Transperineal Ultrasound Characteristics in Patients Undergoing Laparoscopic Ventral Mesh Rectopexy.

Abstract

<h4>Introduction and hypothesis</h4>The objective of this study was to characterize the morphologic changes in anterior compartment dynamics using transperineal ultrasound (TPUS) before and after laparoscopic ventral mesh rectopexy (LVMR) in patients with anorectal functional disorders, focusing on the bladder-symphysis distance (BSD) and retrovesical angle (RVA).<h4>Methods</h4>Patients who underwent LVMR between April 2015 and December 2018 and completed both preoperative and 6-month postoperative TPUS evaluations were included. LVMR involved anterior rectal wall suspension with additional mesh fixation to the posterior vaginal wall. BSD and RVA were measured at rest, during the Valsalva maneuver, and as variances (differences).<h4>Results</h4>Among 63 patients (median age 78 years; BMI 22.1 kg/m²), 12 had pelvic organ prolapse (POP), and nine underwent simultaneous sacrocolpopexy. Postoperative BSD at rest decreased from 19.3 ± 4.4 mm to 18.4 ± 4.5 mm (p = 0.049), and BSD variance significantly decreased from 11.4 ± 6.5 mm to 9.2 ± 4.5 mm (p = 0.031). RVA showed no significant change. After excluding POP cases, BSD variance remained significantly reduced (p = 0.042).<h4>Conclusions</h4>LVMR with posterior vaginal wall suspension was associated with reduced BSD variance on TPUS, suggesting that this posterior support may contribute to bladder neck stabilization.