Extraperitoneal Anterior Suture Rectopexy (EASR): Feasibility Study

Rectal prolapse even though less common causes significant morbidity to the patients. Surgery remains the only curative option for this disease. Ventral mesh rectopexy is the current standard of care but has its own limitations. We describe a novel technique to fix the rectum to the anterior abdominal wall. Seven patients having complete rectal prolapse were included. Both subjective (St Marks score for incontinence, obstructed defecation syndrome score for constipation) and objective parameters (sigmoidoscopy, anal manometry, magnetic resonance defecogram) were assessed in all patients preoperatively. Extraperitoneal space was created and expanded using standard techniques. The prolapsed rectum was reduced and brought inside the extraperitoneal space. Rectum was separated from the urinary bladder. Sutures were taken to fix the anterior wall of rectum to undersurface of abdominal wall. Seven patients (four males, three females) with a mean age of 36.14 (SD 16.3) years diagnosed with isolated complete rectal prolapse underwent the procedure. Four patients had constipation and two had incontinence. Follow-up was for an average of 83.5 (SD 4.6) days. There was no mortality or any significant morbidity. Anatomical correction of rectal prolapse was achieved in all patients. On follow-up, there was improvement in both subjective and objective parameters. None of the patients had recurrence. Laparoscopic extraperitoneal fixation of prolapsed rectum to anterior abdominal wall is safe and feasible. The procedure has good outcomes and no recurrence in the immediate postoperative period. However, long-term validation is required.