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2010 Annual Meeting Abstracts

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NOTES Rectosigmoidopexy Utilizing Transanal Endoscopic Microsurgery (TEM) to Treat Full Thickness Rectal Prolapse in a Porcine Model
*Liliana G Bordeianou, *Patricia Sylla, David Rattner
Massachusetts General Hospital, Boston, MA

Objectives: Perineal rectal prolapse repairs have low complications , but high recurrences. Abdominal rectopexy decreases recurrence, but complications rise. We developed a procedure that would combine the best of both by using TEM.
Design: Cadaver model
Setting: Large animal facility
Subjects: Five swine cadavers
Interventions: A surgical model of rectal prolapse was created by mobilizing rectum and puling it through the anus. The TEM proctoscope was then inserted into the peritoneal cavity trans-anally alongside the sigmoid. The distal sigmoid was identified and pulled towards the sacrum. 2-0 prolene sutures were placed through the TEM platform to secure the lateral walls of the sigmoid to the sacrum. The sigmoid was then handsewn to anus following rectal transection at premarked point.
Main Outcome Measures: Feasibility of procedure: as measured by completion rates, rates of injury to adjacent organs, quality of sigmoidopexy sutures.
Results: In the first two cadavers, three sutures were used to secure sigmoid to sacrum. In the next three two sutures were used. Mean length of resected bowel was 15 cm. No injuries to bladder, ureters or iliac vessels were caused. In first cadaver, one sigmoidopexy suture pulled out with ease upon inspection. In the second cadaver, the sutures were well attached to the sacrum, but attachment into the sigmoid wall pulled out easily. No complications with placement or security of rectosigmoidopexy sutures were encountered in the last three experiments. Thus, cumulative rate of successful placement of sutures was 83 %.
Conclusions: TEM equipment allows addition of sigmoidopexy to standard perineal rectosigmoidectomy and could perhaps reduce rates of recurrent rectal prolapse associated with the perineal approach.

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