title: Perineal sigmoidopexy utilizing transanal endoscopic microsurgery (TEM) to treat full thickness rectal prolapse: a feasibility trial in porcine and human cadaver models.
abstract: BACKGROUND
  Perineal approaches for rectal prolapse repair have low complication rates but high recurrence rates, while abdominal approaches that include sigmoidopexy have lower recurrence rates but higher complication rates. To optimize both recurrence and complication rates, we developed a novel procedure that uses transanal endoscopic microsurgery (TEM) to perform a sigmoidopexy via a perineal approach.
  
  
  METHODS
  We created a rectal prolapse model in six swine and two human cadavers using a previously published technique. The rectum was mobilized and eviscerated transanally. After marking the planned point of sigmoid transection, the rectum was returned to the peritoneal cavity. A TEM proctoscope was inserted transanally alongside the rectum, and the lateral sigmoid colon walls were sutured to the sacrum. The sigmoid colon was then transected where previously planned, and a primary sigmoid anastomosis was performed. Total operative time, sigmoidopexy operative time, and suture security were measured and compared to standard rectosigmoidectomy and abdominal sigmoidopexy times.
  
  
  RESULTS
  No sigmoid colon, iliac vessel, bladder, or ureteral injuries occurred. At least two sigmoidopexy sutures were secure on inspection in all animals and human cadavers, with increasing success of secure suture placement as experience increased. Operative length was similar to traditional abdominal sigmoidopexy.
  
  
  CONCLUSIONS
  TEM sigmoidopexy is technically feasible. This approach has the potential to reduce the recurrence rate associated with perineal approaches alone, but further study is needed to confirm this hypothesis.
authors: Pelvic Floor Disorders Center, Division of Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA, lbordeianou@mgh.harvard.edu.
authors: Liliana
authors: L
authors: Bordeianou
authors: Patricia
authors: P
authors: Sylla
authors: Christine V
authors: CV
authors: Kinnier
authors: David
authors: D
authors: Rattner
mesh_terms: D000818:Animals; D002102:Cadaver; D012809:Colon, Sigmoid / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010502:Perineum / Q000601:surgery*; D012005:Rectal Prolapse / Q000175:diagnosis / Q000601:surgery*; D012720:Severity of Illness Index; D013536:Suture Techniques; D013552:Swine