Laparoscopic lateral suspension (uterus preservation) and ventral mesh rectopexy for the treatment of multi-compartment pelvic organ prolapse: surgical technique

The pelvic structures are anatomically and functionally interconnected, forming an integrated system. The diagnosis and management of multi-compartment pelvic organ prolapse (POP) often require multidisciplinary collaboration among urogynecologists, colorectal surgeons, and radiologists. Individualized surgical planning should be tailored according to the patient's condition and preferences, aiming to correct all compartmental defects in a single procedure whenever possible. In this study, we report a case of a patient presenting with rectal prolapse, anterior vaginal wall prolapse, and uterine prolapse accompanied by severe constipation, who achieved satisfactory outcomes following laparoscopic lateral suspension (uterus preservation) combined with ventral mesh rectopexy. This combined surgical approach is particularly suitable for patients with multi-compartment POP presenting with rectal prolapse and anterior vaginal or apical prolapse, who also express a desire for uterine preservation and report symptoms of constipation. The key technical considerations involve utilizing lateral suspension to correct anterior vaginal and/or apical prolapse, while employing ventral mesh rectopexy to address rectal prolapse. Compared to the combination of ventral mesh rectopexy and sacrocolpopexy, this procedure is technically simpler and maintains appropriate independence between the posterior vaginal wall and the rectum. It not only achieves favorable outcomes in correcting prolapse across all pelvic compartments but also reduces the risks of mesh-related complications and postoperative constipation. The purpose of this video is to share our experience and insights into the multidisciplinary management of multi-compartment POP.