Follow-up is planned at 1, 3, 6, 12 months: we repeated the questionnaire regarding pelvic organ prolapse disorders, clinical evaluation, ODS and fecal incontinence selleck chem Nilotinib scores. We repeated Cinedefecography 3 months after surgery. The study program follows all patients for at least 1 year, final data are under review and statistical analysis, however the preliminary results, are very interesting. Laparoscopic surgical technique We treated all patients before surgery with enema the same day of the operation and antibiotic prophylaxis (2 g Cephalosporin). General anesthesia was necessary in all cases. We placed the patient in lithotomy position with both arms near the body and the thighs spread moderately and bent upwards.
After appropriate preparation and draping, we introduced a Foley catheter in the bladder and a circular anal dilator (CAD) of PPH kit (Ethicon Endo Surgery) through the anus and we fixed it by four stitches. We assessed the extent of rectal prolapse through a gauze mounted on a Klemmer clamp. The ��quipe position was: surgeon on the right side of the patient, first assistant to the left side of the surgeon, second assistant between patient��s legs. The pneumoperitoneum was established via subumbelical open technique, and a 30�� laparoscope was introduced. One 10 mm trocar was inserted under vision into the cross-between umbilical-transverse line in the right side and another 5 mm trocar was inserted symmetrically in the left side. The procedure included the following steps: Peritoneum cavity exploration and patient in Trendelenburg (30�� degrees).
A vaginal valve was pushed up the anterior fornix for adequate exposure into the pelvic peritoneum. Using a 30��30 cm Prolene mesh (Ethicon J&J), V-shaped 25 cm length strips and 2 cm wide were prepared. The mesh was introduced into the abdominal cavity through 10 mm trocar; 2-cm incision of the peritoneum, in the apex of the anterior vaginal fornix was made and the mesh was fixed by a n. 0 prolene stitch on the anterior vaginal vault or on the vaginal apex if the patient had hysterectomy. On the right side, a 2-cm cutaneous incisions were made 2 cm above and 2 cm posteriorly to the anterior superior iliac spine. The aponeurosis of the external oblique muscle was incised and dissociating the fibers of the internal oblique and transverse abdominus muscles by scissors, the sub-peritoneum was reached. Through this incision a long Klemmer was introduced, Cilengitide and we can follow it through the transparency of peritoneum. With this clamp, under laparoscopic vision a subperitoneal tunnel is practised until you reach the anterior fornix of the vagina. The tunnel passes 2 cm above the peritoneal reflection, 2-3 cm below the insertion of the round ligament in the internal inguinal orifice.