title: Endoscopic fixation of the rectum for rectal prolapse: a feasibility and survival experimental study.
abstract: BACKGROUND
  In recent years, there has been considerable interest in developing technology as well as techniques that could widen the therapeutic horizons of endoscopy. Rectal prolapse, a benign localized condition causing considerable morbidity, could be an excellent focus for new endoscopic therapies. The aim of this study was to assess the feasibility and safety of endoluminal fixation of the rectum to the anterior abdominal wall, after pushing it up inside the body, using an in vivo animal model.
  
  
  METHODS
  We performed an in vivo comparative surgical study in a porcine model, including laparoscopic mobilization of the rectum and posterior rectopexy (standard surgical method) or endoluminal tacking of the rectum. After proving feasibility in ex vivo and acute studies, we performed a survival study to evaluate the safety of endoluminal tacking of the mobilized rectum to the anterior abdominal wall. The main outcome measures were successful completion of the tasks, maintenance of the fixation, complications associated with the methods, and survival studies including histopathological examinations of the fixation sites.
  
  
  RESULTS
  There were two groups: laparoscopic rectopexy (8 animals) and endoluminal fixation of the rectum to the anterior abdominal wall (10 animals). There were no differences between these two groups in their postoperative recovery. The group with the endoluminal fixation was found to have adequate attachment of the rectum to the anterior abdominal wall (measured attachment pressure in the endoluminal group = 6.06 ± 0.52 ft-lb, in the control group = 4.86 ± 2.00 ft-lb) on both gross and microscopic evaluation.
  
  
  CONCLUSIONS
  Endoscopic fixation of the mobilized rectum is feasible and safe in this model and in the future may provide an effective alternative to current treatment options for rectal prolapse.
authors.affiliation: Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. kivanova@med.cornell.edu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Milsom
authors.forename: Koiana
authors.initials: K
authors.lastname: Trencheva
authors.forename: Raghava
authors.initials: R
authors.lastname: Pavoor
authors.forename: Joseph
authors.initials: J
authors.lastname: Dirocco
authors.forename: Parul J
authors.initials: PJ
authors.lastname: Shukla
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kawamura
authors.forename: Toyooki
authors.initials: T
authors.lastname: Sonoda
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D034421:Sus scrofa