Transabdominal levatorplasty technique in laparoscopic mesh rectopexy for rectal prolapse

Rectal prolapse is characterized by a full-thickness intussusception of the rectal wall and is associated with a spectrum of coexisting anatomic abnormalities. We developed the transabdominal levatorplasty technique for laparoscopic rectopexy, inspired by Altemeier's procedure. In this method, following posterior mesorectum dissection, we expose the levator ani muscle just behind the anorectal junction. Horizontal sutures, using nonabsorbable material, are applied to close levator diastasis associated with rectal prolapse. The aim of the transabdominal levatorplasty is to (i) reinforce the pelvic floor, (ii) narrow the anorectal hiatus, and (iii) reconstruct the anorectal angle. We report a novel transabdominal levatorplasty technique during laparoscopic rectopexy for rectal prolapse. The laparoscopic mesh rectopexy with levatorplasty technique was performed in eight cases: six underwent unilateral Orr-Loygue procedure, one modified Wells procedure, and one unilateral Orr-Loygue procedure combined with sacrocolpopexy for uterine prolapse. The median follow-up period was 178 (33-368) days, with no observed recurrences. Six out of seven patients with fecal incontinence experienced symptomatic improvement. Although the sample size is small and the follow-up period is short, this technique has the potential to reduce the recurrence rate and improve functional outcomes, as with levatorplasty of Altemeier's procedure. We believe that this technique may have the potential to become an option for rectal prolapse surgery.