title: Resection rectopexy--laparoscopic neuromapping reveals neurogenic pathways to the lower segment of the rectum: preliminary results.
abstract: OBJECTIVE
  Nerve sparing in functional pelvic floor surgery is strongly recommended as intraoperative damage to the autonomic nerves may predispose to persistent or worsened anorectal and urogenital function. The aim of this study was to investigate the intraoperative neural topography above the pelvic floor in patients undergoing laparoscopic resection rectopexy in combination with electrophysiologic neuromapping.
  
  
  METHODS
  Ten consecutive female patients underwent laparoscopic resection rectopexy for rectal prolapse. Intraoperative identification of pelvic autonomic nerves was carried out with a novel intraoperative neuromonitoring system based on electric stimulation under simultaneous electromyography of the internal anal sphincter and manometry of the bladder. Neuromonitoring results were compared to patients' preoperative anorectal and urogenital function and their functional results at the 3-month follow-up.
  
  
  RESULTS
  Laparoscopy in combination with electrophysiologic neuromapping revealed neurogenic pathways to the lower segment of the rectum during surgical mobilization. In all procedures, intraoperative neuromonitoring finally confirmed functional nerve integrity to the internal anal sphincter and the bladder. Patients with preoperatively diagnosed fecal incontinence were continent at the 3-month follow-up. The Wexner score improved in median from preoperative 4 (range 1-18) to 1 (range 0-3) at follow-up (p = 0.012). Cleveland Clinical Constipation Score improved in median from 10 (range 5-17) to 3 (range 1-7; p = 0.005). In none of the investigated patients a new onset of urinary dysfunction did occur. No change in sexual function was observed.
  
  
  CONCLUSIONS
  Laparoscopy in combination with electrophysiologic neuromapping during nerve-sparing resection rectopexy identified and preserved neurogenic pathways heading to the lower segment of the rectum above the level of the pelvic floor.
authors: Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany. werner.kneist@unimedizin-mainz.de
authors: Werner
authors: W
authors: Kneist
authors: Daniel W
authors: DW
authors: Kauff
authors: Gert
authors: G
authors: Naumann
authors: Hauke
authors: H
authors: Lang
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000294:innervation; D052858:Cystocele / Q000601:surgery*; D004558:Electric Stimulation; D004566:Electrodes; D004576:Electromyography; D005242:Fecal Incontinence / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017773:Pelvic Floor / Q000294:innervation / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D012005:Rectal Prolapse / Q000601:surgery*; D020047:Rectocele / Q000601:surgery*; D012007:Rectum / Q000294:innervation* / Q000601:surgery*; D013153:Splanchnic Nerves / Q000293:injuries / Q000503:physiopathology*; D053825:Suburethral Slings; D001743:Urinary Bladder / Q000294:innervation; D014549:Urinary Incontinence / Q000503:physiopathology / Q000517:prevention & control; D014596:Uterine Prolapse / Q000601:surgery*