Borsuk Daniel, Studniarek Adam, Gantt Gerald, Kochar Kunal, Marecik Slawomir
Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Pol Przegl Chir. 2019 Oct 10;91(5):34-37. doi: 10.5604/01.3001.0013.5069.
Rectal prolapse (RP) is often seen in patients over the age of fifty, particularly women. These patients frequently suffer from other concomitant pathologies like rectocele, sigmoidocele, cystocele, or even enterocele. Rectopexy with a mesh has been an established treatment for rectal prolapse. The utilization of the robotic system allows for a successful repair within a confined pelvic space, especially for precise suture placement when working with the mesh. A 77-year-old female presented with obstructed defecation syndrome (ODS) symptoms found to be caused by a progressive rectal prolapse. Her pre-operative ODS score was 9/20. Pelvic floor evaluation revealed concomitant rectocele and sigmoidocele. The patient was offered a robotic-assisted rectopexy with mesh placement to address the three concomitant pathologies. During the procedure, a posterior mesorectal mobilization with autonomic nerves preservation was performed to address the posterior leading edge of the prolapse. Subsequently, the vagina was separated from the anterior portion of the rectum and dissected down to the levator ani muscles and the perineal body. This allowed for the affixation of a polypropylene mesh to the anterior portion of the rectum. Anterior suspension of the mobilized rectum with the mesh addressed all three pathologies. No recurrence or complications occurred at two-year follow up. The patients ODS score decreased to 1/20.
直肠脱垂（RP）常见于50岁以上的患者，尤其是女性。这些患者常伴有其他合并症，如直肠膨出、乙状结肠膨出、膀胱膨出，甚至肠膨出。使用补片的直肠固定术一直是治疗直肠脱垂的既定方法。机器人系统的应用使得在有限的盆腔空间内能够成功进行修复，特别是在使用补片时进行精确的缝线放置。一名77岁女性因进行性直肠脱垂出现排便梗阻综合征（ODS）症状。她术前的ODS评分为9/20。盆底评估显示合并直肠膨出和乙状结肠膨出。该患者接受了机器人辅助的直肠固定术并放置补片，以解决这三种合并症。手术过程中，在保留自主神经的情况下进行直肠后系膜游离，以处理脱垂的后缘。随后，将阴道与直肠前部分离，并向下解剖至肛提肌和会阴体。这使得能够将聚丙烯补片固定在直肠前部。用补片对游离的直肠进行前路悬吊解决了所有三种病症。两年随访时未出现复发或并发症。患者的ODS评分降至1/20。
