[Vaginal prolapse and rectal obstruction. Treated with a vaginal vault mesh colpo suspension and laparoscopic resection rectopexy].
BACKGROUND
Stool outlet obstruction with incomplete or complete rectal prolapse combined with vaginal vault prolapse is a severe form of pelvic floor insufficiency. Combining laparoscopic resection rectopexy with a vaginal vault mesh colpo suspension is a possible way of correcting this defect.


METHODS
The safety of the combination was evaluated in 18 patients.


RESULTS
The procedure was performed successfully with no complications in 16 of the 18 patients. One patient suffered intraoperative rectal injury and therefore received no polypropylene mesh, and one showed intraoperative bleeding requiring transfusion. No secondary surgery was required. Hospital stay lasted an average of 11.4 days (range 8-20) and the urinary catheters could be removed after an average of 4.3 days (range 2-10). No urinary disturbances were noted at the time of hospital release. Short-term mild fever appeared in 28% of cases (5/18). There were two urinary tract infections. No disturbance in healing and no anastomotic insufficiency were observed. The duration of postoperative antibiotic therapy averaged 3 days (range 0-8).


CONCLUSIONS
The combination of laparoscopic resection rectopexy with a vaginal vault mesh colpo suspension might be safe. The close contact between the mesh and anastomosis might induce no increase in insufficiency. Long-term outcome must still be evaluated.
Grebe
M
M
Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg. m.grebe@uke.de
Thiel
B
B
Bley
K
K
Schwarz
N T
NT
D000328:Adult; D000368:Aged; D019841:Defecography; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000601:surgery*; D007443:Intussusception / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012002:Rectal Diseases / Q000175:diagnosis / Q000601:surgery*; D020047:Rectocele / Q000175:diagnosis / Q000601:surgery*; D013526:Surgical Mesh; D014596:Uterine Prolapse / Q000175:diagnosis / Q000601:surgery*