V2-04: A Novel Robotic-Assisted Laparoscopic Repair of Posterior Compartment Prolapse: Treating Women with Defecation Dysfunction

Video

INTRODUCTION

Symptoms associated with posterior compartment prolapse greatly impact a woman&[prime]s quality of life. These symptoms include straining or splinting to defecate, incomplete emptying, and incontinence of feces or gas. Current surgical repair options aim to repair the rectocele, but do not routinely address the size and laxity of the rectum, which may also contribute to defecation symptoms.

METHODS

We present a demonstrative video of a robotic-assisted laparoscopic sacrocolpopexy and laparoscopic posterior colporrhaphy in a woman with a prior supracervical hysterectomy and subsequent robotic sacrocolpopexy with perineorrhaphy. Due to persistent defecation dysfunction combined with physical exam findings consistent with posterior compartment prolapse, the decision was made to proceed with surgical repair after the risks and benefits were discussed. The accompanying video demonstrates a plication using perirectal connective tissue and lightweight polypropylene &[Prime]Y&[Prime] mesh that is ultimately secured to the posterior colporrhaphy for additional support.

RESULTS

In the short-term, this novel procedure has proven effective in treating a small series of women with posterior compartment prolapse and defecation dysfunction. Those women included within our limited series report subjective improvement with regards to their original ailments of bowel dysfunction. No serious adverse events related to this surgical procedure occurred in the peri-operative period or during short-term follow up.

CONCLUSION

While longer follow-up is needed, the robotic-assisted laparoscopic sacrocolpopexy with laparoscopic posterior colporrhaphy represents a technically safe and feasible approach to treating women with posterior compartment prolapse and defecation dysfunction.

Funding: none