Rectopexy

For Rectal prolapse

Rectal mobilisation and fixation to sacrum with either sutures or mesh.

• Posterior
  • Ivalon sponge (Wells’ procedure
  • Fascia lata (Orr Loygue operation)
  • Non-absorbable mesh
• Anterior
  • Anterior mesh slingaround rectum to sacrum (Ripstein’s procedure)
  • Ventral mesh rectopexy (VMR)
• Resection rectopexy (Frykman Goldberg procedure)
  • Sigmoid colectomy with handsewn or stapled anastomosis at sacral promontory.
• Can get worsening constipation, evacuatory difficulties or faecal incontinence following abdominal rectopexy.
• Division of lateral ligaments associated with lower recurrence rates but inconclusive on outcomes of postoperative constipation.

Laparoscopic

• Fewer complications and shorter LOS Ventral mesh vs posterior suture
• No difference in recurrence rates, functional outcomes or complication rates.
• Increased colonic transit time for both, but significantly higher for posterior suture Recurrence:
• Limited evidence on best approach.

Laparoscopic ventral mesh rectopexy

• Laparoscopic approach with dissection along the right lateral aspect of the rectum
• Create a plane between the rectum and the vagina.
• Piece of mesh is sutured onto the front of the rectum, and side of the rectum.
• The top of the mesh is sutured to the top of the sacral promonentry which hitches the rectum up.
• Benefits – avoid posterior and lateral dissection which avoids dissection of the parasympathetic nerves (involved in rectal distension sensation)
• Non-absorbable polypropylene mesh is used.