Laparoscopic Ventral Mesh Rectopexy with Resection of Dolichocolon for Treatment of Obstructed Defecation Syndrome: Technical Report

Obstructed defecation syndrome may respond well to conservative treatment, yet some patients may need surgical intervention. The present report demonstrates the surgical treatment of a woman with obstructed defecation syndrome caused by anterior rectocele and internal rectal prolapse and associated with dolichocolon. A 39-year-old woman with a 5-year history of obstructed defecation syndrome caused by internal rectal prolapse and rectocele was investigated with anal manometry and defecography which confirmed the clinical diagnosis. The procedure entailed laparoscopic ventral mesh rectopexy to correct both internal rectal prolapse and anterior rectocele. In addition, since preoperative barium enema revealed the presence of a long redundant dolichocolon, resection of the sigmoid colon and creation of a stapled anastomosis were also performed. The patients' symptoms were assessed using Wexner constipation score before and after surgery. The operation time of the procedure was approximately 90 min. No intraoperative adverse events were recorded. On follow-up, no complications as anastomotic leak, mesh-related morbidities, or ileus were recorded. At 6 months of follow-up, the patient reported significant improvement in symptoms with a decrease in the Wexner constipation score from 17 preoperatively to 6 postoperatively. No affection of the sexual function or de novo dyspareunia was reported by the patient. Combining resection of sigmoid colon with laparoscopic ventral mesh rectopexy seems to be a feasible option for patients with obstructed defection caused by internal rectal prolapse and anterior rectocele with coexisting dolichocolon. Larger studies with longer follow-up are needed to ascertain this preliminary finding.