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Wu L, Wu H, Mu S, Li XY, Zhen YH, Li HY. Surgical approaches for complete rectal prolapse. World J Gastrointest Surg 2025; 17:102043. [PMID: 40162412 PMCID: PMC11948122 DOI: 10.4240/wjgs.v17.i3.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/02/2024] [Accepted: 01/11/2025] [Indexed: 02/24/2025] Open
Abstract
Complete rectal prolapse, characterized by the protrusion of the rectal wall layers through the anal canal, poses significant treatment challenges, particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system. This study comprehensively reviews the main surgical techniques for complete rectal prolapse, categorized as transabdominal and transperineal/transanal procedures. Despite various techniques, challenges persist, including high recurrence rates and potential complications. Factors influencing the choice of the surgical approach include patient characteristics, symptomatology, and surgical expertise. With advances in medical technology, laparoscopic and robotic surgeries offer promising avenues, albeit with considerations of cost and accessibility. Ultimately, treatment plans tailored to the individual needs of the patient and surgical expertise are essential. Although controversies remain, the continued refinement of surgical techniques holds promise for improving outcomes in complete rectal prolapse surgery.
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Affiliation(s)
- Long Wu
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Huan Wu
- Department of Infectious Disease, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Song Mu
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Xiao-Yun Li
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Yun-Huan Zhen
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Hai-Yang Li
- Key Laboratory of Hepatobiliary and Pancreatic Diseases Treatment and Bioinformatics Research Guizhou Medical University, Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
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Cooper EA, Singh S, Yates C, Hodgkinson J, Cunningham C, Lindsey I. High and low take-off external prolapse phenotypes can be characterised preoperatively on defaecation proctography. Tech Coloproctol 2025; 29:74. [PMID: 40053169 DOI: 10.1007/s10151-024-03093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/18/2024] [Indexed: 03/10/2025]
Abstract
BACKGROUND External rectal prolapse is poorly understood, with controversy surrounding the ideal surgical approach. Anecdotal mentions of high and low take-off in the literature hint at different pathological phenotypes of prolapse. However there has been no effort to define and characterise these terms, or to discuss how take-off might relate to the underlying pathophysiology of prolapse. We aimed to determine if defaecation proctography (DPG) could reliably characterise high and low take-off prolapse. METHODS The study was a retrospective analysis of prospectively collected data. A total of 88 patients with external rectal prolapse were investigated with a defaecating proctogram as part of their routine evaluation between January 2004 and December 2017. Prolapse take-off was determined by the level of origin on proctography. The rectosigmoid junction position at rest and caudal mobility during straining were also determined, relative to sacrococcygeal bony segmental level. RESULTS Take-off was characterised in all 88 patients (median age 64 years old, 92% female), of which 53 (60%) had high take-off and 35 (40%) low take-off prolapse. There was significantly greater rectosigmoid junction caudal mobility (median descent 9 vs 5 cm, p = 0.001, respectively) and a trend to significantly lower resting rectosigmoid position (median sacral level S4 vs S3, p = 0.08, respectively) in the high take-off group compared to low take-off. CONCLUSION In this first formalised description and definition of take-off in the literature, we have shown that defaecating proctogram can satisfactorily identify, discriminate between and characterise two distinct external prolapse phenotypes. We propose two distinct causal pathways to external rectal prolapse, connective tissue failure and levator ani factors. Take-off should be a consideration as a prognostic in clinical practice and research trials.
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Affiliation(s)
- E A Cooper
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - S Singh
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - C Yates
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - J Hodgkinson
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - C Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - I Lindsey
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
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Fuschillo G, Selvaggi L, Cuellar-Gomez H, Pescatori M. Comparison between perineal and abdominal approaches for the surgical treatment of recurrent external rectal prolapse: a systematic review and meta-analysis. Int J Colorectal Dis 2025; 40:26. [PMID: 39875708 PMCID: PMC11775045 DOI: 10.1007/s00384-024-04771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2024] [Indexed: 01/30/2025]
Abstract
PURPOSE Although surgery is the most effective treatment for rectal prolapse, a risk of recurrence reported in literature is 6-27%. The aim of this meta-analysis is to compare the abdominal and perineal approach for surgical treatment of recurrent external rectal prolapse. METHODS A systematic search of PubMed and Embase was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search of PubMed and Embase was conducted from January 2000 to May 2024, for studies reporting surgery for recurrent external rectal prolapse. The primary outcome was the recurrence at the last available follow-up. Secondary endpoints included surgical complications and length of postoperative hospitalization. RESULTS Nine studies, with a total of 531 patients, were included in the analysis. The overall recurrence rate among the studies was 26.3% at a mean follow-up time of 30.5 months. The proportional meta-analysis showed a recurrence rate of 27.9% (95% CI 22.54 to 33.85, I2 75.1%, p = 0.0012) after perineal surgery and of 15.6% (95% CI 11.43 to 20.64, I2 63.7%, p = 0.016) after abdominal surgery. Comparing the two approaches, the meta-analysis showed an OR of 0.66 (95% CI 0.41 to 1.17, I2 66.5%, p = 0.029). The OR for complications was 1.44 (95% CI 0.77 to 2.70, I2 0.0%, p = 0.945), while SMD for length of hospital stay was 0.49 (95% CI 0.20 to 0.79, I2- 67.9%, p = 0.077). CONCLUSIONS Our meta-analysis revealed that the recurrence rate for the perineal approach was almost double the recurrence rate for the abdominal approach. More randomized trials are needed to determine which is the best approach for patients with recurrent external rectal prolapse.
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Affiliation(s)
- Giacomo Fuschillo
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.
| | - Lucio Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Hugo Cuellar-Gomez
- Department of Postgraduate Studies and Research, National Polytechnic Institute, Mexico City, Mexico
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Amery A, Marritt K, Baig Z, Roy H, Gill D, Ginther N. Addition of anal encirclement to perineal proctosigmoidectomy: a retrospective review. Front Surg 2025; 12:1492690. [PMID: 39926041 PMCID: PMC11802564 DOI: 10.3389/fsurg.2025.1492690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Accepted: 01/13/2025] [Indexed: 02/11/2025] Open
Abstract
Background The optimal approach for the surgical management of rectal prolapse is individualized based on anatomical, functional, and surgical factors. In patients with significant comorbidities, perineal approaches are often preferred even though they are associated with higher recurrence rates compared to an abdominal approach. Although anal encirclement was one of the first procedures described for this condition, it is seldom employed given its high recurrence rates. There is currently a lack of data addressing a combination surgery, wherein both a perineal proctosigmoidectomy and anal encirclement are performed simultaneously. Aims To evaluate the efficacy of combining perineal proctosigmoidectomy with anal encirclement using Nylon sutures compared to perineal proctosigmoidectomy alone. Methods This was a single institution, non-randomized, retrospective study conducted at the Royal University Hospital, Saskatoon, Saskatchewan, Canada (July 2017 to October 2022). Patients over the age of 18 with full-thickness rectal prolapse who underwent either perineal proctosigmoidectomy alone or perineal proctosigmoidectomy with anal encirclement were included. There were 23 patients in the perineal proctosigmoidectomy group and 21 patients in the perineal proctosigmoidectomy with anal encirclement group. The primary outcome was prolapse recurrence. Secondary outcomes included operative time, length of hospital stay, and post-operative complications. Results Patients who received perineal proctosigmoidectomy with anal encirclement had significantly lower rates of recurrent prolapse (9.5%) compared to perineal proctosigmoidectomy alone (34.8%) (p = 0.02). Patients who underwent the combined procedure had a shorter length of stay by 2.3 days (p = 0.03). There was no difference in post-operative complications or operating time. Conclusions Routine anal encirclement in perineal proctosigmoidectomy reduces recurrence rates and length of stay without increasing operating time or complications.
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Affiliation(s)
- Aiya Amery
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kayla Marritt
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Zarrukh Baig
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Haven Roy
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dilip Gill
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nathan Ginther
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
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Rajasingh CM, McCarthy MS, Barreto NB, Trickey AW, Bungo C, Neshatian L, Gurland BH. Association Between Frailty and Preoperative Decision-Making in Rectal Prolapse Repair. J Surg Res 2025; 305:331-336. [PMID: 39733470 DOI: 10.1016/j.jss.2024.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 11/13/2024] [Accepted: 11/29/2024] [Indexed: 12/31/2024]
Abstract
INTRODUCTION Abdominal and perineal repairs for rectal prolapse are offered to patients based on surgeon assessment of risk. Interpretations of risk can vary. We sought to understand how the preoperative Risk Analysis Index (RAI) score, a validated measure of frailty, aligned with our existing decision-making process for rectal prolapse repair. METHODS Rectal prolapse repair cases were recorded in an Institutional Review Board approved registry from 2017 to 2022. Abdominal and perineal operations were determined based on an experienced surgeon's recommendation. The preoperative RAI was collected; a score≥30 indicates significant frailty. Preoperative and postoperative characteristics were compared using t-tests and Fisher's exact tests. RESULTS About 130 patients underwent abdominal repairs and 51 underwent perineal repairs. Perineal patients were more often frail (abdominal: 9 [7%] versus perineal: 21 [41%], P < 0.001) and had a higher rate of cardiac comorbidities (abdominal: 42 [32%] versus perineal: 35 [69%], P < 0.001). A similar share of patients were undergoing repair for recurrent prolapse (abdominal: n = 29 [22%] versus perineal: n = 11 [22%], P > 0.99). Perineal repair patients were more likely to need assistance with mobility (n = 24 [47%]) and live in a facility (n = 15 [29%]). Patients in both groups recovered well (complication rate abdominal: 28 [22%] versus 11 [22%], P > 0.99) and were satisfied with postoperative outcomes (Patient Global Impression of Change score abdominal: 6 [interquartile range: 6, 7] versus perineal: 6 [5, 7], P = 0.12). Recurrence rates were higher after perineal repair (abdominal: 12 [9%] versus perineal: 20 [39%], P < 0.001). CONCLUSIONS Most abdominal repair patients were not frail, but many nonfrail patients underwent perineal operations based on surgeon perception of comorbidities. Using the RAI tool may provide an opportunity to guide decision-making around operative approach for rectal prolapse and overcome potential surgeon bias.
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Affiliation(s)
| | | | - Nicolas B Barreto
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Amber W Trickey
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Caitlin Bungo
- Department of Surgery, Stanford University, Stanford, California
| | - Leila Neshatian
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California
| | - Brooke H Gurland
- Department of Surgery, Stanford University, Stanford, California
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Spivak AR, Maspero M, Spivak RY, Sankovic JA, Norman S, Deckard C, Steele SR, Hull TL. Quality of Life, Functional Outcomes, and Recurrence After Resection Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse Repair. Dis Colon Rectum 2025; 68:91-100. [PMID: 39325038 DOI: 10.1097/dcr.0000000000003467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
BACKGROUND Resection rectopexy and ventral mesh rectopexy are widely accepted surgical options for the treatment of rectal prolapse; however, reports on long-term recurrence rates and functional outcomes are lacking. OBJECTIVE We compared quality of life, long-term functional outcomes, and prolapse recurrence after resection rectopexy versus ventral mesh rectopexy. DESIGN We retrospectively reviewed our prospectively collected rectal prolapse surgery database. SETTINGS Patients who underwent resection rectopexy or ventral mesh rectopexy at our center between 2009 and 2016 were included. PATIENTS Two hundred twenty patients were included, of whom 208 (94%) were women; 85 (39%) underwent resection rectopexy and 135 (61%) ventral mesh rectopexy. MAIN OUTCOME MEASURES Prolapse recurrence. RESULTS The resection rectopexy group was younger (median 52 vs 60 years old, p = 0.02) and had more open procedures (20% vs 9%, p < 0.001). After a median follow-up of 110 (interquartile range 94-146) months for resection rectopexy and 113 (87-137) months for ventral mesh rectopexy, recurrences occurred in 21 (26%) in the resection rectopexy and 50 (39%) in the ventral mesh rectopexy group ( p = 0.041). The median time to recurrence was 44 (18-80) months in the resection rectopexy group and 28.5 (11-52.5) months in the ventral mesh rectopexy group ( p = 0.14). There were no differences in the recurrence rate for primary prolapses in resection rectopexy versus ventral mesh rectopexy. The recurrence rate for redo prolapses was higher in the ventral mesh rectopexy group at 63% at 10 years versus 25% in the resection rectopexy group ( p = 0.006). Functional outcomes were similar between the 2 groups. LIMITATIONS Retrospective review, recall bias. CONCLUSIONS Long-term quality of life and functional outcomes after resection rectopexy and ventral mesh rectopexy were comparable. Ventral mesh rectopexy was associated with a higher prolapse recurrence rate after recurrent rectal prolapse repair. See Video Abstract . CALIDAD DE VIDA, RESULTADOS FUNCIONALES Y RECURRENCIA DESPUS DE LA RECTOPEXIA POR RESECCIN VERSUS LA RECTOPEXIA VENTRAL CON MALLA PARA LA REPARACIN DEL PROLAPSO RECTAL ANTECEDENTES:La rectopexia de resección y la rectopexia ventral con malla son opciones quirúrgicas ampliamente aceptadas para el tratamiento del prolapso rectal; sin embargo, faltan informes sobre las tasas de recurrencia a largo plazo y los resultados funcionales.OBJETIVO:Comparamos la calidad de vida, los resultados funcionales a largo plazo y la recurrencia del prolapso después de la rectopexia de resección versus la rectopexia ventral con malla.DISEÑO:Revisamos retrospectivamente nuestra base de datos de cirugía de prolapso rectal recopilada prospectivamente.ENTORNO CLÍNICO:Se incluyeron pacientes sometidos a rectopexia resección o rectopexia ventral con malla en nuestro centro entre 2009 y 2016.PACIENTES:Se incluyeron 220 pacientes, de los cuales 208 (94%) eran mujeres; 85 (39%) fueron sometidos a rectopexia de resección, 135 (61%) rectopexia ventral con malla.INTERVENCIONES:Ninguna.PRINCIPALES MEDIDAS DE VALORACIÓN:Recurrencia del prolapso.RESULTADOS:El grupo de rectopexia de resección era más joven (mediana 52 vs 60 años, p = 0,02) y tenía más procedimientos abiertos (20% vs 9%, p < 0,001). Después de una mediana de seguimiento de 110 (RIC 94 - 146) meses para la rectopexia de resección y 113 (87 - 137) para la rectopexia ventral con malla, se produjeron recurrencias en 21 (26%) del grupo de rectopexia de resección y en 50 (39%) del grupo de rectopexia ventral con malla (p = 0,041). La mediana del tiempo hasta la recurrencia fue de 44 (18 - 80) meses en el grupo de rectopexia de resección y 28,5 (11 - 52,5) en el grupo de rectopexia ventral con malla (p = 0,14). No hubo diferencias en la tasa de recurrencia de prolapsos primarios en la rectopexia de resección versus la rectopexia con malla ventral. La tasa de recurrencia de prolapsos repetidos fue mayor en el grupo de rectopexia con malla ventral, 63% a los 10 años, versus 25% en el grupo de rectopexia con resección (p = 0,006). Los resultados funcionales fueron similares entre los dos grupos.LIMITACIONES:Revisión retrospectiva, sesgo.CONCLUSIÓN:La calidad de vida a largo plazo y los resultados funcionales después de la rectopexia de resección y la rectopexia ventral con malla fueron comparables. La rectopexia ventral con malla se asoció con una mayor tasa de recurrencia del prolapso después de la reparación del prolapso rectal recurrente. (Traducción-Ingrid Melo ).
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Affiliation(s)
- Anna R Spivak
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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O'Connor A, Byrne CM, Heywood N, Davenport M, Klarskov N, Sharma A, Kiff E, Telford K. Anal sphincter function in rectal intussusception and high and low "take-off" external rectal prolapse-A prospective observational study. Colorectal Dis 2024; 26:2069-2079. [PMID: 39370561 DOI: 10.1111/codi.17191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/10/2024] [Accepted: 09/11/2024] [Indexed: 10/08/2024]
Abstract
AIM Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low "take-off". METHODS A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit. Clinical data, AAR, and conventional anal manometry were analysed according to the Oxford prolapse grade. RESULTS A total of 108 (102 [94%] female, median age 62 years [range: 26-95]) patients were recruited into three groups according to prolapse grade: Oxford grades I and II (intrarectal RI, n = 34), Oxford grades III and IV (intra-anal RI, n = 35) and Oxford grade V (ERP, n = 39). As the grade of prolapse increased, resting AAR measurements of opening pressure, opening elastance, closing pressure, and closing elastance decreased (p < 0.001). Maximum resting pressure with manometry was reduced in ERP and intra-anal RI compared to intrarectal RI (p < 0.001). However, incremental squeeze function was not different between the three groups with either AAR or manometry (p > 0.05). There were no differences in AAR or manometry variables between grade IV RI (n = 18) and high take-off ERP (n = 20) (p > 0.05). By contrast, opening pressure (p = 0.010), closing pressure (p = 0.019) and elastance (p = 0.022) were reduced in low take-off ERP (n = 19). CONCLUSION Increasing rectal prolapse grade is associated with reduced anal sphincter function at rest indicating internal anal sphincter dysfunction. Physiological differences exist between high and low take-off ERP with sphincter function in the former similar to that seen in grade IV RI.
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Affiliation(s)
- Alexander O'Connor
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Caroline M Byrne
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nick Heywood
- Department of Colorectal Surgery, East Lancashire NHS Hospitals Trust, Blackburn, UK
| | - Matthew Davenport
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Niels Klarskov
- Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Abhiram Sharma
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Edward Kiff
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karen Telford
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK
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Mantzoros I, Brenta A, Bourtzinakou AA, Kontaxi O, Gemousakakis G, Antoniou N, Bitsianis S, Kotidis E, Kyziridis D, Ioannidis O, Kerasidou O, Gkiouliava A, Pramateftakis M, Aggelopoulos S. Perineal Rectosigmoidectomy (Altemeier's Procedure) in the Treatment of Strangulated Rectal Prolapse: A Case Series and Literature Review. J Pers Med 2024; 14:1095. [PMID: 39590587 PMCID: PMC11595259 DOI: 10.3390/jpm14111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/14/2024] [Accepted: 10/25/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Rectal prolapse (RP) predominantly affects women over the age of 50 and presents as mucosal, internal, or full thickness prolapse. Strangulated rectal prolapse requires immediate medical intervention, and surgical treatment options include both abdominal and perineal approaches. We aim to present a case series of perineal rectosigmoidectomy performed urgently due to strangulation and argue that Altemeier's procedure is the preferred method for treating strangulated rectal prolapse. METHODS Perineal rectosigmoidectomy, particularly Altemeier's procedure, is effective for incarcerated cases. Altemeier's procedure with diverting ileostomy was used in all three patients. RESULTS All patients were successfully treated, with no recurrence of prolapse and stool incontinence. CONCLUSIONS Altemeier's procedure is ideal for the treatment of strangulated rectal prolapse.
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Affiliation(s)
- Ioannis Mantzoros
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Aliki Brenta
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Aikaterini-Antonia Bourtzinakou
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Ourania Kontaxi
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Georgios Gemousakakis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Nikolaos Antoniou
- 2nd Department of Surgery, General Hospital of Thessaloniki “G. Gennimatas”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Stefanos Bitsianis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Efstathios Kotidis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Dimitrios Kyziridis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Orestis Ioannidis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Ourania Kerasidou
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Anna Gkiouliava
- Department of Anesthesiology and Intensive Care, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Manousos Pramateftakis
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
| | - Stamatios Aggelopoulos
- 4th Department of Surgery, General Hospital of Thessaloniki “G. Papanikolaou”, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (I.M.); (A.-A.B.); (O.K.); (G.G.); (S.B.); (E.K.); (D.K.); (O.I.); (O.K.); (M.P.); (S.A.)
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Schabl L, Hull TL, Ban KA, Steele SR, Spivak AR. Recurrence Rates and Risk Factors in the Altemeier Procedure for Rectal Prolapse: A Multicenter Study. Dis Colon Rectum 2024; 67:1465-1474. [PMID: 39087690 DOI: 10.1097/dcr.0000000000003439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Perineal proctosigmoidectomy (Altemeier) is a surgical procedure that is commonly used for the treatment of rectal prolapse. However, there is a diverse range of recurrence rates after Altemeier procedure repair that has been reported in the literature. OBJECTIVE To identify primary and subsequent recurrence rates after perineal proctosigmoidectomy and to define potential risk factors for recurrence. DESIGN Cohort study. SETTINGS Conducted at 6 hospitals affiliated with the Cleveland Clinic. PATIENTS The study included patients who were older than 18 years and were treated with the Altemeier procedure for rectal prolapse between 2007 and 2022. MAIN OUTCOME MEASURES Primary outcomes were rates of primary and subsequent recurrences. Secondary outcomes included potential risk factors for recurrence previously mentioned in the literature. RESULTS We identified 182 patients, of whom 95.1% were women, with a mean age of 79 years (SD 11.4). Overall, procedures were elective in 92.1% of patients, and 14.3% had previously undergone prolapse repairs (Delorme, Thiersch, abdominal suture rectopexy, and abdominal mesh rectopexy). At a mean follow-up period of 27.5 months (SD 45.7), 37.9% of patients experienced recurrence, with 16.5% of patients having multiple recurrences. A subsequent Altemeier procedure was performed in 72.5% of instances. Other treatments included Delorme, abdominal suture rectopexy, abdominal mesh rectopexy, or conservative management. This study identified connective tissue disorders and time since surgery as significant risk factors for recurrence. LIMITATIONS Retrospective design and varying follow-up periods. CONCLUSIONS Perineal proctosigmoidectomy is associated with a significant risk of recurrence. The risk of recurrence increased with the presence of a connective tissue disorder and in proportion to the elapsed time since surgery. These discoveries assist health care professionals in counseling and managing patients who undergo perineal proctosigmoidectomy for rectal prolapse. See Video Abstract . TASAS DE RECURRENCIA Y FACTORES DE RIESGO EN EL PROCEDIMIENTO DE ALTEMEIER PARA EL PROLAPSO RECTAL UN ESTUDIO MULTICNTRICO ANTECEDENTES:La proctosigmoidectomía perineal (Altemeier) es un procedimiento quirúrgico que se utiliza comúnmente para el tratamiento del prolapso rectal. Sin embargo, existe una amplia gama de tasas de recurrencia después de la reparación con el procedimiento de Altemeier que se han informado en la literatura.OBJETIVO:Nuestro objetivo fue identificar las tasas de recurrencia primaria y posterior después de la proctosigmoidectomía perineal, así como definir los posibles factores de riesgo de recurrencia.DISEÑO:Estudio de cohorte.AJUSTES:Realizado en 6 hospitales afiliados a la Clínica Cleveland.PACIENTES:Se incluyeron pacientes mayores de 18 años que fueron tratados con procedimiento de Altemeier por prolapso rectal entre 2007 y 2022.PRINCIPALES MEDIDAS DE VALORACIÓN:Los resultados primarios fueron las tasas de recurrencias primarias y posteriores. Los resultados secundarios incluyeron factores de riesgo potenciales de recurrencia mencionados anteriormente en la literatura.RESULTADOS:Se identificaron 182 pacientes, de los cuales el 95,1% eran mujeres con una edad media de 79 años (DE 11,4). En general, el 92,1% fueron electivos y el 14,3% se habían sometido previamente a reparaciones de prolapso (Delorme, Thiersch, rectopexia con sutura abdominal y rectopexia con malla abdominal). En un período de seguimiento medio de 27,5 meses (DE 45,7), el 37,9% de los pacientes experimentó recurrencia, y el 16,5% de los pacientes tuvo recurrencias múltiples. En el 72,5% de los casos se realizó un procedimiento de Altemeier posterior. Otros tratamientos incluyeron Delorme, rectopexia con sutura abdominal, rectopexia con malla abdominal o manejo conservador. Este estudio identificó los trastornos del tejido conectivo y el tiempo transcurrido desde la cirugía como factores de riesgo importantes de recurrencia.LIMITACIONES:Diseño retrospectivo y períodos de seguimiento variables.CONCLUSIÓN:La proctosigmoidectomía perineal se asocia con un riesgo significativo de recurrencia. El riesgo de recurrencia aumentó con la presencia de un trastorno del tejido conectivo y en proporción al tiempo transcurrido desde la cirugía. Estos descubrimientos ayudan a los profesionales de la salud a asesorar y tratar a los pacientes que se someten a proctosigmoidectomía perineal por prolapso rectal. (Traducción-Dr. Ingrid Melo ).
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Affiliation(s)
- Lukas Schabl
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Ohio
- Department for General-, Visceral- and Thoracic Surgery, University Hospital Salzburg, Salzburg, Austria
| | - Tracy L Hull
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Ohio
| | - Kristen A Ban
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Ohio
| | - Scott R Steele
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Ohio
| | - Anna R Spivak
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Ohio
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Niasse A, Faye PM, Ndong A, Thiam O, Konate I. Strangulated rectal prolapse in adult: Altemeier cure about two cases and literature review. Int J Surg Case Rep 2024; 123:110210. [PMID: 39241477 PMCID: PMC11405903 DOI: 10.1016/j.ijscr.2024.110210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 08/18/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Rectal prolapse is the protrusion of the rectum through the anus. It is a rare condition in young adults. Strangulation is rare but it's a serious complication imposing emergency surgery. Altemeier's recto-sigmoidectomy seems to be an appropriate surgical method for strangulation. The aim of our work was to evaluate this technique in two cases of strangulated rectal prolapse in young adults. CASE PRESENTATION This report is of two men aged 37 and 29. They were seen for the management of irreducible rectal prolapses. They both men gave a long history of constipation and rectal prolapse since childhood. The physical examination found complete rectal prolapse of 13 cm and 15 cm in length respectively. One person had necrosis of the rectal mucosa. The manual reduction failed, why perineal recto-sigmoidectomy was performed. Postoperative course was uneventful. After 24 months follow-up, there was no disorder of anal continence or recurrence. CLINICAL DISCUSSION Strangulated rectal prolapse is rare. This makes consensus in treatment difficult. The risk of necrosis explains the need for surgical excision of the rectum. CONCLUSION Altemeier's technique is a good procedure for the management of strangulated rectal prolapse.
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Affiliation(s)
- Abdou Niasse
- Alioune Diop University Of Bambey, General Surgery Unit of Cheikh Ahmadoul Khadim Hospital in Touba, Diourbel, Senegal.
| | - Papa Mamadou Faye
- Alioune Diop University Of Bambey, General Surgery Unit of Cheikh Ahmadoul Khadim Hospital in Touba, Diourbel, Senegal
| | - Abdourahmane Ndong
- Alioune Diop University Of Bambey, General Surgery Unit of Cheikh Ahmadoul Khadim Hospital in Touba, Diourbel, Senegal
| | - Ousmane Thiam
- Alioune Diop University Of Bambey, General Surgery Unit of Cheikh Ahmadoul Khadim Hospital in Touba, Diourbel, Senegal
| | - Ibrahima Konate
- Alioune Diop University Of Bambey, General Surgery Unit of Cheikh Ahmadoul Khadim Hospital in Touba, Diourbel, Senegal
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Kusunoki C, Uemura M, Osaki M, Nagae A, Tokuyama S, Kawai K, Takahashi Y, Miyake M, Miyazaki M, Ikeda M, Kato T. Reduced port laparoscopic rectopexy for full-thickness rectal prolapse. BMC Surg 2024; 24:246. [PMID: 39227841 PMCID: PMC11370075 DOI: 10.1186/s12893-024-02545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Laparoscopic rectopexy is an established treatment option for full-thickness rectal prolapse. Recently, reduced port surgery (RPS) has emerged as a novel concept, offering reduced postoperative pain and improved cosmetic outcomes compared with conventional multiport surgery (MPS). This study aimed to evaluate the feasibility and safety of RPS for full-thickness rectal prolapse. METHODS From October 2012 to December 2018, 37 patients (MPS: 10 cases, RPS: 27 cases) underwent laparoscopic rectopexy for full-thickness rectal prolapse. Laparoscopic posterior mesh rectopexy (Wells procedure) is the standard technique for full-thickness rectal prolapse at our hospital. RPS was performed using a multi-channel access device, with an additional 12-mm right-hand port. Short-term outcomes were retrospectively compared between MPS and RPS. RESULTS No significant differences were observed between MPS and RPS in the median operative time, the median blood loss volume, the postoperative complication rates, and median hospital stay duration after surgery. CONCLUSION Reduced port laparoscopic posterior mesh rectopexy may serve as an effective therapeutic option for full-thickness rectal prolapse. However, to establish the superiority of RPS over MPS, a prospective, randomized, controlled trial is warranted.
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Affiliation(s)
- Chikako Kusunoki
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan
| | - Mamoru Uemura
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan.
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan.
| | - Mao Osaki
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan
| | - Ayumi Nagae
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan
| | - Shinji Tokuyama
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Kenji Kawai
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Yusuke Takahashi
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Masakazu Miyake
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Surgery, Rinku General Medical Center, 2-23 Rinku Ourai Kita, Izumisanoshi, Osaka, 598-8577, Japan
| | - Michihiko Miyazaki
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Masataka Ikeda
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Division of Lower Gastrointestinal Surgery, Hyogo College of Medicine, 1-1 Mukogawacho Nishinomiya, Hyogo, 663-8501, Japan
| | - Takeshi Kato
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
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12
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Al Zangana I, Al-Taie RH, Al-Badri S, Ismail M. Rectal Prolapse Surgery: Balancing Effectiveness and Safety in Abdominal and Perineal Approaches. Cureus 2024; 16:e69868. [PMID: 39435214 PMCID: PMC11493380 DOI: 10.7759/cureus.69868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2024] [Indexed: 10/23/2024] Open
Abstract
The event in which the entire thickness of the rectum protrudes through the anal canal is called rectal prolapse. This ailment is common in the elderly population and especially in females. It causes some disastrous symptoms, including incontinence to feces and flatus, constipation, and discomfort, because of the weakness in the anorectal junction, making it mandatory for surgical correction. Over time, several surgical techniques have been developed; these are broadly classified into two categories: abdominal and perineal techniques. However, the best approach for surgery that minimizes recurrence while maximizing patient quality of life is still up for debate. A comprehensive review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; a systematic search of the PubMed Database was performed to identify studies published between 2000 and 2024 with the keywords ((Rectal Prolapse) AND ("Perineal" OR "Laparotomy")). The inclusion criteria were focused on studies comparing the outcomes between surgical approaches at the abdominal and perineal locations, particularly on the recurrence rate, postoperative complications, and functional outcomes. In total, 21 studies were included in the review: these ranged from retrospective analysis and prospective studies to a multicentric randomized trial. In this review, abdominal approaches, particularly in the form of laparoscopic rectopexy, consistently demonstrated improved results compared to perineal techniques, with a much lower recurrence rate. The rates of mortality and morbidity were also remarkably lower in laparoscopic operations, which were advocated for suitable patients. However, perineal approaches, while still producing higher rates of recurrence, are a valuable alternative for elderly and high-risk patients due to their being relatively less invasive. Laparoscopic rectopexy can be considered a better surgical method for rectal prolapse, as it has a lower recurrence rate and better functional outcomes. In contrast, perineal approaches will have their place in the management of rectal prolapse, given patient selection for patients at high risk with regard to surgery. Future research should be directed toward multicenter trials with long-term outcomes in order further to fine-tune surgery strategy and criteria for patient selection.
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Affiliation(s)
| | - Rania H Al-Taie
- Department of Surgery, University of Mustansiriyah, College of Medicine, Baghdad, IRQ
| | - Sajjad Al-Badri
- Department of Surgery, University of Baghdad, College of Medicine, Baghdad, IRQ
| | - Mustafa Ismail
- Department of Surgery, Baghdad Teaching Hospital, Medical City Complex, Baghdad, IRQ
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13
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Olson CH, Bordeianou L, Perry WRG, Mellgren A, Wells KKO, Ferrari L, Oliveira L, Spivak AR, Ratto C, Gurland BH. Development of a Consensus-Derived Synoptic Operative Report for Rectal Prolapse: A Report From the Pelvic Floor Disorders Consortium. Dis Colon Rectum 2024; 67:1169-1176. [PMID: 38830262 DOI: 10.1097/dcr.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Narrative operative reports may omit or obscure data from an operation. OBJECTIVE To develop a synoptic operative report for rectal prolapse that includes core descriptors as developed by an international consensus of expert pelvic floor surgeons. DESIGN Descriptors for patients undergoing rectal prolapse surgery were generated through review. Members of the Pelvic Floor Disorders Consortium were recruited to participate in a 3-round Delphi process using a 9-point Likert scale. Descriptors that achieved 70% agreement were kept from the first round, and descriptors scoring 40% to 70% agreement were recirculated in subsequent rounds. A final list of operative descriptors was determined at a consensus meeting, with a final consensus meeting more than 70% agreement. SETTINGS This survey was administered to members of the Pelvic Floor Disorders Consortium. PATIENTS No patient data are included in this study. MAIN OUTCOME MEASURES Descriptors meeting greater than 70% agreement were selected. RESULTS One hundred seventy-six surgeons representing colorectal surgeons, urogynecologists, and urologists distributed throughout North America (56%), Latin America (4%), Western Europe (29%), Asia (4%), and Africa (1%) participated in the first round of Delphi voting. After 2 additional rounds and a final consensus meeting, 16 of 30 descriptors met 70% consensus. Descriptors that met consensus were surgery type, posterior dissection, ventral dissection, mesh used, type of mesh used, mesh location, sutures used, suture type, pouch of Douglas and peritoneum reclosed, length of rectum imbricated, length of bowel resected, levatoroplasty, simultaneous vaginal procedure, simultaneous gynecologic procedure, simultaneous enterocele repair, and simultaneous urinary incontinence procedure. LIMITATIONS The survey represents the views of members of the Delphi panel and may not represent the viewpoints of all surgeons. CONCLUSIONS This Delphi survey establishes international consensus descriptors for intraoperative variables that have been used to produce a synoptic operative report. This will help establish defined operative reporting to improve clinical communication, quality measures, and clinical research. See Video Abstract . DESARROLLO DE UN PROTOCOLO OPERATORIO SINPTICO DERIVADO DE CONSENSO PARA EL PROLAPSO RECTAL UN INFORME DEL CONSORCIO DE TRASTORNOS DEL PISO PLVICO ANTECEDENTES:Los protocolos operativos narrativos frecuentemente pueden omitir u oscurecer datos de un procedimiento.OBJETIVO:Nuestro objetivo es desarrollar un protocolo operatorio sinóptico para el prolapso rectal que incluya descriptores básicos desarrollados por un consenso internacional de cirujanos expertos en piso pélvico.DISEÑO:Los descriptores para pacientes sometidos a cirugía de prolapso rectal se generaron mediante revisión. Se reclutó a miembros del Consorcio de Trastornos del Piso Pélvico para participar en un proceso Delphi de 3 rondas utilizando una escala Likert de 9 puntos. Los descriptores que lograron un 70% de acuerdo se mantuvieron en la primera ronda, los descriptores que obtuvieron un 40-70% de acuerdo se recircularon en rondas posteriores. Se determinó una lista final de descriptores operativos en una reunión de consenso, con una reunión de consenso final de más del 70% de acuerdo.ESCENARIO:Esta fue una encuesta administrada a miembros del Consorcio de Trastornos del Piso Pélvico.PRINCIPALES MEDIDAS DE RESULTADO:Se seleccionaron los descriptores que cumplieron más del 70% de acuerdo.RESULTADOS:Ciento setenta y seis cirujanos en representación de cirujanos colorrectales, uroginecólogos y urólogos distribuidos en América del Norte (56%), América Latina (4%), Europa Occidental (29%), Asia (4%) y África (1%) participaron en la primera ronda de votación Delphi. Después de dos rondas adicionales y una reunión de consenso final, 16 de 30 descriptores alcanzaron un 70% de consenso. Los descriptores que alcanzaron consenso fueron: tipo de cirugía, disección posterior, disección ventral, malla utilizada, tipo de malla utilizada, ubicación de la malla, suturas utilizadas, tipo de sutura, cierre del fondo de saco de Douglas y peritoneo, longitud del recto superpuesto, longitud del intestino resecado, plastía de los elevadores , procedimiento vaginal simultáneo, procedimiento ginecológico simultáneo, reparación simultánea de enterocele y procedimiento simultáneo de incontinencia urinaria.LIMITACIONES:La encuesta representa las opiniones de los miembros del panel Delphi y puede no representar los puntos de vista de todos los cirujanos.CONCLUSIONES/DISCUSIÓN:Esta encuesta Delphi establece descriptores de consenso internacional para las variables intraoperatorias que se han utilizado para producir un protocolo operatorio sinóptico. Esto ayudará a establecer protocolos operativos definidos para mejorar la comunicación clínica, las medidas de calidad y la investigación clínica. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Craig H Olson
- Texas A&M School of Medicine, Baylor Scott and White Medical Center, Waxahachie, Texas
| | - Lilliana Bordeianou
- Section of Colorectal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - William R G Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anders Mellgren
- University of Illinois College of Medicine, Chicago, Illinois
| | - Katerina K O Wells
- Division of Colon and Rectal Surgery, Baylor University Medical Center, Dallas, Texas
| | - Linda Ferrari
- Guy's and St Thomas' Hospital National Health Service, London, United Kingdom
| | - Lucia Oliveira
- Director, Anorectal Physiology Department, Casa de Saude Sao Jose: Casa de Saude, Rio De Janeiro, Brazil
| | - Anna R Spivak
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carlo Ratto
- Proctology Unit, Universita Cattolica del Sacro Cuore, Roma, Italy
| | - Brooke Heidi Gurland
- Division of Colorectal Surgery, Department of Surgery, Stanford College of Medicine, Stanford, California
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Miura Y, Funahashi K, Kurihara A, Kagami S, Suzuki T, Yoshida K, Ushigome M, Kaneko T. The Predictive Risk Factor of Postoperative Recurrence Following Altemeier's and Delorme's Procedures for Full-thickness Rectal Prolapse: An Analysis of 127 Japanese Patients in a Single Institution. J Anus Rectum Colon 2024; 8:171-178. [PMID: 39086885 PMCID: PMC11286377 DOI: 10.23922/jarc.2023-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/07/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives We aimed to identify risk factors for postoperative recurrence (PR) after Altemeier's and Delorme's procedures for full-thickness rectal prolapse (FTRP). Methods We enrolled 127 patients who underwent Altemeier's and Delorme's procedures for FTRP between April 2008 and September 2021. We divided the 127 patients into recurrence and non-recurrence groups and conducted univariate and multivariate analyses. We used six independent variables: age, body mass index (BMI), history of surgical repair for FTRP, coexistence of prolapse in other organs, poor fixation of the rectum on defecography before surgery, length of the prolapsed rectum, and type of surgical procedure (Altemeier's or Delorme's procedures). Results PR developed in 51 (40.1%) patients during a mean follow-up period of 453 (range, 9-3616) days. Comparing the recurrence group (n=51) with the non-recurrence group (n=76), significant difference was observed regarding the coexistence of prolapse in other organs (p=0.017) in the univariate analysis. In the multivariate analysis, significant differences were observed in BMI (OR 1.18, 95% CI 1.030-1.350, p=0.020), coexistence of prolapse in other organs (OR 3.38, 95% CI 1.200-9.500, p=0.021), length of the prolapsed rectum (OR 1.030, 95% CI 1.010-1.060, p=0.015), poor fixity of the rectum on defecography (OR 0.332, 95% CI 0.129-0.852, p=0.022), and surgical procedures (OR 0.192, 95% CI 0.064-0.573, p=0.003). Conclusions The study suggested that increasing BMI, coexistence of prolapse in other organs, length of the prolapsed rectum, poor fixation of the rectum on defecography before surgery, and types of surgical procedure might be risk factors of PR after perineal surgery for FTRP.
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Affiliation(s)
- Yasuyuki Miura
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Akiharu Kurihara
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Satoru Kagami
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Takayuki Suzuki
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kimihiko Yoshida
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Mitsunori Ushigome
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Tomoaki Kaneko
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
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Gendo KM, Feyisa Bogale R, Kenasa G. Green Synthesis, Characterization, and Evaluation of Photocatalytic and Antibacterial Activities of Co 3O 4-ZnO Nanocomposites Using Calpurnia aurea Leaf Extract. ACS OMEGA 2024; 9:28354-28371. [PMID: 38973856 PMCID: PMC11223149 DOI: 10.1021/acsomega.4c01595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024]
Abstract
The green synthesis of transition metal oxide nanocomposites using plant extracts is a new and effective method that avoids the involvement of hazardous chemicals. Nondegradable organic pollutants and antibiotic drug resistance have become serious public health issues worldwide. Hence, the main objective of this study is to synthesize Co3O4-ZnO nanocomposites using Calpurnia aurea leaf extract and evaluate its photocatalytic and antibacterial activities. The green synthesized particles were characterized using UV-vis spectra, Fourier transform infrared spectroscopy, X-ray diffraction techniques, and scanning electron microscopy combined with energy-dispersive X-ray studies. The synthesized particles were found to be crystalline in nature with average crystallite sizes of 23.82, 14.79, 15.99, 16.46, and 21.73 nm. Scanning electron microscopy shows the spherical morphology of Co3O4-ZnO NCs, and energy-dispersive X-ray analysis confirms the formation of highly pure ZnO NPs and Co3O4-ZnO NCs. The photocatalytic activity was performed under natural sunlight using malachite green as an organic dye pollutant. The green synthesized ZnO NPs, Co3O4 NPs, 1:4, 1:3, and 1:2 Co3O4-ZnO NCs showed high degradation efficiency after 60 min of irradiation. The synthetic material showed good potential against Staphylococcus aureus and Escherichia coli, with the highest growth inhibition recorded by 1:2 Co3O4-ZnO NCs. The kinetics study of the photocatalytic degradation was confirmed as pseudo first order, and the possible mechanisms for both photocatalytic and antibacterial activities were clearly determined.
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Affiliation(s)
- Kemal Mohammed Gendo
- Department
of Chemistry, College of Natural and computational Sciences, Wollega University, Nekemte 395, Ethiopia
| | - Raji Feyisa Bogale
- Department
of Chemistry, College of Natural and computational Sciences, Wollega University, Nekemte 395, Ethiopia
| | - Girmaye Kenasa
- Department
of Biology, College of Natural and Computational Sciences, Wollega University, Nekemte 395, Ethiopia
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Bordeianou L, Ogilvie JW, Saraidaridis JT, Olortegui KS, Ratto C, Ky AJ, Oliveira L, Vogler SA, Gurland BH. Durable Approaches to Recurrent Rectal Prolapse Repair May Require Avoidance of Index Procedure. Dis Colon Rectum 2024; 67:968-976. [PMID: 38479014 DOI: 10.1097/dcr.0000000000003212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Surgical treatment of recurrent rectal prolapse is associated with unique technical challenges, partially determined by the surgical approach used for the index operation. Success rates are variable, and data to determine the best approach in patients with recurring prolapse are lacking. OBJECTIVE The study aimed to assess current surgical approaches to patients with prior rectal prolapse repairs and to compare short-term outcomes of de novo and redo procedures, including recurrence of rectal prolapse. DESIGN Retrospective analysis of a prospective database. SETTINGS The Multicenter Pelvic Floor Disorders Consortium Prospective Quality Improvement database. De-identified surgeons at more than 25 sites (81% high volume) self-reported patient demographics, prior repairs, symptoms of incontinence and obstructed defecation, and operative details, including history of concomitant repairs and prior prolapse repairs. PATIENTS Patients who were offered surgery for full thickness rectal prolapse. INTERVENTIONS Incidence and type of repair used for prior rectal prolapse surgery were recorded. Primary and secondary outcomes of index and redo operations were calculated. Patients undergoing rectal prolapse re-repair (redo) were compared with patients undergoing first (de novo) rectal prolapse repair. The incidence of rectal prolapse recurrence in de novo and redo operations was quantified. OUTCOMES The primary outcome of rectal prolapse recurrence in de novo and redo settings. RESULTS Eighty-nine (19.3%) of 461 patients underwent redo rectal prolapse repair. On short-term follow-up, redo patients had prolapse recurrence rates similar to those undergoing de novo repair. However, patients undergoing redo procedures rarely had the same operation as their index procedure. LIMITATIONS Self-reported, de-identified data. CONCLUSION Our results suggest that recurrent rectal prolapse surgery is feasible and can offer adequate rates of rectal prolapse durability in the short term but may argue for a change in surgical approach for redo procedures when clinically feasible. See Video Abstract . LOS ENFOQUES DURADEROS PARA LA REPARACIN DEL PROLAPSO RECTAL RECURRENTE PUEDEN REQUERIR EVITAR EL PROCEDIMIENTO NDICE ANTECEDENTES:El tratamiento quirúrgico del prolapso rectal recurrente se asocia con desafíos técnicos únicos, determinados en parte por el abordaje quirúrgico utilizado para la operación inicial. Las tasas de éxito son variables y faltan datos para determinar el mejor abordaje en pacientes con prolapso recurrente.OBJETIVO:Evaluar los enfoques quirúrgicos actuales para pacientes con reparaciones previas de prolapso rectal y comparar los resultados a corto plazo de los procedimientos de novo y rehacer, incluida la recurrencia del prolapso rectal.DISEÑO:Análisis retrospectivo de una base de datos prospectiva.AJUSTE:Base de datos de mejora prospectiva de la calidad del Consorcio multicéntrico de trastornos del suelo pélvico. Cirujanos no identificados en más de 25 sitios (81% de alto volumen) informaron datos demográficos de los pacientes, reparaciones previas, síntomas de incontinencia y defecación obstruida y detalles operativos, incluido el historial de reparaciones concomitantes y reparaciones previas de prolapso.INTERVENCIONES:Se registro la incidencia y el tipo de reparación utilizada para la cirugía de prolapso rectal previa. Se calcularon los resultados primarios y secundarios de las operaciones de índice y reoperacion. Se compararon los pacientes sometidos a una nueva reparación (reoperacion) de prolapso rectal con pacientes sometidos a una primera reparación (de novo) de prolapso rectal. Se cuantificó la incidencia de recurrencia del prolapso rectal en operaciones de novo y rehacer.RESULTADOS:El resultado primario de recurrencia del prolapso rectal en entornos de novo y redo. Ochenta y nueve (19,3%) de 461 pacientes se sometieron a una nueva reparación del prolapso rectal. En el seguimiento a corto plazo, los pacientes reoperados tuvieron tasas de recurrencia de prolapso similares a los de los sometidos a reparación de novo. Sin embargo, los pacientes sometidos a procedimientos de rehacer rara vez tuvieron la misma operación que su procedimiento índice.LIMITACIONES:Datos no identificados y autoinformados.CONCLUSIONES/DISCUSIÓN:Nuestros resultados sugieren que la cirugía de prolapso rectal recurrente es factible y puede ofrecer tasas adecuadas de durabilidad del prolapso rectal en el corto plazo, pero puede abogar por un cambio en el enfoque quirúrgico para rehacer los procedimientos cuando sea clínicamente factible. (Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Liliana Bordeianou
- Department of Surgery, Pelvic Floor Disorders Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - James W Ogilvie
- Department of Colorectal Surgery, Spectrum Health and Michigan State University, Grand Rapids, Michigan
| | - Julia T Saraidaridis
- Medical University of South Carolina and East Cooper Medical Center, Mt. Pleasant, South Carolina
| | - Kinga S Olortegui
- Section of Colorectal Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Carlo Ratto
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Florida
| | - Alex J Ky
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, New York
| | - Lucia Oliveira
- Anorectal Physiology Department of Rio de Janeiro and Cepemed, Rio De Janeiro, Brazil
| | - Sarah A Vogler
- Division of Colorectal Surgery, University de Roma, Rome, Italy
| | - Brooke H Gurland
- Pelvic Health Center, Department of Surgery, Stanford University, Stanford, California
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Kaneko Y, Behrenbruch C, Keck J. Now is the time to establish a registry for mesh rectopexy. ANZ J Surg 2024; 94:1209-1210. [PMID: 38874257 DOI: 10.1111/ans.19128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Yui Kaneko
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Corina Behrenbruch
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - James Keck
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Gurland BH, Olson CH, McCarthy MS, Bordeianou LG. Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus. Dis Colon Rectum 2024; 67:841-849. [PMID: 38231033 DOI: 10.1097/dcr.0000000000003187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND There is wide variation in prolapse care. OBJECTIVE To determine core descriptor sets for rectal prolapse to enhance outcomes research. DESIGN Descriptors for patients undergoing rectal prolapse surgery were generated through a systematic review and expert opinion. Stakeholders were recruited internationally via listserv and social media. Experts were encouraged to consider the minimum descriptors that could be considered during clinical care, and descriptors were grouped into core descriptor sets. Consensus was defined as greater than 70% agreement. SETTING A 3-round Delphi process using a 9-point Likert scale based on expert results was distributed via survey. The final interactive meeting used a polling platform. PARTICIPANTS The Pelvic Floor Disorders Consortium interdisciplinary group convened to advance the clinical care of pelvic floor disorders. MAIN OUTCOME MEASURES To achieve expert consensus for core descriptor sets for rectal prolapse using a modified Delphi method. RESULTS A total of 206 providers participated, with survey response rates of 82% and 88%, respectively. Responders were from North America (56%), Europe (29%), and Latin America, Asia, Australia, New Zealand, and Africa (15%). Ninety-one percent of participants identified as colorectal surgeons and 80% reported >5 years of experience (35% reported >15 years). Fifty-seven attendees participated in the final meeting and voted on core descriptor sets. Ninety-three percent of participants agreed that descriptors such as age, BMI, frailty, nutrition, and the American Society of Anesthesiology score correlated to physiologic status. One hundred percent of participants agreed to include baseline bowel function. One hundred percent of participants reported willingness to complete a synoptic operative report. Follow-up intervals 1, 3, and 5 years after surgery (76%) with a collection of recurrence and functional outcomes at those time periods reached an agreement. LIMITATIONS Individual bias, self-identification of experts, and paucity of knowledge related to rectal prolapse. CONCLUSIONS This represents the first steps toward international consensus to unify language and data collection processes for rectal prolapse. See Video Abstract . CONJUNTOS DE DESCRIPTORES BSICOS PARA LA INVESTIGACIN DE RESULTADOS DE PROLAPSO RECTAL MEDIANTE UN CONSENSO DELPHI MODIFICADO ANTECEDENTES:Existe una amplia variación en la atención del prolapso.OBJETIVO:Determinar conjuntos de descriptores básicos para el prolapso rectal para mejorar los resultados de la investigación.DISEÑO:Los descriptores para pacientes sometidos a cirugía de prolapso rectal se generaron a través de una revisión sistemática y la opinión de expertos. Las partes interesadas fueron reclutadas internacionalmente a través de listas de servicio y redes sociales. Se animó a los expertos a considerar los descriptores mínimos que podrían considerarse durante la atención clínica, y los descriptores se agruparon en conjuntos de descriptores básicos. El consenso se definió como > 70% de acuerdo.AJUSTE:Se distribuyó mediante encuesta un proceso Delphi de tres rondas que utiliza una escala Likert de 9 puntos basada en resultados de expertos. La reunión interactiva final utilizó una plataforma de votación.PARTICIPANTES:El grupo interdisciplinario del Consorcio de Trastornos del Suelo Pélvico se reunió para avanzar en la atención clínica de los trastornos del suelo pélvico.MEDIDAS PRINCIPALES DE RESULTADOS:Lograr el consenso de expertos para los conjuntos de descriptores básicos para el prolapso rectal utilizando un método Delphi modificado.RESULTADOS:Participaron 206 proveedores con tasas de respuesta a la encuesta del 82% y 88% respectivamente. Los encuestados procedían de América del Norte (56%), Europa (29%) y América Latina, Asia, Australia, Nueva Zelanda y África (15%). El noventa y uno por ciento se identificó como cirujanos colorrectales y el 80% reportó más de 5 años de experiencia (35% > 15 años). Cincuenta y siete asistentes participaron en la reunión final y votaron sobre conjuntos de descriptores básicos. El noventa y tres por ciento estuvo de acuerdo en que descriptores como edad, índice de masa corporal, fragilidad, nutrición y puntuación de la Sociedad Estadounidense de Anestesiología se correlacionaban con el estado fisiológico. El cien por ciento estuvo de acuerdo en incluir la función intestinal inicial. El 100% refirió disposición para realizar un informe operativo sinóptico. Los intervalos de seguimiento 1,3,5 años después de la cirugía (76%) con un conjunto de recurrencias y los resultados funcionales en esos períodos de tiempo coincidieron.LIMITACIONES:Sesgo individual, autoidentificación de los expertos y escasez de conocimientos relacionados con el prolapso rectal.CONCLUSIONES:Esto representa los primeros pasos hacia un consenso internacional para unificar el lenguaje y los procesos de recolección de datos para el prolapso rectal. (Traducción-Yesenia Rojas-Khalil ).
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Bola R, Guo M, Karimuddin A, Liu G, Phang PT, Crump T, Sutherland JM. An examination of rectal prolapse surgery patients' quality of life and symptoms using patient-reported outcome instruments: A prospective cohort study. Am J Surg 2024; 231:113-119. [PMID: 38355344 DOI: 10.1016/j.amjsurg.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND We measured changes in self-reported health and symptoms attributable to rectal prolapse surgery using patient-reported outcome (PRO) measures. METHODS A prospectively recruited cohort of patients scheduled for rectal prolapse repair in Vancouver, Canada between 2013 and 2021 were surveyed before and 6-months after surgery using seven PROs: the EuroQol Five-Dimension Instrument (EQ-5D-5L), Generalized Anxiety Disorder Scale (GAD-7), Pain Intensity, Interference with Enjoyment of Life and General Activity (PEG), Patient Health Questionnaire (PHQ-9), Fecal Incontinence Severity Index (FISI), Gastrointestinal Quality of Life Index (GIQLI), and the Fecal Incontinence Quality of Life Scale (FIQL). RESULTS We included 46 participants who reported improvements in health status (EQ-5D-5L; p < 0.01), pain interference (PEG; p < 0.01), depressive symptoms (PHQ-9; p = 0.01), fecal incontinence severity (FISI; p < 0.01), gastrointestinal quality of life (GIQLI; p < 0.01), and fecal incontinence quality of life (FIQL) related to lifestyle (p = 0.02), coping and behaviour (p = 0.02) and depression and self-perception (p = 0.01). CONCLUSION Surgical repair of rectal prolapse improved patients' quality of life with meaningful improvements in fecal incontinence severity and pain, and symptom interference with daily activities.
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Affiliation(s)
- Rajan Bola
- Faculty of Medicine, University of British Columbia, Vancouver, Canada; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Michael Guo
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada; Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Ahmer Karimuddin
- Department of Surgery, Faculty of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Terry Phang
- Department of Surgery, Faculty of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Trafford Crump
- Department of Surgery, McGill University, Montreal, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Koimtzis G, Stefanopoulos L, Geropoulos G, Chalklin CG, Karniadakis I, Alawad AA, Alexandrou V, Tteralli N, Carrington-Windo E, Papacharalampous A, Psarras K. Mesh Rectopexy or Resection Rectopexy for Rectal Prolapse; Is There a Gold Standard Method: A Systematic Review, Meta-Analysis and Trial Sequential Analysis. J Clin Med 2024; 13:1363. [PMID: 38592257 PMCID: PMC10933911 DOI: 10.3390/jcm13051363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/25/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Rectal prolapse is a benign condition that mainly affects females and the elderly. The most common symptoms are constipation and incontinence. The treatment of choice is surgical, but so far, there has been no gold standard method. The aim of this study is to compare the two most common intrabdominal procedures utilized for treating rectal prolapse: the resection rectopexy and the mesh rectopexy. (2) Methods: In this study, we conducted a thorough systematic review and meta-analysis of the available literature and compared the two different approaches regarding their complication rate, recurrence rate, and improvement of symptoms rate. (3) Results: No statistically significant difference between the two methods was found regarding the operating time, the length of stay, the overall complication rate, the surgical site infection rate, the cardiopulmonary complication rate, the improvement in constipation and incontinence rates, and the recurrence rate. (4) Conclusions: Our study revealed that mesh rectopexy and resection rectopexy for rectal prolapse have similar short- and long-term outcomes. As a result, the decision for the procedure used should be individualized and based on the surgeon's preference and expertise.
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Affiliation(s)
- Georgios Koimtzis
- Department of Oesophageal and Gastric Surgery, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Leandros Stefanopoulos
- Department of Electrical and Computer Engineering, Northwestern University, 633 Clark St., Evanston, IL 60208, USA;
| | - Georgios Geropoulos
- Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh EH4 2XU, UK;
| | - Christopher G. Chalklin
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (I.K.); (A.A.A.)
| | - Ioannis Karniadakis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (I.K.); (A.A.A.)
| | - Awad A. Alawad
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (I.K.); (A.A.A.)
| | - Vyron Alexandrou
- Urology Department, General Hospital of Thessaloniki “G. Gennimata-Agios Dimitrios”, Elenis Zografou 2, 54634 Thessaloniki, Greece;
| | - Nikos Tteralli
- Department of General Surgery, North Hampshire NHS Foundation Trust, Basingstoke RG24 9NA, UK;
| | - Eliot Carrington-Windo
- Department of General Surgery, Grange University Hospital, Caerleon Road, Llanfrechfa, Cwmbran NP44 8YN, UK;
| | | | - Kyriakos Psarras
- School of Medicine, Second Surgical Propedeutic Department, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece;
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21
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Schabl L, Hull T, Erozkan K, Alipouriani A, Ban KA, Steele SR, Spivak AR. Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes. Langenbecks Arch Surg 2024; 409:49. [PMID: 38305915 PMCID: PMC10837248 DOI: 10.1007/s00423-024-03227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure. METHODS We queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier's perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy. RESULTS Ten women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m2 (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred. CONCLUSION Mesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.
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Affiliation(s)
- Lukas Schabl
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Tracy Hull
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Kamil Erozkan
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Ali Alipouriani
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Kristen A Ban
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Scott R Steele
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Anna R Spivak
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
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Williams B, Gupta A, Koller SD, Starr TJ, Star MJH, Shaw DD, Hakim AH, Leinicke J, Visenio M, Perrone KH, Torgerson ZH, Person AD, Ternent CA, Chen KA, Kapadia MR, Keller DS, Elnagar J, Okonkwo A, Gagliano RA, Clark CE, Arcomano N, Abcarian AM, Beaty JS. Emergency Colon and Rectal Surgery, What Every Surgeon Needs to Know. Curr Probl Surg 2024; 61:101427. [PMID: 38161059 DOI: 10.1016/j.cpsurg.2023.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Brian Williams
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Abhinav Gupta
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Sarah D Koller
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Tanya Jt Starr
- Health Corporation of America, Midwest Division, Kansas City, KS
| | | | - Darcy D Shaw
- Health Corporation of America, Midwest Division, Kansas City, KS
| | - Ali H Hakim
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Jennifer Leinicke
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Michael Visenio
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Kenneth H Perrone
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | | | - Austin D Person
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Charles A Ternent
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Kevin A Chen
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Muneera R Kapadia
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Deborah S Keller
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA; Marks Colorectal Surgical Associates, Wynnewood, PA
| | - Jaafar Elnagar
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA
| | | | | | | | - Nicolas Arcomano
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Ariane M Abcarian
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL; Cook County Health, Chicago, IL
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Bhattacharya P, Hussain MI, Zaman S, Randle S, Tanveer Y, Faiz N, Sarma DR, Peravali R. Delorme's vs. Altemeier's in the management of rectal procidentia: systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:454. [PMID: 38041773 DOI: 10.1007/s00423-023-03181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Rectal prolapse is a distressing condition for patients and no consensus exists on optimal surgical management. We compared outcomes of two common perineal operations (Delorme's and Altemeier's) used in the treatment of rectal prolapse. METHODS A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme's and Altemeier's procedures were extracted. Primary outcomes included recurrence rate, anastomotic dehiscence rate and mortality rate. The secondary outcomes were total operative time, volume of blood loss, length of hospital stay and coloanal anastomotic stricture formation. Revman 5.3 was used to perform all statistical analysis. RESULTS Ten studies with 605 patients were selected; 286 underwent Altemeier's procedure (standalone), 39 had Altemeier's with plasty (perineoplasty or levatoroplasty), and 280 had Delorme's. Recurrence rate [OR: 0.66; 95% CI [0.44-0.99], P = 0.05] was significantly lower and anastomotic dehiscence [RD: 0.05; 95% CI [0.00-0.09], P = 0.03] was significantly higher in the Altemeier's group. However, sub group analysis of Altemeier's with plasty failed to show significant differences in these outcomes compared with the Delorme's procedure. Length of hospital stay was significantly more following an Altemeier's operation compared with Delorme's [MD: 3.05, 95% CI [0.95 - 5.51], P = 0.004]. No significant difference was found in total operative time, intra-operative blood loss, coloanal anastomotic stricture formation and mortality rates between the two approaches. CONCLUSIONS A direct comparison of two common perineal procedures used in the treatment of rectal prolapse demonstrated that the Altemeier's approach was associated with better outcomes. Future, well-designed high quality RCTs with long-term follow up are needed to corroborate our findings.
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Affiliation(s)
- Pratik Bhattacharya
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK.
| | - Mohammad Iqbal Hussain
- Department of General Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Shafquat Zaman
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Sophie Randle
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Yousaf Tanveer
- Department of General Surgery, Craigavon Area Hospital, Portadown, Northern Ireland, UK
| | - Nameer Faiz
- Department of General Surgery, The Dudley Group NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK
| | - Diwakar Ryali Sarma
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Rajeev Peravali
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
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Kelley JK, Hagen ER, Gurland B, Stevenson ARL, Ogilvie JW. The international variability of surgery for rectal prolapse. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000198. [PMID: 38020494 PMCID: PMC10649678 DOI: 10.1136/bmjsit-2023-000198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objective There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the patterns in treatment of rectal prolapse. Design A 23-question survey was distributed to the Pelvic Floor Consortium of the American Society of Colorectal Surgeons, the Colorectal Surgical Society of Australia and New Zealand, and the Pelvic Floor Society. Questions pertained to surgeon and practice demographics, preoperative evaluation, procedural preferences, and educational needs. Setting Electronic survey distributed to colorectal surgeons of diverse practice settings. Participants 249 colorectal surgeons responded to the survey, 65% of which were male. There was wide variability in age, years in practice, and practice setting. Main outcome measures Responses to questions regarding preoperative workup preferences and clinical scenarios. Results In preoperative evaluation, 19% would perform anorectal physiology testing and 70% would evaluate for concomitant pelvic organ prolapse. In a healthy patient, 90% would perform a minimally invasive abdominal approach, including ventral rectopexy (56%), suture rectopexy (31%), mesh rectopexy (6%) and resection rectopexy (5%). In terms of ventral rectopexy, surgeons in the Americas preferred a synthetic mesh (61.9% vs 38.1%, p=0.59) whereas surgeons from Australasia preferred biologic grafts (75% vs 25%, p<0.01). In an older patient with comorbidities 81% would perform a perineal approach. Procedure preference (Delormes vs Altmeier) varied according to location (Australasia, 85.9% vs 14.1%; Europe, 75.3% vs 24.7%; Americas, 14.1% vs 85.9%). Most participants were interested in education regarding surgical approaches, however there is wide variability in preferred methods. Conclusion There is significant variability in the preoperative evaluation and surgery performed for rectal prolapse. Given the lack of consensus, it is not surprising that most surgeons desire further education on the topic.
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Affiliation(s)
- Jesse K Kelley
- General Surgery Residency, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
- General Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Edward R Hagen
- Colorectal Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Brooke Gurland
- Colorectal Surgery, Stanford Medicine, Stanford, California, USA
| | - Andrew RL Stevenson
- Colorectal Surgery, St Vincent’s Private Hospital Northside, Brisbane, Queensland, Australia
| | - James W Ogilvie
- Colorectal Surgery, Corewell Health, Grand Rapids, Michigan, USA
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Rincon-Cruz L, Staffa SJ, Dickie B, Nandivada P. Influence of Initial Treatment Strategy on Outcomes for Children With Rectal Prolapse. J Pediatr Gastroenterol Nutr 2023; 77:603-609. [PMID: 37889618 DOI: 10.1097/mpg.0000000000003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Pediatric rectal prolapse is a common and often self-limited condition with multiple management options. Selecting the optimal approach requires personalization and remains a challenge for pediatricians and pediatric surgeons. METHODS A single-center retrospective review of 67 children with rectal prolapse undergoing surgical evaluation between 2010 and 2021. Patients with anorectal malformations, Hirschsprung disease, inflammatory bowel disease, and cystic fibrosis were excluded. We used multivariable logistic regression to compare medical management, sclerotherapy, and surgical correction (rectopexy or transanal resection) as initial treatment strategies, with a primary endpoint of prolapse resolution. RESULTS Younger patients (<5 years) were more likely to be initially treated with medical management alone (P < 0.001). Patients with a psychiatric diagnosis were more likely to be offered either sclerotherapy or surgery upfront (P = 0.009). The resolution rate with surgery as initial management was 79% (n = 11/14). The resolution rate with sclerotherapy as initial management was 54% (n = 13/24), with 33% (n = 8/24) resolving with sclerotherapy alone and 21% (n = 5/24) resolving after a subsequent surgical procedure (P = 0.011). Patients who underwent initial surgical management had an adjusted odds ratio of 8.0 (95% CI: 1.1-59.1; P = 0.042) for resolution of prolapse compared to patients who underwent sclerotherapy initially. Markers of severity (bleeding, need for manual reduction) were not associated with initial therapy offered (P = 0.064). CONCLUSIONS Surgical intervention (sclerotherapy, rectopexy, transanal resection) resolved rectal prolapse in most children (63%). Surgery as an initial management approach had a significantly higher success rate than sclerotherapy, even after controlling for severity of disease, psychiatric diagnosis, need for manual reduction, and age.
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Gomes L, Varghese C, Collinson RJ, Hayes JL, Parry BR, Milne D, Bissett IP. The influence of defaecating proctograms on clinical decision-making in pelvic floor disorders. Colorectal Dis 2023; 25:1994-2000. [PMID: 37583050 DOI: 10.1111/codi.16706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/25/2023] [Accepted: 06/27/2023] [Indexed: 08/17/2023]
Abstract
AIM Defaecating proctogram (DP) studies have become an integral part of the evaluation of patients with pelvic floor disorders. However, their impact on treatment decision-making remains unclear. The aim of this study was to assess the concordance of decision-making by colorectal surgeons and the role of the DP in this process. METHOD Four colorectal surgeons were presented with online surveys containing the complete history, examination and investigations of 106 de-identified pelvic floor patients who had received one of three treatment options: physiotherapy only, anterior Delorme's procedure or anterior mesh rectopexy. The survey assessed the management decisions made by each of the surgeons for the three treatments both before and after the addition of the DP to the diagnostic work-up. RESULTS After the addition of the DP results; treatment choice changed in 219 (52%) of 424 surgical decisions and interrater agreement improved significantly from κ = 0.26 to κ = 0.39. Three of the four surgeons reported a significant increase in confidence. Agreement with the actual treatments patients received increased from κ = 0.21 to κ = 0.28. Intra-anal rectal prolapse on DP was a significant predictor of a decision to perform anterior mesh rectopexy. CONCLUSION The DP improves interclinician agreement in the management of pelvic floor disorders and enhances the confidence in treatment decisions. Intra-anal rectal prolapse was the most influential DP parameter in treatment decision-making.
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Affiliation(s)
- Leanora Gomes
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Rowan J Collinson
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Julian L Hayes
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Bryan R Parry
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - David Milne
- Department of Radiology, University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
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27
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Yiasemidou M, Yates C, Cooper E, Goldacre R, Lindsey I. External rectal prolapse: more than meets the eye. Tech Coloproctol 2023; 27:783-785. [PMID: 37278904 DOI: 10.1007/s10151-023-02829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Affiliation(s)
- M Yiasemidou
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - C Yates
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - E Cooper
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England
| | - R Goldacre
- Nuffield Department of Population Health, Big Data Institute, Oxford University, Oxford, England
| | - I Lindsey
- Pelvic Floor Unit, Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, England.
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Emile SH, Khan SM, Garoufalia Z, Silva-Alvarenga E, Gefen R, Horesh N, Freund MR, Wexner SD. A network meta-analysis of surgical treatments of complete rectal prolapse. Tech Coloproctol 2023; 27:787-797. [PMID: 37150800 DOI: 10.1007/s10151-023-02813-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI). METHODS A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI. RESULTS Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47 months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant. CONCLUSIONS Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.
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Affiliation(s)
- S H Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - S M Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Z Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - E Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - R Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - N Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - M R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA.
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Drissi F, Rogier-Mouzelas F, Fernandez Arias S, Podevin J, Meurette G. Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series. J Clin Med 2023; 12:5751. [PMID: 37685818 PMCID: PMC10488879 DOI: 10.3390/jcm12175751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Introduction: Laparoscopic ventral mesh rectopexy (VMR) is the standard procedure for the treatment of posterior pelvic organ prolapse. Despite significant functional improvement and anatomical corrections, severe complications related to mesh augmentation can occur in a few proportions of patients. In order to decrease the number of rare but severe complications, we developed a variant of the conventional VMR without any rectal fixation and using a robotic approach with biological mesh. The aim of this study was to compare the results of laparoscopic ventral rectopexy with synthetic mesh (LVMRS) to those of robotic ventral rectopexy with biological mesh (RVMRB). Methods: Between 2004 and 2021, patients operated on for VMR in our unit were identified and separated into two groups: LVMRS and RVMRB. The surgical technique for both groups consisted of VMR without any rectal fixation, with mesh distally secured on the levator ani muscles. Results: 269 patients with a mean age of 62 years were operated for posterior pelvic floor disorder: rectocele (61.7%) and external rectal prolapse (34.6%). 222 (82.5%) patients received LVMRS (2004-2015), whereas 47 were operated with RVMRB (2015-2021). Both groups slightly differed for combined anterior fixation proportion (LVMRS 39% vs. RVMRB 6.4%, p < 0.001). Despite these differences, the length of stay was shorter in the RVMRB group (2 vs. 3 days, p < 0.001). Postoperative complications were comparable in the two groups (1.8 vs. 4.3%, p = 0.089) and mainly consisted of minor complications. Functional outcomes were favorable and similar in both groups, with an improvement in bulging, obstructed defecation symptoms, and fecal incontinence (NS in subgroup analysis). In the long term, there were no mesh erosions reported. The overall recurrence rate was 11.9%, and was comparable in the two groups (13% LVMRS vs. 8.5, p = 0.43). Conclusions: VMR without rectal fixation is a safe and effective approach in posterior organ prolapse management. RVMRB provides comparable results in terms of recurrence and functional results, with avoidance of unabsorbable material implantation.
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Affiliation(s)
- Farouk Drissi
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | - Fabien Rogier-Mouzelas
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | | | - Juliette Podevin
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | - Guillaume Meurette
- Division of Digestive Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland;
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Shah ZM, Naz R, Naz S, Zahoor S, Nosheen A, Shahid M, Anwar Z, Keyani R. Incorporation of zinc sulfide nanoparticles, Acinetobacter pittii and Bacillus velezensis to improve tomato plant growth, biochemical attributes and resistance against Rhizoctoniasolani. PLANT PHYSIOLOGY AND BIOCHEMISTRY : PPB 2023; 202:107909. [PMID: 37632995 DOI: 10.1016/j.plaphy.2023.107909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 06/05/2023] [Accepted: 07/24/2023] [Indexed: 08/28/2023]
Abstract
Green nanobiotechnology and beneficial bacterial strains as biofertilizers are crucial in agriculture to achieve food security. Both these strategies have been individually studied in improving plant resistance against phytopathogens along with enhancing plant productivity. Therefore, objective of this study was to explore the eco-friendly and cost-effective approach of utilizing plant growth promoting and disease suppressing bacterial strains and nanoparticles, individually as well as in combination, as bio-stimulants to improve plant growth, antioxidant defense system, nutrition and yield of tomato. A pot experiment was conducted to investigate the zinc sulfide nanoparticles (ZnS NPs) synthesized by using Jacaranda mimosifolia flower extracts (JFE), Acinetobacter pittii and Bacillus velezensis either individually or in combinations to check their potential against Rhizoctonia solani in tomato to suppress root rot infection and improve growth and yield. Among all the combinations the JFE-ZnS NPs + B. velezensis compared to untreated infected plants showed minimum disease incidence and maximum significant protection (66%) against R. solani instigated root rot that was followed by JFE-ZnS NPs + A. pittii and individual application of JFE-ZnS NPs by 58%. The same treatment showed maximum significant increase in plant fresh and dry biomass. B. velezensis significantly increased the photosynthetic pigments when applied individually. However, JFE-ZnS NPs alone and in mixed treatments with B. velezensis efficiently improved total soluble protein, sugar and phenolic contents. The same interactive application of JFE-ZnS NPs + B. velezensis improved the tomato plant nutrition (silicon (Si), magnesium (Mg), calcium (Ca) and potassium (K)) and redox quenching status by improving the activity of antioxidant defense enzymes. Overall, the interactive use of JFE-ZnS NPs with A. pittii and B. velezensis very appropriately prepared the host plant to fight against the negative effects of root rot pathogen in tomato. Advancements in interactively investigating the nanoparticles with beneficial plant growth promoting bacterial strains importantly can contribute in resolving the challenges of food security. According to our information, this is a pioneer report for implying JFE-ZnS NPs in synergism with A. pittii and B. velezensis to hinder the root rot in tomatoes.
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Affiliation(s)
| | - Rabia Naz
- Department of Biosciences, COMSATS University Islamabad, Pakistan.
| | - Sidra Naz
- Department of Biosciences, COMSATS University Islamabad, Pakistan
| | - Sidra Zahoor
- Department of Biosciences, COMSATS University Islamabad, Pakistan
| | - Asia Nosheen
- Department of Biosciences, COMSATS University Islamabad, Pakistan
| | - Muhammad Shahid
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Pakistan
| | - Zahid Anwar
- Department of Computer Science, COMSATS University Islamabad, Vehari Campus, Pakistan
| | - Rumana Keyani
- Department of Biosciences, COMSATS University Islamabad, Pakistan
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Brusciano L, Gambardella C, Falato A, Ronchi A, Tolone S, Lucido FS, Del Genio G, Gualtieri G, Terracciano G, Docimo L. Rectal Prolapse Pathological Features: Findings in Patients With Outlet Obstruction Treated With Stapled Transanal Rectal Resection. Dis Colon Rectum 2023; 66:e826-e833. [PMID: 35239529 DOI: 10.1097/dcr.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obstructed defecation syndrome is a common multifactorial disease for which treatment is based primarily on clinic presentation for the lack of reliable instrumental and anatomopathological criteria. OBJECTIVE The study aimed to analyze the pathological findings of the resected rectal specimens after stapled transanal rectal resection in patients affected by outlet obstruction. DESIGN Retrospective cohort study. SETTINGS University hospital. PATIENTS Patients who underwent rectal resection for obstructed defecation syndrome due to internal rectal prolapse were included. INTERVENTIONS Specimens of patients with obstructed defecation syndrome were analyzed through conventional histology and morphometric image analysis and compared with those of rectal specimens excised for oncological diseases. MAIN OUTCOME MEASURES Analysis of the anatomopathological impairments underlying rectal prolapse. RESULTS From January 2017 to December 2020, 46 specimens from the stapled transanal rectal resection group were compared with 40 specimens from the control group. In the stapled transanal rectal resection group, conventional histology revealed 34 samples (73.9%) had moderate- to severe-grade fibrosis with moderate-grade nerve degeneration in 33 cases (71.7%). In the control group, conventional histology revealed the absence of fibrosis in 31 specimens (77.5%), whereas the absence of nerve degeneration was detected in 37 specimens (92.5%). In the stapled transanal rectal resection group, morphometric image analysis showed severe-grade fibrosis in 25 cases (54.4%) compared to only low-grade fibrosis in 11 cases (27.5%). LIMITATIONS The small sample size and the retrospective design of the study were limitations. Moreover, there was no chance to use specimens from healthy volunteers as the control group. CONCLUSIONS Stapled transanal rectal resection specimens showed a higher rate of fibrosis and nerve dysplasia, an important parameter that is typically not considered preoperatively and could lead patients with rectal prolapse to the best treatment approach. See Video Abstract at http://links.lww.com/DCR/B928 . CARACTERSTICAS ANATOMOPATOLGICAS EN EL PROLAPSO DE RECTO HALLAZGOS EN PACIENTES CON OBSTRUCCIN DEL TRACTO DE SALIDA TRATADOS CON RESECCIN RECTAL TRANSANAL CON GRAPAS ANTECEDENTES:El síndrome de obstrucción del tracto de salida, es una afección multifactorial común, cuyo tratamiento está basado principalmente en la presentación clínica, ésto, debido a la falta de criterios confiables tanto instrumentales como anatomopatológicos.OBJETIVO:Analizamos los hallazgos histopatológicos de las piezas de resección rectal obtenidas por vía transanal mediante grapas, realizadas en pacientes que presentaban obstrucción del tracto de salida.DISEÑO:Este fue un estudio de cohorte retrospectivo.AJUSTE:El escenario fue un hospital universitario.PACIENTES:Aquellos sometidos a resección rectal por síndrome obstructivo del tracto de salida causada por un prolapso rectal interno.INTERVENCIONES:Los especímenes de pacientes con síndrome obstructivo defecatorio fueron analizados mediante histología convencional y análisis de imágenes morfométricas, comparados con especímenes rectales resecados por enfermedad oncológica.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario se concentró en la investigación de las deficiencias anatomopatológicas subyacentes del prolapso rectal interno.RESULTADOS:Desde enero de 2017 hasta diciembre de 2020, se compararon 46 especímenes del grupo de resección rectal transanal con grapas con 40 especímenes del grupo de control. En histología convencional, el grupo de resección rectal transanal con grapas, 34 muestras (73,9%) presentaron un grado de fibrosis moderada-severa con un grado moderado de degeneración neurógena en 33 casos (71,7%). En el grupo control, la histología convencional reveló ausencia de fibrosis en 31 especímenes (77,5 %), mientras que la ausencia de degeneración neurógena se detectó en 37 controles (92,5 %). En el grupo de resección rectal transanal con grapas, el análisis de imágenes morfométricas mostró fibrosis moderada y fibrosis severa en 19 (41,3%) y 25 (54,4%) casos, respectivamente. En el grupo control, el análisis de imágenes morfométricas mostró solo un bajo grado de fibrosis en 11 casos (27,5%). Se encontró una diferencia significativa en todos los grados de fibrosis y displasia neurógena entre los grupos en las evaluaciones de análisis de imagen morfométrica e histología convencional (p < 0,001).LIMITACIONES:El pequeño tamaño de la muestra y el diseño retrospectivo del estudio. Además, no existe la posibilidad de utilizar un grupo de control con muestras de voluntarios sanos.CONCLUSIONES:Los especímenes de resección rectal transanal con grapas mostraron una mayor tasa de fibrosis y displasia neurógena, parámetro importante que actualmente no está considerado antes de la operación y en un futuro muy cercano podría orientar a los pacientes con prolapso rectal interno hacia un mejor enfoque de tratamiento. Consulte Video Resumen en http://links.lww.com/DCR/B928 . (Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Luigi Brusciano
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Claudio Gambardella
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Armando Falato
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Salvatore Tolone
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Francesco S Lucido
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Gianmattia Del Genio
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giorgia Gualtieri
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Gianmattia Terracciano
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Ludovico Docimo
- Division of General, Oncologic, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy
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Oruc M, Erol T. Current diagnostic tools and treatment modalities for rectal prolapse. World J Clin Cases 2023; 11:3680-3693. [PMID: 37383136 PMCID: PMC10294152 DOI: 10.12998/wjcc.v11.i16.3680] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
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Affiliation(s)
- Mustafa Oruc
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Timucin Erol
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
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Rogier-Mouzelas F, Drissi F, Podevin J, Duchalais E, Meurette G. Anatomic and functional results of ventral biological mesh rectopexy for posterior pelvic floor disorders. J Visc Surg 2023; 160:188-195. [PMID: 36344359 DOI: 10.1016/j.jviscsurg.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Ventral mesh rectopexy (VMR) is the gold standard for rectal prolapse surgery, but the type of mesh reinforcement is still a matter of debate. The aim of this study was to assess the anatomic and functional results of a single center cohort of patients receiving ventral rectopexy with biological mesh compared to a reference group who had implantation of synthetic mesh. We also assessed the predictive factors for recurrence. PATIENTS AND METHODS Seventy patients (2015-2021) were included in the biological mesh group and were compared to a reference group of 345 patients operated on with a synthetic mesh (2004-2017). RESULTS In the biological mesh group, the mean age of patients was 65 years (53-72). The main disorders of the posterior pelvic floor were rectal prolapse (30 cases) or rectocele (37 cases). Two patients had solitary rectal ulcer syndrome and one had internal prolapse. VMR was performed by a laparoscopic approach with robotic assistance in 93%. After a median follow-up of 12 (4.5-23) months, the anatomic recurrence rate was 10%. The median satisfaction score assessed in a telephone interview by a semi-quantitative scale from 0 to 10 was 7. Compared to the synthetic group, neither the morbidity rate (Dindo>2) (0.6% synthetic versus 1.4% biological mesh), nor the recurrence rate (12% synthetic versus 10% biological (ns) with an average interval of 13.5 versus 14 months, respectively) were statistically significantly different. CONCLUSION VMR with biological mesh represents an alternative to synthetic mesh. Despite its resorbable nature, biological mesh does not seem to increase the risk of recurrence and offers satisfying functional results after a medium term follow-up.
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Affiliation(s)
- F Rogier-Mouzelas
- Cancer, digestive and endocrine surgery clinic, University Hospital Center of Nantes, 44093 Nantes cedex 1, France
| | - F Drissi
- Cancer, digestive and endocrine surgery clinic, University Hospital Center of Nantes, 44093 Nantes cedex 1, France
| | - J Podevin
- Cancer, digestive and endocrine surgery clinic, University Hospital Center of Nantes, 44093 Nantes cedex 1, France
| | - E Duchalais
- Cancer, digestive and endocrine surgery clinic, University Hospital Center of Nantes, 44093 Nantes cedex 1, France
| | - G Meurette
- Cancer, digestive and endocrine surgery clinic, University Hospital Center of Nantes, 44093 Nantes cedex 1, France.
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Singh S, Smyth E, Jones O, Cunningham C, Lindsey I. Outcomes of rectal prolapse surgery in patients with benign joint hypermobility syndrome. Tech Coloproctol 2023; 27:491-494. [PMID: 36869924 DOI: 10.1007/s10151-023-02770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/04/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Rectal prolapse is a debilitating disorder of the pelvic floor, and treatment outcomes are variable. Previous studies have identified underlying benign joint hypermobility syndrome (BJHS) in some patients. We sought to determine the outcomes of these patients after undergoing ventral rectopexy surgery (VMR). METHODS All consecutive patients who were referred to the pelvic floor unit at our institution between February 2010 and December 2011 were considered for recruitment into the study. Following recruitment, they were assessed using the Beighton criteria to determine the presence or absence of benign joint hypermobility syndrome. Both groups underwent similar surgical interventions and were then followed up. The need for revisional surgery was recorded in both groups. RESULTS Fifty-two patients [34 normal; M:F, 1:6; median age 61 (range 22-84) years; 18 BJHS; M:F, 0:1; median age 52 (range 25-79) years] were recruited. A total of 42 patients completed the full 1-year follow-up (26 normal, 16 benign joint hypermobility syndrome). Patients with benign joint hypermobility syndrome were significantly younger (median age 52 versus 61 years, p < 0.001) with male to female ratio of 0:1 versus 1:6, respectively. In addition, they were significantly more likely to require revisional surgery than those without the condition (31% versus 8% p < 0.001). In most cases, this was in the form of a posterior stapled transanal resection of the rectum procedure. CONCLUSIONS Patients with BJHS presenting for rectal prolapse surgery were younger and are more likely to require further surgery for rectal prolapse recurrence than those without the condition.
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Affiliation(s)
- Sandeep Singh
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
| | - Edward Smyth
- Department of Colorectal Surgery, Musgrove Park Hospital, Taunton, UK
| | - Oliver Jones
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Ian Lindsey
- Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
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Sciberras P, Calleja R, Bugeja R, Montebello G, Camilleri-Brennan J. Pelvic Vascular Malformations and Recurrent Rectal Prolapse in a Patient With Maffucci Syndrome: A Diagnostic and Therapeutic Challenge. Cureus 2023; 15:e39095. [PMID: 37332422 PMCID: PMC10270431 DOI: 10.7759/cureus.39095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Maffucci syndrome is an extremely rare congenital condition characterized by the development of multiple enchondromas and haemangiomas, primarily on the extremities, and an association with various tumors. Colonic and pelvic floor function has never been explored in patients with Maffucci syndrome. We report a case illustrating the challenges in managing colonic and pelvic floor dysfunction in a female patient secondary to vascular malformations as part of Maffucci syndrome.
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Affiliation(s)
- Peter Sciberras
- Surgery, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | | | - Rebecca Bugeja
- Surgery, Northern Care Alliance NHS Foundation Trust, Salford, GBR
| | | | - John Camilleri-Brennan
- Surgery, NHS Forth Valley, Stirling, GBR
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, GBR
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Kwak HD, Chung JS, Ju JK. A comparative study between transanal and transabdominal approaches in treatment of complete rectal prolapse. Int J Colorectal Dis 2023; 38:78. [PMID: 36959426 DOI: 10.1007/s00384-023-04371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
Formulating clear guidelines for the most reliable treatment methods for complete rectal prolapse appears challenging. The authors designed this study to compare the results according to the approaches for female complete rectal prolapse and to suggest a more effective method. The transanal and abdominal groups showed differences in operating time, hospital stay, and recurrence rate. However, both groups demonstrated improvement in postoperative functional evaluation. PURPOSE There is a wide variety of surgical methods to treat rectal prolapse; however, to date, no clear agreement exists regarding the most effective surgical method. This study was designed to compare the results according to the surgical approach for complete rectal prolapse in women. METHODS This study was conducted from March 2016 to February 2021 on female patients with rectal prolapse who underwent surgery. First, all patients were classified into mucosal and complete layer groups to confirm the difference in results between the two groups, and only complete layer prolapse patients were divided into transanal and abdominal approaches to compare parameters and functional outcomes in each group. RESULTS A total of 180 patients were included, with an average age of 71.7 years and 102 complete prolapses. The complete layer group was found to have more abdominal access, longer operating time, and higher recurrence rates compared to the mucosal layer group. (p<0.001) When targeting only the complete layer patients, there were 65 patients with the transanal and 37 with the abdominal (laparoscopic) approaches. The abdominal approach group had a longer operating time and hospital stay (p<0.001, respectively) and lower recurrence rate than the transanal group (transanal vs. abdominal, 38% vs. 10.8%, p=0.003), while the Wexner constipation and incontinence scores showed improved results in both groups. CONCLUSION Although operating time and hospitalization period were shorter in the transanal group, laparoscopic abdominal surgery is a procedure that can reduce the recurrent rate for complete rectal prolapse.
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Affiliation(s)
- Han Deok Kwak
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, Chonnam National University Hospital, Chonnam National University, 42 Jaebong-ro, Gwangju, 61469, Republic of Korea
| | - Jun Seong Chung
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, Chonnam National University Hospital, Chonnam National University, 42 Jaebong-ro, Gwangju, 61469, Republic of Korea
| | - Jae Kyun Ju
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, Chonnam National University Hospital, Chonnam National University, 42 Jaebong-ro, Gwangju, 61469, Republic of Korea.
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Chowdhury F, D'Souza N, Balasuriya H, Gonsalves SJ, Ng KS. Surgical approach for the laparoscopic-assisted Altemeier procedure - A video vignette. Colorectal Dis 2023; 25:517-518. [PMID: 36205063 DOI: 10.1111/codi.16357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Fatiha Chowdhury
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Nigel D'Souza
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Hasitha Balasuriya
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | | | - Kheng-Seong Ng
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Concord Institute of Academic Surgery, University of Sydney, Concord, New South Wales, Australia
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Chung JS, Ju JK, Kwak HD. Comparison of abdominal and perineal approach for recurrent rectal prolapse. Ann Surg Treat Res 2023; 104:150-155. [PMID: 36910558 PMCID: PMC9998957 DOI: 10.4174/astr.2023.104.3.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose Rectal prolapse is a benign disease in which the rectum protrudes below the anus. Although many studies have been reported on the treatment of primary rectal prolapse for many years, there is a lack of treatment or clinical research results on recurrent rectal prolapse. This study aimed to evaluate the outcomes of surgical approaches for recurrent rectal prolapse. Methods We studied patients who underwent surgical treatment for recurrent rectal prolapse disease from March 2016 to February 2021. We analyzed the previous operation methods in patients with recurrent rectal prolapse, as well as the operation time, complication rate, hospital stay, and re-recurrence rates in the perineal and abdominal approach groups. Results Out of a total of 239 patients, 41 patients who underwent surgery for recurrent rectal prolapse were retrospectively enrolled. Recurrent rectal prolapses were surgically treated either by the perineal approach (n = 25, 61.0%) or by the abdominal approach (n = 16, 39.0%). The operation times were significantly longer in the abdominal approach than in the perineal approach (98.44 minutes vs. 58.00 minutes, P = 0.001). Hospital stay was significantly longer in the abdominal approach than in the perineal approach (9.19 days vs. 6.00 days, P = 0.012). Re-recurrence rate after repeat repair was not significantly different between the 2 groups (P = 0.777). Conclusion Although the perineal approach shortened the operation time and hospital stay, there were no significant differences between the 2 groups in postoperative complications and re-recurrence rate. Both approaches can be good surgical options for the treatment of recurrent rectal prolapse.
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Affiliation(s)
- Jun Seong Chung
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.,Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.,Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Natural Orifice Transanal Endoscopic Rectopexy for Complete Rectal Prolapse: Prospective Evolution of a New Technique and Short-term Outcomes. Dis Colon Rectum 2023; 66:118-129. [PMID: 36515516 DOI: 10.1097/dcr.0000000000002453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoluminal surgery for the management of rectal prolapse remains largely experimental. OBJECTIVE To evaluate the evolution and short-term outcomes of a new endoluminal technique for the management of complete rectal prolapse. DESIGN This was a prospective study. SETTINGS This study was conducted at a single tertiary care teaching center. PATIENTS A total of 29 patients were included. The first 12 patients underwent the procedure with our initial technique, and the last 17 patients were subjected to the new modified procedure. The follow-up duration was 3 years for the older technique and 26 months for the newer technique. INTERVENTION This technique involves: 1) ventral "suture" rectopexy: rectum is fixed anteriorly to the anterior abdominal wall using percutaneously placed sutures. 2) Posterior rectum is fixed to the sacral promontory using tackers through a submucosal tunnel. MAIN OUTCOME MEASURES Safety, recurrence, functional outcomes, morbidity, and mortality were the main outcome measures. RESULTS There were improvements in constipation and incontinence scores, anal manometric pressures, anorectal angle, anorectal descent, and quality of life postoperatively in both groups. In patients undergoing the modified procedure, there was a significant decrease in duration of surgery (220 ± 48.89 vs 110 ± 12.51 min), shortened hospital stay (4.6 ± 1.71 vs 2.6 ± 0.65 d), decreased recurrence (25% vs 5.8%), and complications (surgical-site infection and retrorectal abscess). LIMITATIONS Short follow-up, small sample size, and single-center study were the limitations. CONCLUSION This is a novel endoluminal technique for treating rectal prolapse obviating perirectal dissection, abdominal incisions, or a mesh. This can now be performed under complete endoscopic and fluoroscopic vision. It avoids general anesthesia and therefore can be an alternative for patients with comorbid conditions in whom the standard abdominal procedure may not be well tolerated. Larger randomized multicentric studies with longer follow-ups are warranted. See Video Abstract at http://links.lww.com/DCR/C59. RECTOPEXIA ENDOSCPICA TRANSANAL POR ORIFICIO NATURAL PARA EL PROLAPSO RECTAL COMPLETO EVOLUCIN PROSPECTIVA DE UNA NUEVA TCNICA Y RESULTADOS A CORTO PLAZO ANTECEDENTES:La cirugía endoluminal para el tratamiento del prolapso rectal ha permanecido en gran parte experimental.OBJETIVO:Este estudio tiene como objetivo evaluar la evolución y los resultados a corto plazo de una nueva técnica endoluminal para el manejo del prolapso rectal completo.DISEÑO:Estudio prospectivo.ÁMBITOS:Único centro docente de tercer nivel de atención.PACIENTES:Se incluyeron un total de 29 pacientes (19 hombres y 10 mujeres) con prolapso rectal completo. Los primeros 12 pacientes fueron sometidos al procedimiento con nuestra técnica anteriormente descrita y los últimos 17 pacientes fueron sometidos al nuevo procedimiento modificado. La duración del seguimiento es de 3 años para la técnica más antigua y de 26 meses para la técnica más nueva.INTERVENCIÓN:Esta técnica implica: A) Rectopexia de "sutura" ventral: el recto se fija anteriormente a la pared abdominal anterior mediante suturas colocadas percutáneamente. B) El recto posterior se fija al promontorio sacro mediante grapas a través de un túnel submucoso.PRINCIPALES MEDIDAS DE RESULTADO:Seguridad, recurrencia, resultados funcionales, morbilidad y mortalidad.RESULTADOS:Hubo mejorías en las puntuaciones de estreñimiento (ODS) e incontinencia (SMIS), presiones manométricas anales (reposo y contracción), ángulo anorrectal, descenso anorrectal y calidad de vida post operatoria en ambos grupos. En los pacientes sometidos al procedimiento modificado hubo una significativa disminución en la duración de la cirugía (220 + 48,89 vs 110 + 12,51 minutos), acortamiento de la estancia hospitalaria (4,6 + 1,71 vs 2,6 + 0,65 días), disminución de la recurrencia (25% vs 5,8%) y complicaciones (infecciónes del sitio quirúrgico y abscesos retrorrectales).LIMITACIONES:Seguimiento corto, tamaño de muestra pequeña, estudio de un solo centro.CONCLUSIÓNES:La rectopexia endoscópica transanal por orificio natural (NOTER) es una novedosa técnica endoluminal para el tratamiento del prolapso rectal que evita la disección perirrectal, las incisiones abdominales o la fijación de una malla. Este procedimiento puede realizar hoy día bajo visión completa endoscópica y fluoroscópica. Evita la anestesia general y, por lo tanto, puede ser una alternativa para pacientes con condiciones comórbidas donde el procedimiento abdominal estándar puede no ser bien tolerado. Se justifican estudios multicéntricos aleatorios más grandes con un seguimiento más prolongado para validar aún más esta nueva técnica. Consulte Video Resumen en http://links.lww.com/DCR/C59. (Traducción-Dr Osvaldo Gauto).
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The Middle Compartment: Keystone or Cul De Sac? Dis Colon Rectum 2022; 65:1415-1417. [PMID: 36102875 DOI: 10.1097/dcr.0000000000002604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Does Concomitant Pelvic Organ Prolapse Repair at the Time of Rectopexy Impact Rectal Prolapse Recurrence Rates? A Retrospective Review of the Prospectively Collected Pelvic Floor Disorders Consortium Quality Improvement Database Pilot. Dis Colon Rectum 2022; 65:1522-1530. [PMID: 36102871 DOI: 10.1097/dcr.0000000000002495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pelvic organ prolapse is reported in 30% of women presenting with rectal prolapse. Combined repair is a viable option to avoid the need for future pelvic floor interventions. However, the added impact of adding a modicum of middle compartment suspension by closing the pouch of Douglas during a rectal prolapse repair has not been studied. OBJECTIVE The study aimed to assess the impact of middle compartment suspension on the durability of rectal prolapse repair. We also aimed to determine whether adding some form of pouch of Douglas closure to achieve middle compartment suspension leads to any improvements in the rates or severity of postoperative constipation or in the rates or severity of postoperative fecal incontinence. DESIGN This study was a retrospective analysis of a multicenter prospective database. SETTING Data were analyzed from the Pelvic Floor Disorders Consortium Quality Improvement in Rectal Prolapse Surgery database. Deidentified surgeons at more than 20 sites (75% academic, 81% high volume) self-reported patient demographics, previous repairs, symptoms of fecal incontinence and obstructed defecation, and operative details, including addition of concomitant gynecologic repairs, use of mesh, posterior or ventral dissection, and sigmoidectomy. PATIENTS Patients were included who underwent abdominal repair for rectal prolapse. INTERVENTIONS Abdominal rectopexy procedures with and without middle compartment suspension were compared. Middle compartment suspension was defined as excision and closure of the pouch of Douglas with some degree of colpopexy or culdoplasty. MAIN OUTCOME MEASURES The primary outcome of prolapse recurrence and secondary outcomes of incontinence and constipation were calculated via univariate and multivariable regression by comparing those who underwent rectopexy with and without middle compartment suspension. RESULTS Of the 198 patients (98% female, age 60.2 ± 15.6 years) who underwent abdominal repairs (59% robotic), 138 patients (70%) underwent some concomitant middle compartment suspension. Patients who had an added middle compartment suspension seemed to have lower early rectal prolapse recurrences. On multivariable regression to control for age, previous repairs, and the use of mesh, addition of some form of pouch of Douglas repair was associated with a decrease in short-term recurrences. LIMITATIONS Our data need to be interpreted cautiously. Future studies are critically needed to further explore this observation, with an a priori, prospective definition of middle compartment suspension, validated measurement of concomitant pathology, and longer follow-up. CONCLUSION Our results suggest that some middle compartment suspension at the time of rectal prolapse repair may improve short-term durability of rectal prolapse repair. See Video Abstract at http://links.lww.com/DCR/C30 . LA REPARACIN CONCOMITANTE DEL PROLAPSO DE RGANOS PLVICOS EN EL MOMENTO DE LA RECTOPEXIA AFECTA LAS TASAS DE RECURRENCIA DEL PROLAPSO RECTAL UNA REVISIN RETROSPECTIVA DE UNA BASE DE DATOS RECOPILADA PROSPECTIVAMENTE DEL CONSORCIO SOBRE LA MEJORA DE LA CALIDAD DE TRASTORNOS DEL PISO PLVICO ANTECEDENTES:El prolapso de órganos pélvicos se informa en el 30 % de las mujeres que presentan prolapso rectal y la reparación combinada es una opción viable para evitar la necesidad de futuras intervenciones del suelo pélvico. Sin embargo, no se ha estudiado el impacto adicional de agregar un mínimo de suspensión del compartimento medio cerrando el fonde de saco de Douglas durante una reparación de prolapso rectal.OBJETIVO:Nuestro objetivo fue evaluar el impacto de la suspensión del compartimento medio con respecto a la durabilidad de la reparación del prolapso rectal. Quisimos de igual manera determinar si el agregado de algún tipo de cierre del fondo de saco de Douglas para lograr la suspensión del compartimento medio conduce a alguna mejora en las tasas o la gravedad del estreñimiento posoperatorio así como en las tasas o la gravedad de la incontinencia fecal posoperatoria.DISEÑO:Análisis retrospectivo de una base de datos prospectiva.ESCENARIO:Base de datos Multicenter Pelvic Floor Disorders Consortium Prospective Quality Improvement. Cirujanos no identificados en >20 sitios (75% académicos, 81% de alto volumen) datos demográficos de pacientes auto informados, reparaciones previas, síntomas de incontinencia fecal y defecación obstruida, y detalles quirúrgicos, incluida la suma de reparaciones ginecológicas concomitantes, uso de malla, disección anterior o posterior y sigmoidectomía.INTERVENCIONES:Se compararon los procedimientos de rectopexia abdominal con y sin suspensión del compartimento medio). La suspensión del compartimento medio se definió como la escisión y cierre del fondo de saco de Douglas con algún grado de colpopexia o culdoplastia.RESULTADOS:El resultado principal de la recurrencia del prolapso y los resultados secundarios de incontinencia y estreñimiento se calcularon mediante regresión uni y multivariable al comparar los que fueron sometidos a rectopexia con y sin suspensión del compartimento medio.PACIENTES:Pacientes sometidos a reparación abdominal por prolapso rectal.RESULTADOS:De los 198 pacientes (98% mujeres, edad 60,2 ± 15,6 años) sometidas a reparaciones abdominales (59% robótica), 138 (70%) fueron sometidas igualmente y de manera concomitante a alguna suspensión del compartimento medio. Los pacientes a los que se les añadió una suspensión del compartimento medio parecían tener menores recurrencias tempranas del prolapso rectal y, en la regresión multivariable para controlar la edad, las reparaciones previas y el uso de malla, la adición de alguna forma de reparación del fondo de saco de Douglas se asoció con una disminución de las recurrencias a corto plazo.LIMITACIONES:Nuestros datos deben interpretarse con cautela. Se necesitan de manera critica, estudios futuros para explorar más a fondo esta observación, con una definición prospectiva a priori de la suspensión del compartimento medio, una medición validada de la patología concomitante y un seguimiento más prolongado.CONCLUSIONES:Nuestros resultados sugieren que alguna suspensión del compartimento medio en el momento de la reparación del prolapso rectal puede mejorar la durabilidad a corto plazo de la reparación del prolapso rectal. Consulte Video Resumen en http://links.lww.com/DCR/C30 . (Traducción-Dr. Osvaldo Gauto ).
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Rajasingh CM, Gurland BH. Management of Full Thickness Rectal Prolapse. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy. Tech Coloproctol 2022; 26:991-995. [PMID: 35994138 DOI: 10.1007/s10151-022-02689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
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Suzuki S, Godai T, Kato S, Onodera A, Endo K, Onuma S, Honjo Y, Shirai J, Numata M, Kumakiri Y, Suzuki S, Yamamoto Y. A Case of Robotic Posterior Rectopexy for Full-thickness Rectal Prolapse. J Anus Rectum Colon 2022; 6:72-76. [PMID: 35128140 PMCID: PMC8801250 DOI: 10.23922/jarc.2021-028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
We describe our experience with robotic posterior rectopexy for a patient with full-thickness rectal prolapse. To our knowledge, this is the first report of such a case in the literature. A 94-year-old woman presented with a history of gradually worsening rectal prolapse. On examination, we found that the rectum was completely prolapsed, and we observed a prolapsed intestinal tract. Surgery was indicated and robotic rectopexy was performed without intraoperative complications. The postoperative course was uneventful, and she was discharged 10 days after the operation. One year later, there were no signs of recurrence. Robotic surgery has become common in recent years. We used robotic surgery for rectopexy, including the suturing procedure. Suturing in robotic surgery is easier than that in laparoscopic surgery, and we demonstrated that robotic rectopexy could be safely and easily performed. The trial was registered in the UMIN clinical trial registry (number 000040378).
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Affiliation(s)
| | - Teni Godai
- Department of Surgery, Fujisawa Shonandai Hospital
| | - Shin Kato
- Department of Surgery, Fujisawa Shonandai Hospital
| | | | - Kazuya Endo
- Department of Surgery, Fujisawa Shonandai Hospital
| | | | - Yui Honjo
- Department of Surgery, Fujisawa Shonandai Hospital
| | - Junya Shirai
- Department of Surgery, Fujisawa Shonandai Hospital
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Smedberg J, Graf W, Pekkari K, Hjern F. Comparison of four surgical approaches for rectal prolapse: multicentre randomized clinical trial. BJS Open 2022; 6:6511762. [PMID: 35045155 PMCID: PMC8769527 DOI: 10.1093/bjsopen/zrab140] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Several different procedures have been described for surgical treatment of rectal prolapse and consensus on the optimal approach has not been reached. The Swedish Rectal Prolapse Trial was performed with the aim to compare the outcomes after the most common surgical approaches to rectal prolapse. METHOD A multicentre randomized trial was conducted from 2000 to 2009. Patients were randomized between a perineal or an abdominal approach for correction of rectal prolapse (randomization A) if eligible for any procedures. Patients considered unsuitable for random allocation were only included in randomizations B or C. Patients in randomization B (perineal group) were randomized to Delorme's or Altemeier's procedures and those in randomization C (abdominal group) to suture rectopexy or resection rectopexy. Primary outcomes were bowel function and quality of life, measured using Wexner incontinence score and RAND-36, and secondary outcomes were complications and recurrence at 3 years. RESULTS During the study period, 134 patients were randomized: 18 in randomization A group, 80 in randomization B group and 54 in randomization C group; of these, 122 patients underwent surgery. Mean follow-up was 2.6 years. Improvements in Wexner and RAND-36 scores were seen but with no significant difference between the groups. Health change scores were significantly improved from baseline up to 1 year after surgery (P < 0.001). At 3 years, recurrence rates were two of seven patients for abdominal versus five of eight patients for perineal approach (P = 0.315), 18 of 31 patients (58 per cent) for Delorme's versus 15 of 30 patients (50 per cent) for Altemeier's (P = 0.611) and four of 19 patients (21 per cent) for suture rectopexy versus two of 21 patients (10 per cent) for resection rectopexy (P = 0.398). There were no significant differences regarding postoperative complications. CONCLUSION For all procedures, significant improvements from baseline in health change scores were noted after surgery. Recurrence rates were higher than previously reported. Registration number: NCT04893642 (http://www.clinicaltrials.gov).
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Affiliation(s)
- J Smedberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - W Graf
- Department of Surgical Sciences, Section of Surgery, Akademiska Sjukhuset, Uppsala, Sweden
| | - K Pekkari
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - F Hjern
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Pellino G, Fuschillo G, Simillis C, Selvaggi L, Signoriello G, Vinci D, Kontovounisios C, Selvaggi F, Sciaudone G. OUP accepted manuscript. BJS Open 2022; 6:6564775. [PMID: 35390136 PMCID: PMC8989040 DOI: 10.1093/bjsopen/zrac018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background External rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP. Methods This was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle–Ottawa Scale and Cochrane tool. Results Fifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, and several outcomes from RCTs were not consistent with those observed in non-RCTs. Conclusion The overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic.
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Affiliation(s)
- Gianluca Pellino
- Correspondence to: Gianluca Pellino, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy (e-mail: ; ; @GianlucaPellino)
| | - Giacomo Fuschillo
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Costantinos Simillis
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lucio Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giuseppe Signoriello
- Section of Statistic, Department of Experimental Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Danilo Vinci
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francesco Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Guido Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
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Ju J, Kwak H, Chung J. A comparative study on the surgical options for male rectal prolapse. J Minim Access Surg 2022; 18:426-430. [PMID: 35708386 PMCID: PMC9306117 DOI: 10.4103/jmas.jmas_214_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: Rectal prolapse is known to be a rare condition in males compared to females. This study aimed to analyse the frequency of male rectal prolapse and compare the results of different surgical approaches performed at a single centre. Patients and Methods: The authors included patients who underwent surgical treatment for rectal prolapse from March 2016 to February 2021. The proportion of males, mean age and recurrence rates were calculated. Patients were divided into two groups, transanal approach and laparoscopic abdominal approach group, to identify the para-operative parameters including functional tests. Results: A total of 56 males, comprising 23.7% (56/236) of all patients. The mean age was 60.8 years, with a recurrence rate of 7 cases (12.5%) during 7.2 months of follow-up. Forty patients underwent transanal procedures, and fifteen underwent laparoscopic abdominal procedures. The mean operative time was longer in the laparoscopic group (transanal vs. abdominal, 57.5 vs. 70.6 min, P < 0.003), and intra-operative bleeding was greater in the transanal group (12.4 vs. 3.4 ml, P < 0.001). Full-layer prolapse (36.8 vs. 81.2% P = 0.003) and longer length (5.6 vs. 7.8 cm, P = 0.048) were more common in laparoscopic group. Time to feeding resumption was shorter after the transanal group (1.2 vs. 1.7 days, P = 0.028). There was no difference between the groups in terms of post-operative complications and recurrence rates. Both Wexner's constipation and incontinence scores showed significant improvement postoperatively. Conclusion: The frequency of male rectal prolapse was 23.7%, and perioperative factors differed between transanal and abdominal approaches, but recurrence rates and functional test results did not differ significantly.
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Hong KD, Hyun K, Um JW, Yoon SG, Hwang DY, Shin J, Lee D, Baek SJ, Kang S, Min BW, Park KJ, Ryoo SB, Oh HK, Kim MH, Chung CS, Joh YG. Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study. Ann Surg Treat Res 2022; 102:234-240. [PMID: 35475228 PMCID: PMC9010966 DOI: 10.4174/astr.2022.102.4.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Kwang Dae Hong
- Department of Colorectal Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Keehoon Hyun
- Department of Colorectal Surgery, Song Do Hospital, Seoul, Korea
| | - Jun Won Um
- Department of Colorectal Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Seo-Gue Yoon
- Department of Colorectal Surgery, Song Do Hospital, Seoul, Korea
| | - Do Yeon Hwang
- Department of Colorectal Surgery, Song Do Hospital, Seoul, Korea
| | - Jaewon Shin
- Department of Colorectal Surgery, Dae-Hang Hospital, Seoul, Korea
| | - Dooseok Lee
- Department of Colorectal Surgery, Dae-Hang Hospital, Seoul, Korea
| | - Se-Jin Baek
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Sanghee Kang
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Byung Wook Min
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Kyu Joo Park
- Department of Colorectal Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Colorectal Surgery, Seoul National University Hospital, Seoul, Korea
| | - Heung-Kwon Oh
- Department of Colorectal Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Hyun Kim
- Department of Colorectal Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choon Sik Chung
- Department of Colorectal Surgery, Hansol Hospital, Seoul, Korea
| | - Yong Geul Joh
- Department of Colorectal Surgery, Hansol Hospital, Seoul, Korea
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Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, Abongwa H, De Simone B, Gallo G, Rossi G, Abu-Zidan F, Agnoletti V, de'Angelis G, de'Angelis N, Ansaloni L, Baiocchi GL, Carcoforo P, Ceresoli M, Chichom-Mefire A, Di Saverio S, Gaiani F, Giuffrida M, Hecker A, Inaba K, Kelly M, Kirkpatrick A, Kluger Y, Leppäniemi A, Litvin A, Ordoñez C, Pattonieri V, Peitzman A, Pikoulis M, Sakakushev B, Sartelli M, Shelat V, Tan E, Testini M, Velmahos G, Wani I, Weber D, Biffl W, Coccolini F, Catena F. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16:48. [PMID: 34530908 PMCID: PMC8447593 DOI: 10.1186/s13017-021-00384-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Hariscine Abongwa
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Belinda De Simone
- Department of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, Poissy, France
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Rossi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- Department of Emergency and general Surgery, Pavia University Hospital, Pavia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Alain Chichom-Mefire
- Faculty of Health Sciences, Department of Surgery, University of Buea, Buea, Cameroon
| | - Salomone Di Saverio
- General surgery 1st unit, Department of General Surgery, University of Insubria, Varese, Italy
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Mario Giuffrida
- Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Carlos Ordoñez
- Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | | | - Andrew Peitzman
- University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Manos Pikoulis
- 3rd Department of Surgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
| | | | - Vishal Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Edward Tan
- Department of Surgery, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo" Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
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