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Laparoscopic Suture Rectopexy with Culdoplasty, Vaginal Wall Repair, and Perineorrhaphy for Rectal Prolapse

Marcus V. Ortega, MD1,2; Emily C. Von Bargen, DO1,2*; Liliana G. Bordeianou, MD1,3*

1Pelvic Floor Disorders Center, Massachusetts General Hospital, Boston, MA
2Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA
3Section of Colorectal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
*Operating Surgeons

1. Introduction

2. Surgical Approach and Laparoscopic Access

3. Reduce Bowel out of Pelvis

4. Preparation of Sacral Promontory for Sutures

  1. Locate Sacral Promontory
  2. Clear Sacral Promontory

5. Rectum Mobilization

  1. Lateral - Right
  2. Anterior
  3. Lateral Stalks - Right
  4. Lateral - Left
  5. Finish Posterior
  6. Review Dissection

6. Suture

  1. Approach
  2. Place Sutures
  3. Extracorporeal Tying

7. Review Progress

8. Approach to Culdoplasty

9. Culdoplasty

10. Reconstruct Pouch of Douglas

11. Finish Closing Peritoneum

12. Perineorrhaphy and Levator Plication

  1. Approach
  2. Inject Local Anesthetic
  3. Excise Epithelium
  4. Tag Apex
  5. Bring Together Levator Muscles
  6. Rebuild Perineal Body
  7. Close Epithelium
  8. Rectal Exam

13. Cystoscopy

14. Post-op Remarks