Question

A 60-year-old lady presents with complete rectal prolapse.
Current status of laparoscopic ventral mesh rectopexy in the management of rectal prolapse.

Hint:

Laparoscopic ventral mesh rectopexy offers an effective, minimally invasive option for the treatment of rectal prolapse, with better recovery times and lower recurrence rates compared to traditional surgery.

Answer 1

Laparoscopic ventral mesh rectopexy (LVMR) is a minimally invasive surgical technique that has gained popularity in the management of rectal prolapse. It is known for its excellent outcomes in terms of prolapse reduction and minimal complications.
Step 1: Surgical Technique:
LVMR involves the fixation of the rectum to the sacrum via a mesh inserted through a laparoscopic approach. The mesh is placed on the ventral side of the rectum, which helps to prevent further prolapse. The procedure involves minimal dissection and has a lower complication rate compared to traditional abdominal approaches.
Step 2: Advantages of Laparoscopic Ventral Mesh Rectopexy:
1. Minimally Invasive: The laparoscopic approach reduces postoperative pain, results in smaller incisions, and leads to shorter hospital stays.
2. Lower Recurrence Rate: Studies have shown that LVMR has a lower recurrence rate compared to traditional open rectopexy and perineal approaches.
3. Faster Recovery: The minimally invasive nature of the procedure allows for faster recovery times and quicker return to normal activities.
4. Improved Cosmetic Outcomes: Smaller incisions reduce scarring and improve the cosmetic outcomes for the patient.
Step 3: Potential Complications:
1. Mesh Complications: Although rare, complications such as mesh infection, mesh erosion, or displacement can occur.
2. Bowel Dysfunction: Some patients may experience altered bowel function postoperatively, including constipation or fecal incontinence.
3. Injury to Surrounding Structures: There is a risk of injury to surrounding organs such as the bladder, uterus, or small bowel during the procedure.
Step 4: Clinical Outcomes and Long-Term Results:
LVMR has shown good clinical outcomes in terms of both functional improvement and anatomical correction. The procedure has a high success rate in reducing prolapse and improving quality of life, with a lower risk of recurrence compared to traditional approaches.
Step 5: Current Status:
LVMR is now considered a standard treatment for patients with rectal prolapse, especially those who are candidates for minimally invasive surgery. It is particularly beneficial for younger, healthier patients and those who prefer a laparoscopic approach. However, it is still important to select the appropriate patients, as not all cases of rectal prolapse are suitable for this approach.