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腹腔镜治疗直肠外脱垂多次手术后复发:一例报告

Laparoscopic approach to recurrence following multiple surgeries for external rectal prolapse: a case report.

作者信息

Toda Kosuke, Aoyama Taro, Hirai Kenjiro, Uemura Taisuke, Fujita Haruku, Okabe Asami, Ohe Hidenori, Tachibana Tsuyoshi, Mitsuyoshi Akira

机构信息

Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan.

出版信息

Surg Case Rep. 2021 Mar 19;7(1):71. doi: 10.1186/s40792-021-01154-2.

Abstract

INTRODUCTION

The optimal procedure for recurrent external rectal prolapse remains unclear, particularly in laparoscopic approach. In addition, pelvic organ prolapse (POP) is sometimes concomitant with rectal prolapse. We present a case who underwent laparoscopic procedure for the recurrence of full-thickness external rectal prolapse coexisting POP.

CASE PRESENTATION

An 81-year-old parous female had a 10-cm full-thickness external rectal prolapse following the two operations: the first was perineal recto-sigmoidectomy and the second was laparoscopic posterior mesh rectopexy. Imaging study revealed that the recurrent rectal prolapse was concomitant with both cystocele and exposed vagina, what we call POP. We planned and successfully performed laparoscopic ventral mesh rectopexy (LVMR) with laparoscopic sacrocolpopexy (LSC) using self-cut meshes without any perioperative complication.

CONCLUSION

This is the first report of LVMR and LSC for recurrent rectal prolapse with POP following the perineal recto-sigmoidectomy and laparoscopic posterior mesh rectopexy. Even for recurrent rectal prolapse with POP, our experience suggests that LVMR and LSC could be utilized.

摘要

引言

复发性直肠外脱垂的最佳手术方式仍不明确,尤其是在腹腔镜手术中。此外,盆腔器官脱垂(POP)有时与直肠脱垂同时存在。我们报告一例因全层直肠外脱垂复发并伴有POP而接受腹腔镜手术的病例。

病例介绍

一名81岁经产妇,在接受了两次手术(第一次是会阴直肠乙状结肠切除术,第二次是腹腔镜后路补片直肠固定术)后出现了10厘米的全层直肠外脱垂。影像学检查显示,复发性直肠脱垂合并膀胱膨出和阴道外露,即我们所说的POP。我们计划并成功实施了腹腔镜前路补片直肠固定术(LVMR)和腹腔镜骶骨阴道固定术(LSC),使用自切割补片,未出现任何围手术期并发症。

结论

这是首例关于会阴直肠乙状结肠切除术和腹腔镜后路补片直肠固定术后复发性直肠脱垂合并POP行LVMR和LSC的报告。即使对于复发性直肠脱垂合并POP,我们的经验表明LVMR和LSC也可应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f775/7979842/e9faa4efff45/40792_2021_1154_Fig1_HTML.jpg

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