Rectal prolapse as a complication of transrectal NOTES in an experimental porcine model

Trindade, Anelise BonillaValente, Fernanda SoldatelliMorchbacher, Priscilla DominguesJunqueira, Amanda Moreira CezarCirne-Lima, Elzabeth ObinoGerardi, Daniel GuimarãesContesini, Emerson Antonio

Background: Rectal prolapse is the protrusion of one or more layers of the rectum through the anal sphincter. Some of the possible causes are tenesmus, endoparasitism and large bowel inflammation. Natural orifice transluminal endoscopic surgery (NOTES) consists of advanced techniques to gain access to body cavities through natural openings without skin incision. Different access routes may be used. However, transrectal NOTES has not been often reported. This paper reports a case of rectal prolapse after transrectal NOTES in a porcine model. Case: A healthy, female domestic swine underwent experimental peritoneoscopy through transrectal route. The animal weighed 20 kg and was approximately 90 days old. Under general anesthesia, a pneumoperitoneum was created and, after this, the rectal lining was pulled out and incised so that the endoscope could be introduced into the abdominal cavity. Subsequently, the cavity was deflated and the rectal wall was sutured under direct viewing with single-layer extramucosal sutures closed with 3-0 polyglactin 910 and simple continuous pattern in the muscular region and submucosa. There was edema of the rectal lining with a slight protrusion and was reduced manually. There was prolapse recurrence and a pursestring suture was placed around the anus. The suture ruptured about 72 h after the endoscopic procedure and self-mutilation of the perineal...(AU)

1. rectal access
2. rectal injury
3. scarless surgery
4. endoscopic surgery
5. peritoneoscopy