Laparoscopic ventral mesh rectopexy for internal rectal prolapse

Internal rectal prolapse is when the lowest part of the bowel (rectum) telescopes on itself. It is more common in women who have had children but also happens in nulliparous women and in men. Factors related to the development of the condition are age, childbirth, constipation and straining. It may be associated with prolapse of other pelvic organs and some people may have a predisposition because of abnormalities in collagen. It is not life threatening but it can be a distressing and demoralising condition, with negative effects on quality of life. Symptoms include discomfort, pain, constipation, difficult evacuation (obstructed defaecation syndrome), faecal incontinence and discharge of mucus or blood. In women it can be associated with vaginal bulge (rectocele), painful intercourse, lower back pain, urinary dysfunction, and vaginal prolapse and enterocele.

Conservative treatment of internal rectal prolapse may include pelvic floor exercises and advice to improve defaecatory habits, reduce constipation and improve incontinence. These are often termed biofeedback or pelvic floor re‑training. Surgical treatment of internal rectal prolapse is classified into perineal (Delorme's operation) and abdominal procedures. Open abdominal surgery and laparoscopic procedures, with or without robotic assistance, use mesh or direct suturing and may involve resection of the sigmoid colon.

Laparoscopic ventral mesh rectopexy (LVMR) is done under general anaesthesia using keyhole surgery, in which 3 to 4 small incisions are made in the abdomen. The peritoneum over the rectum is dissected, exposing the muscle coat which is mobilised into the rectovaginal septum in females and the level of the seminal vesicles in males. The mesh is secured to the rectum anteriorly, as low as possible in the fascia, using sutures, and fixed to the sacral promontory with permanent sutures or small metal tacks. The peritoneum is closed over the mesh to prevent the bowel becoming trapped or adhering to the mesh. In women, LVMR may help control rectocele or enterocele associated with rectal prolapse.