A step-by-step approach to endorectal proctopexy (ERPP): how we do it

Area of Science:

• Colorectal surgery
• Pelvic floor disorders
• Gastroenterology

Background:

• Obstructed defecation syndrome (ODS) encompasses conditions like internal mucosal prolapse and rectocele.
• Surgical interventions are available, with perineal approaches favored in specific patient groups.
• Endorectal proctopexy (ERPP), or internal Delorme procedure, was previously described for ODS treatment.

Purpose of the Study:

• To detail the technical steps of ERPP for ODS using video aid.
• To evaluate the efficacy and safety of ERPP in a large patient cohort.

Main Methods:

• Retrospective analysis of 100 consecutive ERPP cases for ODS.
• Detailed description of the ERPP surgical technique.
• Assessment of outcomes including complication rates, symptom scores, and recurrence.

Main Results:

• Significant improvement in Cleveland Clinic Constipation Score and ODS score (median 18.9 to 5 and 18.5 to 5, respectively; p < 0.0001).
• Low anatomical recurrence rate of 6% at a mean follow-up of 36 months.
• Complications included suture line dehiscence (4%), bleeding (4%), and transient continence issues (12% urgency, 6% soiling).

Conclusions:

• ERPP is a safe and effective surgical option for ODS.
• The procedure offers good long-term functional outcomes and a low recurrence rate.
• ERPP should be considered a valuable tool in the management of pelvic floor disorders by colorectal surgeons.