1. MBBS, MS (Gold Medalist) FIMSA Dip Yoga (Gold Medalist) FCLS
POPSTARR
Brij B. Agarwal
MBBS, MS (Gold Medalist) FIMSA
Dip Yoga (Gold Medalist) FCLS
Vice Chairman, Professor & Senior Consultant, Department of Laparoscopic & General Surgery,
GRIPMER  & Sir Ganga Ram Hospital, New Delhi, India.
International Advisor, SLS America
Secretary, Association of Surgeons of India, Delhi
Associate Editor, Indian Journal of Surgery
Vice President, International Society of Colo-Proctology
Chairman, Delhi State, International Medical Sciences Academy
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

2. Brij B. Agarwal Nothing To Disclose
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

3. What is POPSTARR? POPSTARR is pelvic organ prolapse surgery with STARR
STARR i.e. Stapled Transanal Resection Rectopexy is a procedure for posterior compartment pelvic repair.
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

4. Pelvic Floor Dysfunction
Pelvic floor has three compartments
Anterior deals with urinary symptoms
Middle deals with urogenital symptoms
Posterior deals with defecatory disorders
Posterior compartment is dealt with STARR
POPSTARR addresses anterior and middle compartments.
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

5. Principles of POPSTARR
The pelvic floor reconstruction is prosthesis based (mesh).
The sling of mesh aims at
Repositioning the sagging viscera by lifting it up cranially and towards anterior abdominal wall.
The sling is anchored anteriorly and not posteriorly, hence avoiding any neurogenic & other sequelae of sacral fixation.
The uterosacral ligaments are used as pulley for middle compartment
The anterior cervix is used as pulley for anterior compartment
The V-shaped sling is completely extra-peritoneal
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

6. The Position of the Patient
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

7. Port Positions
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

8. Mesh sling fashioning
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

9. Diagnostic lap and uterosacrals
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

10. Extraperitoneal uterosacral tunneling
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

11. Left sling placement
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

12. Right sling placement
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

13. Final Appearance
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

14. Postoperative
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

15. Index Case (June 2010)
A 60 years’ lady presented with chief complaint of constipation refractory to medical management for last > 10 years.
Her clinical presentation was consistent with ODS (Score 21).
MR Defecography- full-thickness internal rectal prolapse + intra- rectal intussusception + deep enterocele+ > 5 cms. rectocele+ Large cystocele.
She was not a suitable case for STARR due to enterocele.
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

16. Outcome
Last seen at At 42 month follow up, the lady was free of ODS (Score <5)
MR Defecography at 12 months showed absence of enterocele / cystocele / rectocele but the intra-rectal intussusception was still seen < 30% of pre-op
Brij B Agarwal, SELSICON, August 8, 2015, Cochin

17. Thanks for your kind attention and patient listening
Thank You
Pooja Pant, Ramneek Kaur, Nayan Agarwal & Krishna Adit Agarwal
Brij B Agarwal, SELSICON, August 8, 2015, Cochin