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Published on: February 12, 2022
Laparoscopic Rectopexy for Neorectal Prolapse after Robot-Assisted Intersphincteric Resection for Low Rectal Cancer:
Yuzo Harada1, Shigenobu Emoto1, Hiroaki Nozawa1
1Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Introduction:
Intersphincteric resection (ISR) is a sphincter-preserving procedure for lower rectal cancer; however, it can cause neorectal prolapse. Transanal repairs are commonly described but may fail, while transabdominal approaches are less frequently reported because of adhesions, bowel injury, and stoma risks. We present a patient with neorectal prolapse after robot-assisted ISR in whom transanal repair failed and subsequent laparoscopic rectopexy achieved a successful outcome, with a review of the literature.
Case Presentation:
A 72-year-old male patient underwent robot-assisted partial ISR with an ileostomy for lower rectal cancer. Neorectal prolapse and a posterior subcutaneous bulge appeared 1 month after surgery. Despite transanal repair using the Delorme procedure, 18 months after the initial surgery, the prolapse recurred within 1 month. Therefore, a laparoscopic rectopexy was performed. Adhesions around the neorectum were lysed, and the mobilization of the bowel was achieved until the anal canal. After confirming that cranial traction resolved both the neorectal prolapse and the bulge, a mesh was placed behind the bowel, and the seromuscular layer was fixed to the mesh and pelvis. The postoperative course was uneventful and no recurrence was observed during the 6-month follow-up.
Conclusions:
Although transanal repair is commonly performed after ISR due to concerns regarding adhesions and bowel injury, this case suggests that laparoscopic fixation can be effective in selected patients.
