Multimedia article. External pelvic rectal suspension (the express procedure) for internal rectal prolapse, with or without concomitant rectocele repair: a video demonstration.

Abstract

PURPOSE:

Internal rectal prolapse has been proposed as a cause of symptomatic rectal evacuatory dysfunction. Abdominal rectopexy, the standard surgical approach, has significant attendant risk and does not address any concomitant rectocele. This video was designed to demonstrate a novel surgical method that uses porcine collagen implants (Permacol), designed to correct internal rectal prolapse, with or without rectocele.

METHODS:

INCLUSION CRITERIA:

severe rectal evacuatory dysfunction refractory to maximal conservative therapy and full-thickness internal rectal prolapse impeding rectal emptying on defecography with or without associated functional rectocoele; normal colonic transit. Patients undergo comprehensive preoperative and postoperative symptomatic assessment and anorectal physiologic testing, including defecography. A crescenteric perineal skin incision allows development of the rectovaginal/rectoprostatic plane to Denonvilliers fascia, with rectal mobilization. A curved tunneller inserted via the perineal wound is guided retropubically to emerge through suprapubic wounds created on each side. Permacol T-strips are sutured to the anterolateral rectal wall bilaterally, upward traction exerted, and the stem of each T-strip is sutured to the suprapubic periosteum, suspending the rectum. Concomitant rectocele is repaired using a Permacol patch in the rectovaginal plane.

RESULTS:

Short-term results for the "Express" are encouraging with improvement in evacuatory and prolapse symptoms and concomitant anatomic improvement at defecography.

CONCLUSIONS:

This procedure promises to be an effective technique for managing patients with refractory evacuatory dysfunction secondary to internal rectal prolapse, with or without rectocele.

• Authors: Julia E Dench, S Mark Scott, Peter J Lunniss, Lee S Dvorkin, Norman S Williams
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 49 Issue 12 Pg. 1922-6 (Dec 2006) ISSN: 0012-3706 [Print] United States
• PMID: 17053866 (Publication Type: Interactive Tutorial)

Chemical References

• Permacol
• Collagen

Topics

• Collagen (therapeutic use)
• Digestive System Surgical Procedures (methods)
• Female
• Humans
• Rectal Prolapse (surgery)
• Rectocele (surgery)
• Surveys and Questionnaires
• Suture Techniques