In patients with rectal prolapse, the incidence of concomitant uterine/vaginal prolapse is up to 38%. For these patients, addition of sacrocolpopexy to rectopexy may be appropriate.  There is no difference in operative morbidity when adding sacrocolpopexy to a rectopexy procedure. It is a safe procedure, with low risk for recurrence, improves bowel function and quality of life in most patients. This video aims to show the surgical laparoscopic treatment of a patient with stage IV genital prolapse combined to rectal prolapse.

Patient: 61yo female, reporting vaginal bulging and “tumor” in the anal region for a year. When evaluated by pelvic organ prolapse quantification (POP-Q) it was evidenced: Ba +6, C +7, Bp +6, D +6, GH 5, PB 3 and TVL 8 associated with a total rectal prolapse. There was no urinary leakage during stress maneuvers even with reduction of genital prolapse. Patient presented glandular cell atypia on oncotic colpocytology. Facing diagnosis of stage IV uterine prolapse and rectal prolapse, surgical proposal was laparoscopic total hysterectomy and bilateral salpingoophorectomy with sacrocolpopexy and rectopexy with handmade polypropylene mesh plus perineoplasty and anal sphincter pexy, which was performed on 12/02/20 at Vila Nova Cachoeirinha Maternity Hospital.

The patient had a successful postoperative evolution with the correction of both prolapses, without complaints and evolving with de novo urinary incontinence, which was corrected successfully with transobturatory midurethral sling.

Colposacropexy and rectopexy with handmade polypropylene mesh performed in a single procedure is a minimal invasive surgical option in combined advanced rectal and genital prolapse.

Yusuke Watadani, M.D.  • Sarah A. Vogler, M.D.  • Jeffrey S. Warshaw, M.D. Taijiro Sueda, M.D. Ann C. Lowry, M.D.  • Robert D. Madoff, M.D. Anders Mellgren, M.D., Ph.D.; Sacrocolpopexy With Rectopexy for Pelvic  Floor Prolapse Improves Bowel Function and  Quality of Life
Cristina B. Geltzeiler & Elisa H. Birnbaum & Matthew L. Silviera & Matthew G. Mutch & Joel Vetter & Paul E. Wise & Steven R. Hunt & Sean C. Glasgow; Combined rectopexy and sacrocolpopexy is safe for correction of pelvic organ prolapse