Perineal descent (PD) is a coloproctology disease which is frequently related with pelvic organ prolapse (POP). While laparoscopic approach is an accepted treatment por POP, treatments for PD are less well-known. The first therapeutic step for this disease consists of conservative measures in the form of laxatives, suppository use, enema use and biofeedback, with no clear surgical approach to this condition. We present a surgical technique that provides hold to the whole perineum restoring the PD and POP in one procedure, the Integral Perineal Sacrocolpopexy (IPSC).

We present the case of 66-year-old woman who was referred to our service due to POP sensation of 3 years. She also complained about constipation with no urinary symptoms. She had no history of abdominal surgeries, or other medical issues. Physical exploration revealed a grade III cystocele and non-functioning pelvic floor muscles without urinary leak. A dynamic MRN showed a moderate PD with a cystocele during Valsalva manoeuvre. Laparoscopic approach was offered.

The laparoscopy approached was performed in a 30° Trendelenburg position with 3 5-mm trocars, two placed medially to the anterior superior iliac spines and one placed at the midpoint between the pubis and umbilicus, and a 10-mm umbilical telescope port over the umbilicus.  We used polypropylene, macroporous, monofilament, mesh which must be prepared before the implant. 
We opened the posterior peritoneum over the sacral promontory. Careful dissection over the promontory was performed to avoid bleeding of presacral vessels. We extended the incision inferiorly along the right lateral aspect of the rectum to expose recto-vaginal space. Then the dissection was continued toward the muscle laterally to the rectum. The posterior mesh was fixed in both sides of the rectum, as anterior as possible, avoiding the middle rectal artery and nerve, and to the uterosacral ligaments and the upper dorsal side of the vagina. 
Then we performed a vesico-vaginal dissection until identifying the bladder neck. After that two latero-vesical spaces were created until the endopelvic-fascia was exposed, and then communicated with the vesicovaginal space. The anterior mesh was placed through these communications and fixed to the muscle and the anterior vaginal wall with non-reabsorbed sutures. 
The anterior mesh was placed with the posterior and both meshes fixed to the promontory. We covered the meshes with peritoneum with reabsorbed sutures. The operation time was 130 minutes and the patient was discharged 2 days after the surgery without any complication. She referred no constipation, POP symptoms or pain 6 month after the surgery. We have performed this surgery in 11 more cases with PD and POP, with a mean surgical time of 130 minutes and a surgical succeed of 100% of solving POP and PD, without complications or pain.

The IPSC ensures a hold for the whole perineum and pelvic organs. It is an option for patients with symptomatic pelvic organ prolapse and perineum descent.