Multimedia manuscript. Laparoscopic rectopexy with posterior mesh fixation

The purpose of this multimedia article is to present a technique of laparoscopic rectopexy with fixation of the rectum to the sacrum using a short strip of mesh.

The technique is presented in a video clip.

The laparoscopic rectopexy procedure is usually performed using four ports. First, the upper rectum is mobilized on its right side, and dissection posterior to the rectum is performed all the way down to the level of the pelvic floor. Anterior mobilization is performed next, and the rectovaginal septum is dissected all the way down to the level of the pelvic floor. A short strip of mesh, approximately 5 cm × 2 cm in diameter, is introduced through the right lower quadrant port. The mesh is placed vertically on the sacrum from the level of the sacral promontory downward, and secured to the sacrum using endo-tackers, which should be applied below the promontory and adjacent to the midline to avoid injury to the hypogastric nerves. The mesorectum is then secured to the mesh in four points using absorbable sutures. Applying adequate sutures directly to the presacral fascia using the relatively small needles that can go through the ports may be a difficult task. Suturing to the mesh, however, is very easy, and in our opinion may be considered the main advantage of the posterior mesh technique. Ten female patients (age range, 26-84 years) underwent rectopexy using this technique. At a mean follow-up of 2.2 years, two had recurrent prolapse-one of which, the only patient in whom absorbable tackers were used-had in-house recurrence and refixation. Complications included one patient with mild pelvic pain, which spontaneously resolved in 3 weeks.

The presented technique may ease fixation of the rectum to the sacrum and potentially improve results.