Abstract
TECHNIQUE Satisfactory hold is achieved in the quadriceps tendon with sutures. Using the Acufex® DirectorTM Drill Guide (Smith & Nephew, Andover, MA, US), the desired entry and exit locations for drill holes are selected on the patella (Fig 1). Three to four 2.4mm drill tip passing pins are placed (Fig 2). Each passing pin is then overdrilled with the 4.5mm ENDOBUTTON® (Smith & Nephew) cannulated drill bit. The free ends of suture are passed through the eyes of the 2.4mm drill tip passing pins (Fig 3) and pulled through the tunnels, exiting at the inferior pole (Fig 4). The repair can be tensioned as required before tying the suture ends at the inferior pole of the patella.
Highlights
Various techniques for quadriceps tendon repair have been described with biomechanical studies suggesting greater failure threshold with longitudinally placed drill holes.[1]
TECHNIQUE Satisfactory hold is achieved in the quadriceps tendon with sutures
The free ends of suture are passed through the eyes of the 2.4mm drill tip passing pins (Fig 3) and pulled through the tunnels, exiting at the inferior pole (Fig 4)
Summary
Laparoscopic ventral mesh rectopexy using a composite mesh is a technique gaining more recognition for management of pelvic floor disorders such as full thickness rectal prolapse, obstructive defecation symptoms and vaginal vault prolapse. A recent Cochrane review concluded that laparoscopic rectopexy results in fewer postoperative complications and an earlier discharge[1] over open methods.[2] We describe a novel technique for preparation of the mesh. TECHNIQUE Two longitudinal pieces of the standard 3cm x 20cm strip of polypropylene or polyester mesh are used; the second piece is placed at right angles to prepare a T shape. The second piece is stitched with four sutures, forming a T shape (Fig 1)
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