Laparoscopic low ventral rectocolpopexy (LLVR) for rectal and rectogenital prolapse: surgical technique and functional results.

BACKGROUND: Laparoscopic ventral rectopexy limits the risk of autonomic nerve damage, and the colpopexy allows correction of a concomitant prolapse of the middle compartment. The aim of this study is to describe a modified laparoscopic ventral rectocolpopexy procedure with a low approach to the sacral hollow (laparoscopic low ventral rectocolpopexy: LLVR). We propose this technique to manage combined rectogenital prolapse. METHODS: Between November 2006 and June 2009, all patients with symptomatic rectal prolapse associated with genital prolapse and/or enterocele underwent LLVR. Demographics, results of imaging studies, mortality, morbidity, and functional outcome were retrospectively analyzed. RESULTS: Thirty patients underwent LLVR: two patients suffered from a full-thickness rectal prolapse while 28 had symptomatic recto-anal intussusception. The mean operating time was 94 ± 39 minutes. Conversion to laparotomy was never needed. Hospital stay ranged between 2 and 14 days (mean of 5 ± 2.5 days). No mortality was recorded and only two complications occurred (6.6%): one trocar site incisional hernia and one vaginal suture erosion in a patient who had concomitant hysterectomy. After a mean follow-up of 13.9 months, constipation was completely resolved or improved in 92.8% patients. Significant reduction in the mean Altomare obstructed defecation score (14.7-5.6; p < 0.05) was recorded. Preoperative incontinence improved after the procedure in all patients affected. No new cases of postoperative constipation or fecal incontinence were registered. Only one case of recurrence in a patient with recto-anal intussusception was recorded (3.4%), after 19 months. CONCLUSIONS: Laparoscopic low ventral rectocolpopexy is safe and associated with very low morbidity. In the medium term, it provides good result for prolapse and associated symptoms.

[Pilonidal cysts and fistulas: radical excision "en bloc" and closure "per primam"]. / Cisti e fistole pilonidali: escissione radicale "en bloc" e chiusura "per primam".

For the radical surgical treatment of pilonidal cysts and fistulas, the authors suggest the excision "en bloc" of the complete pathological tissue and the primary closure, according to a procedure which considers not only a accurate surgical technique and a kind of dressing which avoids pressure and traction on the sutures, but also a s.t. antibiotic prophylaxis based on culture tests. This kind of approach in surgical treatment showed according to their experience, excellent immediate and long term results, causing slight inconvenience to patients, with a short recovery with regard to cases treated without primary closure.