EP338 - Natural Orifice Ventral Suture Rectopexy – A Viable Alternative in High Risk Patients.

Sunday, May 11, 2025

9:00 AM – 9:05 AM PT

Location: Monitor 8. Sails Pavilion, Upper Level

ePoster Presenter(s)

AC

Abhijit Chandra, MD, MCh

Head of the department, Surgical gastroenterology
King George's Medical University
King George Medical University,KucknowIndia
Lucknow, Uttar Pradesh, India

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AM

ARUN Manoharan, n/a

Senior Resident
KGMU LUCKNOW
puducherry, Puducherry, India

Disclosure information not submitted.
JS

Julie Nishant Shah, n/a

Senior Resident
King George Medical University
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
DG

Deeban Ganesan, NA

Assistant professor
KGMU
Lucknow, Tamil Nadu, India

Disclosure information not submitted.
PR

Pritheesh Rajan, MS, MCh

Associate Consultant
Aster Medcity, Kochi
Kochi, Kerala, India

Disclosure information not submitted.
DS

Dhruv Sharma, n/a

Senior Resident
Delhi Medical council
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
RR

Ram Raj, MS

Senior Resident
King George's Medical University
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
AA

Akash Ramdeo Agrawal, n/a

Senior Resident
Department of Surgical Gastroenterology, KGMU
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
AD

Adiveeth Deb, NA

Senior Resident
KGMU, Lucknow
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
US

Utkarsh Srivastava, n/a

Assistant Professor
Surgical Gastroenterology, King George's Medical University, Lucknow
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.
RJ

Rohit JAIN JAIN, n/a

I have done MCh in surgical gastroenterology and I am more interested in colorectum.
King George Medical University
Lucknow, Uttar Pradesh, India

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Abhijit Chandra, MD, MCh, N/A: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Complete rectal prolapse leads to impaired quality of life, more so in the elderly. Its overall incidence is low but increases with age, being more common in the elderly females. Laparoscopic or robotic abdominal rectopexy, the current treatment of choice in the young is often not feasible in the elderly group due to coexisting morbidities. Perineal procedures being less morbid, are therefore often recommended in this high risk group, albeit with higher recurrences. An ideal operation in this subgroup should be minimally invasive, avoid general anesthesia, have low recurrence and good functional outcomes.

Methods/Interventions: Elderly patients having rectal prolapse deemed high risk for general anesthesia were included. Both subjective (St Marks score for incontinence, ODS score for constipation, a validated quality of life questionnaire) and objective parameters (sigmoidoscopy, anal manometry, MR defecogram) were assessed in all patients preoperatively. Our follow up protocol included assessment of subjective parameters at 6, 12 months and objective parameters at 1 month for all patients and where possible at 6/12 months.
The procedure is done under intravenous sedation in lithotomy with trendelenburg position. Initial suture is placed at the apex of prolapse, which served as a reference point for future luminal sutures once the prolapse is reduced using an indigenous endorectal fixator device. The retropubic space is expanded using hydroxyethylstarch under ultrasound guidance. Next, the anterior rectum is elevated within this space and fixed to the undersurface of anterior abdominal wall using percutaneous transfascial sutures under endosonographic vision.

Results/Outcomes: 18 patients (10 males, 8 females) with a mean age of 66 ± 11.2 years diagnosed with isolated complete rectal prolapse underwent the procedure. Their symptoms ranged from 7 months to 34 years. 14 patients had constipation and 4 had incontinence prior to the procedure. All patients had comorbidities making them unfit for general anesthesia. 4 patients had previously failed Delorme procedure. All patients have been followed till date with an average of 20 months. The mean hospital stay was 1.8 ± 0.5 days. There was no mortality or any significant morbidity. Anatomical correction of rectal prolapse was achieved in all patients. A significant improvement in SMIS, ODS scores and quality of life questionnaires were observed following surgery. Post-operative anal manometry showed improvement in anal resting and squeeze pressures. On follow up MR defecogram, decrease in anorectal descent and improvement in anorectal angles were observed. Three patients had surgical site infection which subsided with oral antibiotics. Three patients had partial recurrence of rectal prolapse, one of which was retreated by anterior fixation and two by anal encirclement.

Conclusion/Discussion: Current abdominal approaches in high risk elderly patients may not be possible due to associated comorbidities. This procedure avoids abdominal incisions, mesh placement and general anesthesia. Perineal procedures fail to fix the rectum, do not achieve anatomical correction, leading to higher recurrences. Our procedure addresses these concerns by fixing the prolapsed rectum anteriorly through its lumen (“perineal rectopexy”). Natural orifice ventral suture rectopexy is a viable option for fragile patients providing good functional outcomes and acceptable recurrences in short term.