Recto (colpo, perineo) sacropexia ventral en el tratamiento del prolapso rectal y rectogenital / Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse

Introducción La sacrorrectopexia ventral con malla permite la corrección del prolapso rectal minimizando la disección del recto. La colpopexia posterior corrige los prolapsos apicales y posteriores de la vagina. La combinación de ambos procedimientos permite la corrección simultánea de los prolapsos de los órganos pelvianos (POP).Objetivo Presentar los resultados de una serie de pacientes con distintos tipos de POP tratados mediante la misma técnica quirúrgica. Material y método Entre enero de 2005 y agosto de 2008 intervinimos mediante una recto(colpo)sacropexia ventral a 57 pacientes diagnosticados de alguna forma de POP, que dividimos en tres grupos: grupo A, prolapso rectal total aislado o combinado con histerocele o colpocele (11 pacientes); grupo B, rectoenterocele con invaginación rectal interna y/o periné descendente (4 pacientes), y grupo C, prolapso genital del compartimento medio-posterior (42 pacientes). Se intervino por vía laparoscópica a los 15 pacientes de los grupos A y B y a 11 del grupo C. En 41 casos se empleó una malla biológica, y en los demás, una sintética macroporosa. Resultados La media de edad de la serie era 66 (19–81) años; 55 eran mujeres y 2, varones; la mediana de seguimiento fue 25 (4–48) meses). No hubo complicaciones postoperatorias mayores. En el grupo A registramos una recurrencia del prolapso (1/11); los 7 pacientes que presentaban incontinencia mejoraron tras la intervención; no se registró ningún caso de estreñimiento de novo y 8 de los 9 pacientes de los grupos A y B, con defecación obstructiva, mejoraron. En el grupo C se detectaron 9 (21%) recurrencias de alguno de los compartimentos vaginales, pero sólo 4 (9%) requirieron reintervención. En todas las recurrencias se había utilizado una malla biológica (..) (AU)

Introduction Ventral sacral-rectopexy with mesh corrects rectal prolapse and minimises rectal dissection. Subsequent colpopexy corrects apical and posterior prolapses of the vagina. The combination of both procedures can lead to the simultaneous correction of pelvic organ prolapses (POP). Objective To present the results of a patient series with several types of POP treated using the same approach and operation. Material and method A total of 57 patients diagnosed with any type of POP were operated on between January 2005 and August 2008 using ventral rectal-colpo-sacropexy, who were grouped into three types: A, total rectal prolapse isolated or combined with a hysterocele or colpocele (11 patients); B, rectoenterocele with internal rectal invagination and/or descending perineum (4 patients); and C, middle and posterior genital compartment prolapse (42 patients). The laparoscopic approach was used in the 15 patients of groups A and B and 11 from group C. A b iological mesh was used in 41 patients and a macroporous synthetic one in the rest. Results The mean age of the patients in the series was 66 (19–81) years, with 55 females and 2 males. The median follow up was 25 (4–48) months. There were no major post-surgical complications. A recurrence of prolapse was recorded in one patient in group A (1/11); the 7 patients who suffered from incontinence improved after the surgery, no case of de novo constipation being recorded and an improvement in 8 of the 9 patients from groups A and B with obstructive defaecation. There were 9 (21%) recurrences detected in group C, but only 4 (9%) required reintervention. In all the recurrences a biological mesh had been used. Conclusions Laparoscopic ventral rectal-colpo-pexy is an effective technique to correct POP. Although safe and innocuous, the results with biological meshes did not last as long (AU)

[Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse]. / Recto (colpo, perineo) sacropexia ventral en el tratamiento del prolapso rectal y rectogenital.

INTRODUCTION: Ventral sacral-rectopexy with mesh corrects rectal prolapse and minimises rectal dissection. Subsequent colpopexy corrects apical and posterior prolapses of the vagina. The combination of both procedures can lead to the simultaneous correction of pelvic organ prolapses (POP). OBJECTIVE: To present the results of a patient series with several types of POP treated using the same approach and operation. MATERIAL AND METHOD: A total of 57 patients diagnosed with any type of POP were operated on between January 2005 and August 2008 using ventral rectal-colpo-sacropexy, who were grouped into three types: A, total rectal prolapse isolated or combined with a hysterocele or colpocele (11 patients); B, rectoenterocele with internal rectal invagination and/or descending perineum (4 patients); and C, middle and posterior genital compartment prolapse (42 patients). The laparoscopic approach was used in the 15 patients of groups A and B and 11 from group C. A biological mesh was used in 41 patients and a macroporous synthetic one in the rest. RESULTS: The mean age of the patients in the series was 66 (19-81) years, with 55 females and 2 males. The median follow up was 25 (4-48) months. There were no major post-surgical complications. A recurrence of prolapse was recorded in one patient in group A (1/11); the 7 patients who suffered from incontinence improved after the surgery, no case of de novo constipation being recorded and an improvement in 8 of the 9 patients from groups A and B with obstructive defaecation. There were 9 (21%) recurrences detected in group C, but only 4 (9%) required reintervention. In all the recurrences a biological mesh had been used. CONCLUSIONS: Laparoscopic ventral rectal-colpo-pexy is an effective technique to correct POP. Although safe and innocuous, the results with biological meshes did not last as long.