Laparoscopic-Modified Semi-Spiral Mesh Rectopexy for Rectal Prolapse

Background: Laparoscopic procedure for rectal prolapse has extend throughout the world as a minimally invasive treatment. Various techniques have been reported regarding the use of mesh, fixation, and rectal mobilization. However, a standard technique has not been established yet. Method: The original procedure of laparoscopic ventral mesh rectopexy was modified as described below. The posterior rectal cavity was dissected in proximity to the levator ani, and the lateral ligament was partially divided. After mobilization of the rectum, trimmed polypropylene mesh was placed on the ventral side of the upper rectum and fixed. The mesh was fixed in a semi-spiral shape along the long axis of the intestinal tract. Results: Fifteen patients underwent this procedure. The length of rectal prolapse were 5 (4-30) cm. The grade of rectal prolapse according to the Oxford Grading System was V in all patients. The median operative time and blood loss were 176 (range: 100-252) minutes and 0 (0-43) mL, respectively. No postoperative complications were observed in any of the patients. One patient experienced recurrence (6.7%). The remaining 14 patients did not experience recurrence during the follow-up period, which had a median of 54.5 months (range: 6-119 months). Conclusion: This modified laparoscopic semi-spiral mesh rectopexy may be considered for the surgical treatment of rectal prolapse.