ASSOCIATION OF VENTRAL RECTOPEXY WITH MESH AND LAPAROSCOPIC SIGMOIDECTOMY: AN APPROACH OPTION FOR OBSTRUCTED DEFECATION SYNDROME IN RECTOCELE ASSOCIATED WITH SIGMOIDOCELE

Case Presentation A 72-year-old woman presented with a 5-year history of obstructed defecation syndrome. Initially diagnosed with rectocele, she was managed with laxatives, which provided good results at first. However, in the past six months, her symptoms worsened significantly, including severe difficulty passing stools, a sensation of blockage, and rectal heaviness despite the use of stimulant laxatives. Defecography revealed an enlarged rectocele measuring 5.5 cm and a sigmoidocele compressing the distal rectum. A laparoscopic abdominal surgery was planned, combining sigmoidectomy with ventral rectopexy due to the presence of sigmoidocele. The surgical procedure was performed using a 12 mm trocar in the right iliac fossa and 5 mm ports in the other quadrants. A reverse-J incision was made on the peritoneum from the promontory to the right of the rectum, reaching the peritoneal reflection and exposing the ligament of the sacrum. Dissection proceeded into the rectovaginal septum, separating the anterior rectal wall from the posterior vaginal wall down to the levator ani muscles. A coated composite mesh (Proceed®, 15x5 cm) was fixed to the anterior rectal wall with separate non-absorbable sutures (Ethibond 2-0®) at distal, mid, and proximal levels below the peritoneal reflection and to the vaginal apex. Approximately five Securestrap® staples secured the cranial portion of the mesh to the promontory. Sigmoid resection was performed along its wall, with lateral gutter mobilization to prevent devascularization and minimize tissue damage. A double-stapled colorectal end-to-end anastomosis was performed. The peritoneum was closed using a continuous V-Loc® suture to cover the mesh. The patient had an excellent postoperative course, with bowel movements resuming on the second day and discharge on the third day. At the 4-month follow-up, the patient was no longer using laxatives, evacuating daily with only dietary adjustments.

Discussion Ventral rectopexy was initially developed for rectal prolapse with the aim of reducing postoperative constipation (from 54% to 15%). Over the past 15 years, it has also been used for obstructed defecation syndrome caused by rectocele and intussusception, yielding good results. Sigmoidocele, though less commonly associated with other anatomical abnormalities, presents a challenging decision-making scenario. The technique modification in this case, combining sigmoidectomy with ventral rectopexy, may be a viable option to improve intestinal constipation in these patients.

Conclusion The combination of sigmoidectomy with ventral rectopexy using mesh may be an attractive surgical option for treating obstructed defecation syndrome associated with sigmoidocele.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025