PFD Week 2018-Management of Recurrent Posterior Prolapse, Perineal Descent, and Defecatory Dysfunction in a Patient with a Prior Sacrocolpopexy: A Combined Repeat Sacrocolpoperineopexy and Modified Anterior Rectopexy Approach

Management of Recurrent Posterior Prolapse, Perineal Descent, and Defecatory Dysfunction in a Patient with a Prior Sacrocolpopexy: A Combined Repeat Sacrocolpoperineopexy and Modified Anterior Rectopexy Approach

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Video Transcription

Video Summary

The video discusses the management of recurrent posterior prolapse, perineal descent, and defecatory dysfunction in a patient with a previous sacrocolpopexy. The perineal body's importance in supporting the pelvic floor is highlighted, even in stage 4 prolapse. The patient’s medical history is explained, including a prior hysterectomy and sacrocolpopexy with mesh. The video then goes on to detail the procedure, which involved dissecting out the proximal arm of the mesh, wide mobilization of the rectum, plication of rectal tissue, attachment of a new mesh to the perineal body and posterior vaginal wall, and attachment of the rectal plication to the posterior aspect of the mesh. The procedure resulted in positive outcomes and the patient was discharged with no complications. No credits were provided. The key elements of the procedure include wide mobilization of the rectum, posterior plication, no levator plication, permanent sutures connecting the mesh to the perineum, and attachment of the posterior plication to the mesh.

Asset Subtitle

Sarah Huber, MD

Meta Tag

Category Pelvic Organ Prolapse

Category Surgery - Robotic Procedures

Keywords

recurrent posterior prolapse

perineal descent

defecatory dysfunction

sacrocolpopexy

perineal body