science

Ventral rectopexy

Ventral rectopexy is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Ventral rectopexy rather than just read about it. In short: Ventral rectopexy is a surgical procedure for external rectal prolapse, internal rectal prolapse (rectal intussusception), and sometimes other conditions such as rectocele, obstructed defecation syndrome, or solitary rectal ulcer syndrome. The rectum is fixed into the desired position, usually using a biological or synthetic mesh which is attached to the sacral promontory.

Key takeaways

Ventral rectopexy belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Ventral rectopexy to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Ventral rectopexy from memory before moving on to harder problems.

Reference excerpt

Ventral rectopexy is a surgical procedure for external rectal prolapse, internal rectal prolapse (rectal intussusception), and sometimes other conditions such as rectocele, obstructed defecation syndrome, or solitary rectal ulcer syndrome. The rectum is fixed into the desired position, usually using a biological or synthetic mesh which is attached to the sacral promontory. The effect of the procedure is correction of the abnormal descended position of the posterior compartment of the pelvis (i.e., the rectum), reinforcement of the anterior (front) surface of the rectum, and elevation of the pelvic floor. In females, the rectal-vaginal septum is reinforced, and there may be an opportunity to simultaneously correct any prolapse of the middle compartment (i.e., the uterus). In such cases, ventral rectopexy may be combined with sacrocolpopexy. The surgery is usually performed laparoscopically (via small openings made in the abdomen).

Background There are over 300 different variations of surgical procedures described for rectal prolapse, and this area has seen rapid development. However, there is no clear consensus regarding the best method. Surgical treatment for rectal prolapse may be via the perineal or abdominal (transabdominal/peritoneal) approach. Generally speaking, perineal procedures have less complications but higher rates of recurrence compared to abdominal procedures. Ventral rectopexy falls into the abdominal procedure category, and can be considered as a type of abdominal rectopexy. Abdominal rectopexy encompasses several procedures which involve mobilization and fixation of the rectum, with or without resection, via an abdominal surgical approach. Some of types of abdominal rectopexy are now rarely or never performed. For example, the Ripstein rectopexy (anterior fixation of mesh below the sacral promontory) and the Wells procedure (involving detachment of the lateral ligaments of the rectum) are not longer performed. Risks associated with abdominal rectopexy procedures include post-operative problems with defecation such as new or worsened constipation, obstructed defecation or fecal incontinence. In males, mobilization of the rectum may risk the development of erectile dysfunction. New or worsened constipation does not seem to be a significant problem with ventral rectopexy, which represents the most recent development of abdominal rectopexy. Another way of categorizing surgery for prolapse of pelvic organs is into suspensive or resective (involving removal of sections of the bowel wall) classifications. Ventral rectopexy alone is a suspensive type surgery, a category which also includes colposacropexy. Resection rectopexy additionally involves removal of a section of the sigmoid colon (sigmoidectomy). It is thought to have decreased post operative problems of constipation, because the redundant colon is removed and therefore cannot "kink". However, there is no evidence that this improves the outcomes, and the necessary creation of an anastomosis (surgically created joining between two ends of bowel when a section of bowel is removed) increases the risk of severe complications.

Orr-Loygue procedure (lateral mesh rectopexy) Ventral rectopexy with an autologous graft (fascia lata), and then with a synthetic mesh for external rectal prolapse was first reported in 1971. The Orr-Loygue procedure (lateral mesh rectopexy) was described in 1984. The Orr-Loygue procedure involved anterior and posterior mobilization of the rectum to the level of the levator ani muscle and removal of the pouch of Douglas. Mesh was sutured to the lateral surfaces (sides) of the rectum.

Ventral rectopexy Ventral rectopexy was developed as a modification of the Orr-Loygue procedure by D'Hoore in 2004. In ventral rectopexy, there is no posterior dissection and mobilization of the rectum apart from to expose the sacral promontory. With no posterior (dorsal) or lateral dissection, damage to the autonomic nerves is minimized. As a result, there are less problems with post-operative constipation. According to one source, there is no excision of the pouch of Douglas, but another source states that ventral mesh rectopexy results in elimination of the pouch of Douglas. The mesh is placed directly onto the anterior (ventral) surface of the rectum. This procedure aims to suspend the middle and lower sections of the rectum. This modified procedure is now known as the anterior rectopexy or ventral rectopexy. D'Hoore also used a laparoscopic approach (laparoscopic ventral mesh rectopexy, LVMR). After 2002, the minimally invasive trans-anal approach known as stapled trans-anal rectal resection (STARR) became popular for treating obstructed defecation syndrome. However, over time, there has been a general trend away from STARR towards abdominal rectopexy for surgical treatment of obstructed defecation syndrome. Ventral mesh rectopexy has become one of the most popular options for rectal prolapse. Ventral rectopexy also provides the opportunity to simultaneously correct any prolapse of the middle compartment of the pelvis, and is sometimes combined with sacrocolpopexy. Some have called for caution with regards to the rapid rise in popularity of ventral mesh rectopexy, citing lack of high quality evidence and concerns about long term efficacy and possible mesh related complications. One author described laparoscopic ventral mesh rectopexy as a possible "bandwagon" phenomenon because there has been overwhelming acceptance of the procedure, despite it being a relatively unproven idea which may eventually be proven valid, or may be abandoned in future.

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Worked examples

Example 1 — a first encounter with Ventral rectopexy

Start with the simplest possible case. Write down what Ventral rectopexy claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Ventral rectopexy before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Ventral rectopexy ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Ventral rectopexy

In research: Ventral rectopexy appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Ventral rectopexy in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Ventral rectopexy is common in secondary-school and first-year university syllabi. It links to neighbouring topics Colorectal surgery, Defecation, Digestive system surgery, so understanding it makes those chapters shorter.
In everyday life: Look for Ventral rectopexy outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Ventral rectopexy in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Ventral rectopexy means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Ventral rectopexy out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Ventral rectopexy in simple terms?

Why does Ventral rectopexy matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Ventral rectopexy?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Ventral rectopexy.