Sutured rectal lift for obstructed defecation: Mesh-free sphincter-preserving transanal technique for Oxford grade II-III prolapse

Figure 1 Sylarum^® device. IU: Intervention unit, anatomical double-curved, closed-top, inverted T-shaped intervention frame, providing optimal visualization of the operative field by preventing protrusion of tissue or stool into the device’s inner channel; CP: Control platform, the transparent nature of the control platform allows easy identification of the dentate line, which can be used as a reliable anatomical reference point.

Figure 2 Stepwise illustration of the initial sutured rectal lift suture sequence. A: Internal rectal prolapse; B: Superficial mucosal-submucosal pass with barbed suture; C: Deep muscular pass at the samelevel; D: Deep pass 3 mm caudally with semiloop; E: Closure of the anchoring stitch; F: Cranial mucosa plication.

Figure 3 Final stages of sutured rectal lift and multilayer reinforcement. A: Second semiloop positioned above the margin of the prolapse; B: Third semiloop placed below the first stitch; C: Resulting folding of the rectal wall after suture tightening; D: Second layer of deep muscular reinforcement using non-adsorbable monofilament suture; E: Final knot securing the reinforcement layed; F: Final result after repeating the procedure on all six quadrants.