Anterior vaginal prosthetic suspension (POPS), Douglas obliteration and transanal rectal resection (TRANSTAR) in severe tricompartimental prolapse correction
Autori: MONGARDINI M. - URCIUOLI P. - GIOFRÈ M. - BRUNELLI D. - DEGLI EFFETTI E. - KARPATHIOTAKIS M. - FEBBRAIO 2011
Università degli Studi di Roma "La Sapienza" – Dipartimento di Scienze Chirurgiche – Azienda Policlinico Umberto I – ROMA
The main causes of recurrent pelvic prolapse after corrective surgery are related to a lot of factors (chronic pathological increases in intra-abdominal pressure, impaired healing processes, surgical techniques, etc.). The use of synthetic mesh in pelvic floor reconstructive surgery seems to guarantee its reliability, especially when autologous tissue is of poor quality or insufficient quantity.
The abdominal anterior colpopexy is one of the most successful operations for complex pelvic floor prolapse with excellent results. In this case Antonio Longo planned a corrective procedure consisting of anterior laparoscopic mesh colpopexy (POPS) associated with transanal rectal resection (STARR) in selected cases of women with tricompartimental prolapse: it involves suturing a synthetic mesh that connects and supports vagina and uterus to the aponeuroses of the right and left abdominal muscles in trans pre-peritoneal way. Our experience, although limited, has shown a success of this procedure and an optimal resolution of referred symptoms.
We present our POPS-TRANSTAR procedure and Douglas obliteration (open technique and Pfannenstiel incision) for an unusual case of rectal prolapse and outlet obstruction in a 67 year old female worsened by severe tricompartimental pelvic floor prolapse, rectocele (> 7 cm), anterior peritoneocele (> 10 cm), cystocele and colpo-histerocele.