V78 - Robotic ventral rectopexy, sacrocolpopexy with ventral rectal plication for rectocele with severe enterocele

CME Eligible

Purpose/Background: Enterocele refers to herniation of peritoneal contents in the posterior cul-de-sac below the PCL and into the rectovaginal space. Depending on the contents of the hernia sac, it may be more accurately described as an enterocele, peritoneocele and sigmoidocele. When a posterior vaginal bulge is detected with symptoms, surgical repair is considered. Although there were many surgical options, there was no definite treatment. It is stronger to elevate the normally horizontal vaginal axis toward a vertical direction with or without mesh than tissue repairs. This case demonstrates how effective vertical direction correction can be achieved by simultaneously correcting mid-to-posterior compartment pelvic organ prolapse using robotic sacrocolpopexy and ventral rectopexy with rectal plication in a patient with symptomatic rectocele and severe enterocele.

Methods/Interventions: A 79-year-old female patient visited our hospital with symptoms of a palpable vaginal mass and defecation difficulty using pressing on the perineum. Preoperative physical examinations including MR defecography and pelvic floor 3D ultrasound revealed POP-Q, grade I cystocele, 3cm sized rectocele along with severe enterocele. At. MR defecography, H-line, M-line were 7.9, 4.9 cm moderately increased and enterocele was severely increased at 9.7 cm.

Results/Outcomes: This patient underwent robotic assisted sacrocolpopexy and ventral rectopexy with rectal plication. The operation time was 195 minutes, blood loss was 50cc, and it was completed without any special events. She was discharged 4 days after surgery and had no unusual findings. After surgery, enterocele and rectocele was not observed at pelvic 3D ultrasound. At MR defecography scheduled one month later, there was no complication and enterocele ans rectocele was not observed. The postoperative defecation score (obstructive defecation score, 12 to 4 and Wexner constipation score, 8 to 0) were reduced.

Conclusion/Discussion: Robotic-assisted sacrocolpopexy, ventral rectopexy with rectal plication is effective in fixing mid-to-posterior pelvic organ prolapse that descends during defecation, and rectal plication reinforces the sagging of the rectovaginal septum.

Therefore, robotic assisted sacrocolpopexy, ventral rectopexy with rectal plication is safe and can be an effective surgical option for patients who has mid-to-posterior pelvic organ prolapse.