84 - Freie Mitteilung
17. Mai 2019, 08:15 - 09:45, Bellavista 5, 6. OG
Video: Combined laparoscopic mesh augmented ventral rectopexy and colposacropexy
D. C. Steinemann1, F. V. Angehrn1, M. von Flüe1, V. Geissbühler1, 2, Presenter: D. C. Steinemann1 (1Basel, 2Winterthur)
In patients with symptomatic multicompartment prolapse of the pelvic floor combined surgical and gynecological reconstruction is indicated. Sacrocolpopexy is the gold standard in the treatment of female genital prolapse and may be combined with ventral mesh augmented rectopexy.
In this instructive video we present our technique of combined laparoscopic ventral rectopexy and sacrocolpopexy using synthetic meshes. The 79-year old patient presented with combined fecal incontinence and obstructed defecation for anterior rectocele with rectoanal intussusception and enterocele. Furthermore urinary urge incontinence, voiding dysfunction and a bulging feeling because of a recurrent cystocele II and a vaginal prolapse II were reported. The patient underwent vaginal hysterectomy and anterior/posterior repair eight years before.
As a first step the peritoneum is opened beginning at the sacral promontory and continued on the right side of the rectum down to the pouch of Douglas. The rectovaginal septum is opened and the rectum is mobilized down to the pelvic floor. Afterwards the peritoneum over the anterior and posterior vaginal wall is cleared, and the bladder is mobilized distally from the anterior vaginal wall. A 3 cm wide strip of a polypropylene mesh is sutured to the extraperitoneal anterior rectal wall. Then another 3 cm wide strip of the polypropylene mesh is sutured to the anterior surface of the vagina under the bladder. After the two meshes are adjusted they are fixed to the medial anterior longitudinal ligament at the promontory using non-absorbable tackers. The peritoneum is closed using a absorbable self-locking suture completely covering both meshes. Six weeks after surgery the patient reported normal bowel movements without incontinence or obstructed defecation and absence of urinary incontinence while a moderate nycturia persisted.
In our experience combined laparoscopic ventral rectopexy and sacrocolpopexy is a safe procedure with low morbidity that is well tolerated also in elderly patients. The indication has to be based on symptoms and should be well balanced against conservative treatment and surgery without meshes. A great benefit is the correction of a multi-compartment pelvic floor prolapse as a single intervention.