Laparoscopic rectopexy for recurrent rectal prolapse after laparoscopic intersphincteric resection : A case report Shigetake ZENITANI 1 , Masahisa OHTSUKA 1 , Kazuya IWAMOTO 1 , Atsushi NAITO 1 , Mitsunobu IMASATO 1 , Hiroki AKAMATSU 1 1Department of Surgery, Osaka Police Hospital Keyword: 直腸脱 , ISR , 直腸固定術 pp.292-297
Published Date 2021/7/15
DOI https://doi.org/10.11477/mf.4426200918
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 [Aims] We report an elderly woman who underwent laparoscopic rectopexy for recurrent rectal prolapse after laparoscopic intersphincteric resection (Lap-ISR) for lower rectal cancer. [Patient] An 83-year-old woman presented to our hospital with recurrent rectal prolapse after lap-ISR. She had received neoadjuvant chemoradiotherapy prior to lap-ISR with left pelvic side-wall lymph node resection for lower rectal cancer. One year after lap-ISR, she developed rectal prolapse and underwent a Gant-Miwa/Thiersch procedure at another hospital. However, despite using a perineal approach, her rectal prolapse recurred. [Results] We decided to perform a laparoscopic rectopexy. Postoperative intraperitoneal adhesions around the rectum were not severe, except at the posterior rectal wall and pelvic surface of the sacrum. We therefore chose a laparoscopic suture rectopexy rather than our usual method with a mesh. After peeling off the adhesions around the rectum as much as possible, we pulled out the rectum in the intersphincteric space and then fixed the mesorectum to the presacral fascia using monofilament string. The operating time was 123 minutes and there were no intraoperative complications. The patient was discharged on the 8th postoperative day. She has no recurrence 5 months after surgery and no symptoms such as incontinence. [Conclusions] Laparoscopic rectopexy is a challenging technique in such cases, but it should be considered because of its minimally invasive nature.

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