LAPAROSCOPIC VENTRAL RECTOPEXY (D'HOORE) FOR THE TREATMENT OF ACUTE RECTAL PROLAPSE POST-ABDOMINOPLASTY: A DEFINITIVE SOLUTION FOR AN UNEXPECTED PROBLEM

Case Presentation A 56-year-old woman underwent abdominoplasty. In the postoperative period, she experienced difficulty evacuating, and after 10 days, she presented with acute externalization of all layers of the rectal wall (rectal prolapse) measuring approximately 7 cm, which brought her to the emergency department. Manual reduction was performed, and she was admitted for clinical observation. During her next bowel movement in the hospital, she experienced another painful externalization, again requiring assisted manual reduction. A decision was made to perform laparoscopic ventral rectopexy with mesh. The most notable feature of this procedure was the significant reduction of the abdominal cavity caused by the prior abdominoplasty. A 12-mm trocar was inserted in the right iliac fossa, and three 5-mm ports were placed in the other quadrants. The peritoneum was incised at the anterior-lateral right peritoneal reflection in an inverted J shape. Dissection exposed the promontory and isolated the anterior ligament of the spine. The procedure continued through the rectovaginal septum, separating the anterior rectal wall from the posterior vaginal wall down to the pelvic floor (levator ani muscles). A covered polypropylene mesh (Proceed® 15×5 cm) was fixed to the anterior rectal wall with separate non-absorbable sutures (Ethibond 2-0®) at distal, middle, and proximal levels below the peritoneal reflection. The cranial portion of the mesh was secured to the anterior spinal ligament with Securestrap® staples. Additionally, the vaginal vault was pexed to the mesh. The patient had an excellent postoperative course, achieving normal bowel function from the second day onward without further externalization. She was discharged on the fourth postoperative day. Six months after the surgery, the patient has had no complaints of intestinal issues or prolapse recurrence.

Discussion Ventral rectopexy is currently widely accepted and utilized for managing rectal prolapse, becoming the most common abdominal procedure due to its excellent long-term outcomes, with a low recurrence rate of 8% over a 10-year follow-up. Functional outcomes are also favorable, with an 80% improvement in fecal incontinence and a reduction in constipation rates from 54% to 15%. Its use for acute rectal prolapse with incarceration has not been specifically described in the literature, making this case an innovative approach in this context.

Conclusion The D’Hoore technique proved to be a safe and definitive treatment for acute rectal prolapse caused by increased abdominal pressure following abdominoplasty.

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

Publication History

Article published online:
25 April 2025