ROBOTIC VENTRAL MESH RECTOPEXY FOR COMPLETE RECTAL PROLAPSE
EAES Academy. Armentano S. 07/05/22; 363117; P162
Serena Armentano
Contributions
Contributions
Abstract
Aims:
Complete rectal prolapse (CRP) , is defined as a full-thickness protrusion of the rectal wall through
the anus. The aim of treatment is to control the prolapse and relieve incontinence while preventing
constipation. Ventral mesh rectopexy has gained acceptance for the correction of CRP, with
minimal morbidity, low recurrence rate and postoperative constipation. The adoption of a robotic
assistance provides comparable results to a laparoscopic approach with additional technical
improvements,. We report a case of CRP successfully treated in our institution with a robotic
ventral mesh rectopexy
Methods:
A 80-year-old female otherwise healthy presented with severe constipation, with straining and
fecal incontinence, mucoid discharge and tenesmus. Physical examination revealed a complete 8
cm-lenght external rectal prolapse, associated with a severe hypotonia of internal sphincter.
Preoperative work-up included colonoscopy and anorectal manometry. The patient was considered
suitable for robotic ventral mesh rectopexy
Results:
A robotic daVinci Xi ventral mesh rectopexy was successfully performed. Critical steps of the
procedure are described. After port placement, the uterus was lifted and peritoneum was divided
starting from the sacral promontory; then the anterior rectal wall was fully mobilized from the
vagina reaching the pelvic floor, leaving posterior and lateral attachments and preserving nerves. A
titanium-coated light-weight polypropylene mesh (TiLoop®) was fixed to the anterior rectal wall
and to the presacral fascia. Finally, the peritoneum was closed overlying the mesh. There were no
intraoperative complications.
The patient was discharged on postoperative day 2 after an uneventful course. At 6-month follow-
up, the patient reported improvement of anal incontinence and had no further recurrence.
Conclusion:
In our experience robotic ventral mesh rectopexy demonstrated as a safe and feasible procedure for
the treatment of RP. Although current literature has not proven its superiority compared to
laparoscopic approach, this technique may facilitate some surgical steps (i.e., dissection in a narrow
pelvis, intracorporeal suturing and mesh fixation) improving surgeons’ performance.
Complete rectal prolapse (CRP) , is defined as a full-thickness protrusion of the rectal wall through
the anus. The aim of treatment is to control the prolapse and relieve incontinence while preventing
constipation. Ventral mesh rectopexy has gained acceptance for the correction of CRP, with
minimal morbidity, low recurrence rate and postoperative constipation. The adoption of a robotic
assistance provides comparable results to a laparoscopic approach with additional technical
improvements,. We report a case of CRP successfully treated in our institution with a robotic
ventral mesh rectopexy
Methods:
A 80-year-old female otherwise healthy presented with severe constipation, with straining and
fecal incontinence, mucoid discharge and tenesmus. Physical examination revealed a complete 8
cm-lenght external rectal prolapse, associated with a severe hypotonia of internal sphincter.
Preoperative work-up included colonoscopy and anorectal manometry. The patient was considered
suitable for robotic ventral mesh rectopexy
Results:
A robotic daVinci Xi ventral mesh rectopexy was successfully performed. Critical steps of the
procedure are described. After port placement, the uterus was lifted and peritoneum was divided
starting from the sacral promontory; then the anterior rectal wall was fully mobilized from the
vagina reaching the pelvic floor, leaving posterior and lateral attachments and preserving nerves. A
titanium-coated light-weight polypropylene mesh (TiLoop®) was fixed to the anterior rectal wall
and to the presacral fascia. Finally, the peritoneum was closed overlying the mesh. There were no
intraoperative complications.
The patient was discharged on postoperative day 2 after an uneventful course. At 6-month follow-
up, the patient reported improvement of anal incontinence and had no further recurrence.
Conclusion:
In our experience robotic ventral mesh rectopexy demonstrated as a safe and feasible procedure for
the treatment of RP. Although current literature has not proven its superiority compared to
laparoscopic approach, this technique may facilitate some surgical steps (i.e., dissection in a narrow
pelvis, intracorporeal suturing and mesh fixation) improving surgeons’ performance.
Aims:
Complete rectal prolapse (CRP) , is defined as a full-thickness protrusion of the rectal wall through
the anus. The aim of treatment is to control the prolapse and relieve incontinence while preventing
constipation. Ventral mesh rectopexy has gained acceptance for the correction of CRP, with
minimal morbidity, low recurrence rate and postoperative constipation. The adoption of a robotic
assistance provides comparable results to a laparoscopic approach with additional technical
improvements,. We report a case of CRP successfully treated in our institution with a robotic
ventral mesh rectopexy
Methods:
A 80-year-old female otherwise healthy presented with severe constipation, with straining and
fecal incontinence, mucoid discharge and tenesmus. Physical examination revealed a complete 8
cm-lenght external rectal prolapse, associated with a severe hypotonia of internal sphincter.
Preoperative work-up included colonoscopy and anorectal manometry. The patient was considered
suitable for robotic ventral mesh rectopexy
Results:
A robotic daVinci Xi ventral mesh rectopexy was successfully performed. Critical steps of the
procedure are described. After port placement, the uterus was lifted and peritoneum was divided
starting from the sacral promontory; then the anterior rectal wall was fully mobilized from the
vagina reaching the pelvic floor, leaving posterior and lateral attachments and preserving nerves. A
titanium-coated light-weight polypropylene mesh (TiLoop®) was fixed to the anterior rectal wall
and to the presacral fascia. Finally, the peritoneum was closed overlying the mesh. There were no
intraoperative complications.
The patient was discharged on postoperative day 2 after an uneventful course. At 6-month follow-
up, the patient reported improvement of anal incontinence and had no further recurrence.
Conclusion:
In our experience robotic ventral mesh rectopexy demonstrated as a safe and feasible procedure for
the treatment of RP. Although current literature has not proven its superiority compared to
laparoscopic approach, this technique may facilitate some surgical steps (i.e., dissection in a narrow
pelvis, intracorporeal suturing and mesh fixation) improving surgeons’ performance.
Complete rectal prolapse (CRP) , is defined as a full-thickness protrusion of the rectal wall through
the anus. The aim of treatment is to control the prolapse and relieve incontinence while preventing
constipation. Ventral mesh rectopexy has gained acceptance for the correction of CRP, with
minimal morbidity, low recurrence rate and postoperative constipation. The adoption of a robotic
assistance provides comparable results to a laparoscopic approach with additional technical
improvements,. We report a case of CRP successfully treated in our institution with a robotic
ventral mesh rectopexy
Methods:
A 80-year-old female otherwise healthy presented with severe constipation, with straining and
fecal incontinence, mucoid discharge and tenesmus. Physical examination revealed a complete 8
cm-lenght external rectal prolapse, associated with a severe hypotonia of internal sphincter.
Preoperative work-up included colonoscopy and anorectal manometry. The patient was considered
suitable for robotic ventral mesh rectopexy
Results:
A robotic daVinci Xi ventral mesh rectopexy was successfully performed. Critical steps of the
procedure are described. After port placement, the uterus was lifted and peritoneum was divided
starting from the sacral promontory; then the anterior rectal wall was fully mobilized from the
vagina reaching the pelvic floor, leaving posterior and lateral attachments and preserving nerves. A
titanium-coated light-weight polypropylene mesh (TiLoop®) was fixed to the anterior rectal wall
and to the presacral fascia. Finally, the peritoneum was closed overlying the mesh. There were no
intraoperative complications.
The patient was discharged on postoperative day 2 after an uneventful course. At 6-month follow-
up, the patient reported improvement of anal incontinence and had no further recurrence.
Conclusion:
In our experience robotic ventral mesh rectopexy demonstrated as a safe and feasible procedure for
the treatment of RP. Although current literature has not proven its superiority compared to
laparoscopic approach, this technique may facilitate some surgical steps (i.e., dissection in a narrow
pelvis, intracorporeal suturing and mesh fixation) improving surgeons’ performance.
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