments: anterior, middle, and posterior. Posterior compartment disorders include rectal prolapse (RP), which involves full-thickness descent of the rectum through the anal muscles or rectal intussusception (RI). RI is the funnel-shaped infolding of the rectal wall that occurs during defecation. AbstractVentral rectopexy has gained popularity in Europe to treat full-thickness rectal external and internal prolapse. This procedure has been shown to achieve acceptable anatomic results with low recurrence rates, few complications, and improvements of both constipation and fecal incontinence. The authors review the principles, techniques, and outcomes of ventral rectopexy.

Surgery for constipation: systematic review and practice recommendations

“…Seven systematic [3,[22][23][24][25][26][27] and 4 narrative [28][29][30][31] reviews have focused on the outcome of rectal suspension. Of the systematic reviews, 3 [3,23,26] focused on full thickness external rectal prolapse, 2 included both full-thickness prolapse and constipation participants, and 2 [22,25] analysed outcomes of robotic surgery.…”

Descending perineum syndrome: new perspectives

“…Laparoscopic ventral mesh rectopexy has gained popularity in Europe as a treatment for full-thickness external and internal rectal prolapse. This procedure has been shown to achieve acceptable anatomical results with low recurrence rates, few complications, and improvements in both constipation and fecal incontinence [41,42]. Recently, Lundby et al commented on this technique saying that: (1) Only level 3 evidence exists; (2) special attention should be paid to possible mesh-related complications and long-term sequelae that could have a significant impact on quality of life; and (3) a clear correlation between surgical correction of the anatomical abnormalities and improvement in obstructed defecation syndrome has not been demonstrated [43].…”

The Role of Synthetic and Biologic Materials in the Treatment of Pelvic Organ Prolapse

“…This is believed to be due to autonomic denervation incurred during posterior mobilization as well as division/ligation of the lateral stalks. 61 While dissection of the lateral stalks of the rectum has been associated with decreased recurrence rates, Varma et al recommends preservation of the rectal stalks. This recommendation came with the caveat that an increase in recurrence rates would be expected with this practice.…”

“…Frequently, diastasis of the levator ani, an abnormally deep cul-de-sac, a redundant sigmoid colon, a patulous anal sphincter, and/or the loss of rectal sacral attachments are present. [1][2][3][4] Enterocele, rectocele, rectal prolapse, and total pelvic organ prolapse are benign conditions, which cause significant morbidity including pelvic discomfort, chronic drainage of blood, and/or mucous from the anus as well fecal incontinence and constipation and obstructed defecation symptoms. [5][6][7][8][9] The development of pelvic organ prolapse is multifactorial.…”