Laparoscopic Rectovaginopexy for Neorectal Prolapse After Transanal Total Mesorectal Excision

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Excerpt

Transanal total mesorectal excision (TaTME) is a novel surgical approach to treat rectal cancers of the lower and mid rectum. The potential benefits of TaTME compared with laparoscopic total mesorectal excision include better access to the dissection planes of the distal rectum with improved oncological outcome and a decreased permanent stoma rate. However, the use of novel surgical approaches can result in novel types of complications.
As an example, we present the case of a female patient (75 years old) with a rectal prolapse after TaTME (for a pT3aN0 distal rectal cancer). Her low anterior resection syndrome (LARS) score deteriorated to major when the rectal prolapse was present. Because the LARS score was limited to minor without the prolapse present, and in shared decision making with the patient, a laparoscopic rectovaginopexy was performed.
At laparoscopy, the neorectum could easily be dissected out of its surroundings. Both the afferent loop of the side-to-end coloanal anastomosis and the posterior wall of the vagina could be suspended to the promontory with a mesh predominantly in a standard fashion.
Postoperative recovery was uneventful. Currently, 6 months after this procedure, the patient has returned to a minor LARS score again without signs of tumor recurrence. She is very satisfied with the outcome. See Video at https://www.youtube.com/watch?v=w-aFrZQoHqs&feature=youtu.be.

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