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Elbarmelgi MY, Shafik AA, Badee SF, Mohamed OR, Tamer M. Levatorplasty's role in rectal prolapse management for patients with wide pelvic hiatus: a cohort study. BMC Surg 2025; 25:19. [PMID: 39794720 PMCID: PMC11724573 DOI: 10.1186/s12893-024-02693-9] [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: 07/14/2024] [Accepted: 12/02/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND AND AIMS Rectal prolapse (RP) is a debilitating condition and can cause symptoms of fecal incontinence, obstructed defecation, incomplete evacuation of the rectum, and pain. In recent years, there has been increasing evidence that prolapse development is strongly associated with pelvic hiatus (GH) size (normal 4.5 +/- 0.7). Multiple surgical studies have suggested that an enlarged pelvic hiatus may be associated with prolapse recurrence. The main aim of this study is to assess the role of combining levatorplasty -with different rectal prolapse surgeries- on recurrence rate and improvement of symptoms in patients that were treated for rectal prolapse with wide pelvic hiatus. PATIENTS AND METHODS Our study is a combined retrospective and prospective cohort study which included sixty patients with rectal prolapse with wide pelvic hiatus, they were divided into two groups (each group thirty patients). One group underwent rectal prolapse repair, the other group underwent rectal prolapse repair with levatorplasty. RESULTS Levatorplasty group showed improvement in Wexner score, recurrence rate in comparison to the other group. Both groups showed similar results in postoperative pain and dyspareunia. CONCLUSION Rectal prolapse repair combined with levatorplasty in patients complaining of rectal prolapse with wide pelvic hiatus have better outcome mainly in decreasing recurrence rate.
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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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Vurture G, Jacobson N. Resolution of symptoms of rectal prolapse after repair of vaginal prolapse: A report of two cases. Case Rep Womens Health 2024; 42:e00606. [PMID: 38596813 PMCID: PMC11002792 DOI: 10.1016/j.crwh.2024.e00606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Pelvic organ prolapse (POP) is a very common problem that can affect any aspect of the pelvic floor. Often, vaginal and rectal prolapse occur simultaneously. Prior case reports have suggested resolution of symptoms of rectal prolapse in those with concomitant rectal and vaginal prolapse; however, the overall body of evidence is limited. We present the cases of two patients who had complete resolution of their symptoms of rectal prolapse after repair of a concomitant vaginal prolapse. Both patients underwent a traditional rectocele repair and perineoplasty, and subsequently reported complete resolution of their symptoms of rectal prolapse, which persisted at their six-month post-operative visits. The second patient ultimately canceled a previously scheduled rectopexy with colorectal surgery. Perhaps a rectocele repair with perineoplasty is limiting rectal mobility, and therefore eliminating its ability to prolapse or intussuscept and cause bothersome symptoms. We suggest that those with concomitant vaginal and rectal prolapse desiring corrective surgery first undergo a less invasive vaginal repair. Post-operative re-evaluation of the symptoms rectal prolapse might then demonstrate that a more invasive rectal prolapse repair, which may involve a colon resection and prolonged hospital stay, was not in fact needed. Further prospective and randomized study is needed to determine the long-term outcomes of concomitant rectal and vaginal prolapse in those who first undergo a vaginal repair.
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Affiliation(s)
- Gregory Vurture
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hackensack Meridian Health - Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Nina Jacobson
- Division of Urogynecology, Department of Obstetrics and Gynecology, Hackensack Meridian Health - Jersey Shore University Medical Center, Neptune, NJ, USA
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Wang B, Han W, Zhai Y, Shi R. Sigmoido-rectal intussusception anastomosis in the Altemeier procedure for complete rectal prolapse: preliminary results of a new technique. Front Surg 2024; 11:1340500. [PMID: 38375412 PMCID: PMC10875026 DOI: 10.3389/fsurg.2024.1340500] [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] [Received: 11/18/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose Our research introduces an innovative surgical approach, combining the Altemeier Procedure with Sigmoido-rectal Intussusception Anastomosis, effectively reducing recurrence, minimizing complications, and improving postoperative anal function in rectal prolapse patients. Materials and methods This retrospective study, conducted at tertiary referral hospitals including Shandong University of Traditional Chinese Medicine's Affiliated Hospital, Linyi People's Hospital, and Pingyi People's Hospital, examined data from patients undergoing conventional Altemeier surgery or Altemeier combined with Sigmoido-rectal Intussusception Anastomosis. Analyzing hospitalization and follow-up data from January 2009 to December 2022, the study focused on prolapse recurrence, complications, and anal function as primary outcome indicators across these three study centers. Results In the study, both groups had an average follow-up of (12.5 ± 2.41) months, and only two traditional group patients experienced mortality. Recurrence rates significantly differed, with 26.47% in the traditional group and 1.54% in the modified group (P < 0.001). The modified group showed no perioperative anastomotic dehiscence, contrasting with a 13.24% occurrence in the conventional group (P = 0.003). Primary complications in the modified group included anastomotic hemorrhage, with rates of 17.65% and 6.15% in the traditional and modified groups, respectively (P = 0.077). At 12 months postoperatively, both groups improved in anal manometry parameters and the Wexner anal incontinence score. Resting pressure was significantly lower in the traditional group (32.50 ± 1.76 mmHg) than the modified group (33.24 ± 2.06 mmHg) (P = 0.027), while the extrusion pressure was higher in the modified group (64.78 ± 1.55 mmHg) than the traditional group (62.85 ± 2.30 mmHg) (P < 0.001). The Wexner anal incontinence score was significantly lower in the modified group (2.69 ± 1.65) than the traditional group (3.69 ± 1.58, P = 0.001). Conclusion This retrospective study affirms that adding Sigmoido-rectal Intussusception Anastomosis to the Altemeier procedure reduces recurrence and complications. While both approaches enhance postoperative anal function in complete rectal prolapse patients, the combined method, particularly with Sigmoido-rectal Intussusception Anastomosis, proves more effective.
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Affiliation(s)
- Benjun Wang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Weiwei Han
- Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuze Zhai
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Renjie Shi
- Department of Anorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Anorectal Surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, China
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Penton AA, Jochum SB, Eberhardt JM. Unusual presentation of colon cancer as rectal prolapse in middle-aged male. Clin Case Rep 2023; 11:e6908. [PMID: 36873063 PMCID: PMC9979960 DOI: 10.1002/ccr3.6908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/10/2023] [Indexed: 03/06/2023] Open
Abstract
Rectal prolapse is typically a benign idiopathic condition. Rarely, rectal prolapse can be due to or associated with colorectal carcinoma. Here we present a middle-aged gentleman with no previous medical or surgical history, who presented with rectal prolapse secondary to sigmoid adenocarcinoma.
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Affiliation(s)
- Ashley A. Penton
- Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
| | - Sarah B. Jochum
- Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
| | - Joshua M. Eberhardt
- Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
- Division of Colon and Rectal Surgery, Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
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Kalev G, Marquardt C, Schmerer M, Ulrich A, Heyl W, Schiedeck T. Resection rectopexy as part of the multidisciplinary approach in the management of complex pelvic floor disorders. Innov Surg Sci 2023; 8:29-36. [PMID: 37842195 PMCID: PMC10576551 DOI: 10.1515/iss-2022-0027] [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: 11/06/2022] [Accepted: 05/22/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required. Methods All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications. Results Two hundred and eighty seven patients were assigned to one of the following groups: PG1 - patient group one: after resection rectopexy (n=141); PG2 - after ventral rectopexy (n=8); PG3 - after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4 - after combined resection rectopexy and trans-vaginal pelvic floor repair (n=76). The duration of follow-up was 14 months for PG1 (median, IQR 37 months), 11 months for PG2 (mean, SD 9 months), 7 months for PG 3 (median, IQR 33 months), and 12 months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. "De novo" constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade ≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499). Conclusions Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.
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Affiliation(s)
- Georgi Kalev
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Christoph Marquardt
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Marten Schmerer
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Anja Ulrich
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Wolfgang Heyl
- Department of Obstetrics and Gynecology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Thomas Schiedeck
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
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Kwan B, Gillespie C, Warwick A. Colonoscopic findings in patients with pelvic floor dysfunction. ANZ J Surg 2023. [PMID: 36655344 DOI: 10.1111/ans.18258] [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: 08/01/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUNDY Colonoscopy is often performed in the initial workup of pelvic floor dysfunction, even in the absence of red flag symptoms. Current guidelines suggest colonoscopy is only required in the presence of rectal bleeding, diarrhoea or change in bowel habit. The aim of this study was to evaluate the prevalence of significant pathology found at colonoscopy in patients with pelvic floor dysfunction. METHODS Retrospective chart review was performed on all patients presenting to a functional colorectal outpatient clinic between May 2018 and August 2019. Information was collected on presenting symptoms, whether colonoscopy had been performed within 5 years, quality of bowel preparation, withdrawal time, number of polyps detected, histology, presence of diverticular disease, colorectal malignancy, inflammatory bowel disease, solitary rectal ulcer or rectal prolapse. RESULTS There were 260 patients seen within the study period, of which 67% had undergone recent colonoscopy within the last 5 years. The mean age was 53 and 219 (84%) patients were female. Average withdrawal time was 13 min. Polyps were found in 48.7% and adenomas in 32.4% of all colonoscopies. The adenoma detection rate was 32.7%. None of the colonoscopies found evidence of malignancy. A new diagnosis of inflammatory bowel disease was discovered in two patients. CONCLUSION There was low rates of serious pathology such as malignancy or inflammatory bowel disease in patients referred to a functional clinic. However, colonoscopy is still useful in workup of pelvic floor dysfunction, as many patients have erratic bowel habits or vague symptoms, and will have adenomas found.
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Affiliation(s)
- Bianca Kwan
- Brisbane Academic Functional Colorectal Unit, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Chris Gillespie
- Brisbane Academic Functional Colorectal Unit, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Warwick
- Brisbane Academic Functional Colorectal Unit, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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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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Evaluation and Management of Rectal Prolapse Among Geriatric Patients. Adv Emerg Nurs J 2022; 44:297-301. [DOI: 10.1097/tme.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dawoud C, Argeny S, Harpain F, Riss S. Obstruktives Defäkationssyndrom. COLOPROCTOLOGY 2022; 44:277-286. [DOI: 10.1007/s00053-022-00630-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 01/05/2025]
Abstract
ZusammenfassungDas obstruktive Defäkationssyndrom (ODS) ist eine Form der Verstopfung, die mit einer Stuhlentleerungsstörung verbunden ist. Das Krankheitsbild ist noch nicht vollständig verstanden, dementsprechend ist die Evidenz zur Pathogenese und Therapie limitiert. Prinzipiell werden funktionelle Ursachen, wie der Anismus oder das Puborektalissyndrom, von anatomischen Ursachen unterschieden. Häufige mechanische Hindernisse sind die Rektozele oder eine Intussuszeption, die zu einer erschwerten Defäkation führen können. Zur Auswahl der passenden Therapie ist entscheidend, die kausale Ursache festzustellen. Konservative Behandlungsversuche sollten primär angewendet werden und umfassen unter anderem das Beckenbodentraining, die Biofeedbacktherapie, den Einsatz von Laxanzien oder die anale Irrigation. Es gibt eine große Zahl chirurgischer Therapieoptionen mit unterschiedlichen Vor- und Nachteilen. Gute Fachkenntnis und Erfahrung sind entscheidend, um die geeignete Therapie für den Betroffenen auszuwählen.
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Attaallah W, Akmercan A, Feratoglu H. The role of rectal redundancy in the pathophysiology of rectal prolapse: a pilot study. Ann Surg Treat Res 2022; 102:289-293. [PMID: 35611091 PMCID: PMC9111960 DOI: 10.4174/astr.2022.102.5.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Rectal prolapse is hypothesized to be caused due to weakness of the pelvic floor which is related to childbearing. However, half of the female patients with rectal prolapse were reported to be nulliparous and this hypothesis doesn't explain the prolapse in males. The aim of this study is to evaluate the role of rectal redundancy in rectal prolapse pathophysiology. Methods This study was conducted prospectively. Fourteen patients who underwent rectopexy were included in the study group. A total of 17 patients who underwent laparotomy for another reason and who have no symptoms regarding rectal prolapse were included in the control group. In order to measure the redundancy of the rectum, we have calculated the ratio of length of intraperitoneal rectum (R) to length of distance between promontorium and peritoneal reflection (PRx). The primary outcome of this study was to evaluate whether the R/PRx ratio is higher in patients with rectal prolapse compared to the control group. Results Comparing the anatomic features showed that the length of sigmoid colon and length of PRx were not significantly different between the two groups. However, the length of intraperitoneal rectum was significantly higher in the prolapse group. Furthermore, the median R/PRx ratio in the prolapse group was significantly higher than in the control group. Conclusion This study showed that intraperitoneal rectum in patients with rectal prolapse is significantly more redundant than in the normal population. This could be considered reasonable evidence for the role of rectal redundancy on rectal prolapse pathophysiology.
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Affiliation(s)
- Wafi Attaallah
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Akmercan
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Hale Feratoglu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Mitchell CM, Salyards GW, Theriault BR, Langan GP, Luchins KR. Evaluation of Pain and Distress and Therapeutic Interventions for Rectal Prolapse in Mice to Reduce Early Study Removal. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2021; 60:692-699. [PMID: 34749842 DOI: 10.30802/aalas-jaalas-21-000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rectal prolapse (RP) is a common clinical condition in mice, that does not have a recognized or documented standard of care. At our institution, an average of 240 mice develop RP each year. Our practice has been to recommend euthanasia upon identifying a RP based on its appearance as a painful or distressful condition. This study aimed to assess treatment options that would maintain the RP mucosa and allow mice to reach their study endpoint, and to evaluate the perception of this condition as a painful or distressful event. This study used 120 mice with spontaneous RP, concurrently assigned to ongoing research protocols. Mice were randomly assigned to 1 of 3 treatment groups: petroleum jelly, lidocaine jelly, or no treatment. Fecal samples were collected for pathogen testing, and all mice received an initial base score, followed by weekly blind scores. Upon euthanasia, RP tissue was collected for histopathology. Of the 120 mice identified with RP, 47 mice were breeders; 28% successfully produced 22 additional litters after developing RP. Seventy-three were nonbreeders, with 92% reaching their research study endpoint. No statistically significant differences were detected between the 3 treatment groups based on gross mucosal health, pain and distress, or histopathology. In this study, none of the mice in any group were euthanized based on the RP endpoint scoring criteria. These findings demonstrate that treatment is unnecessary for RP, and mice with RP did not show signs of pain or distress. In adherence to the 3Rs, this study supports animal number reduction and clinical refinement, allowing mice with RPs to reach their intended research study endpoints or produce additional litters.
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Affiliation(s)
- Cara M Mitchell
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
| | - Gregory W Salyards
- Division of Veterinary Resources Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Betty R Theriault
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
| | - George P Langan
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kerith R Luchins
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
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Abstract
Complete rectal prolapse or rectal procidentia is a debilitating disease that presents with fecal incontinence, constipation, and rectal discharge. Definitive surgical techniques described for this disease include perineal procedures such as mucosectomy and rectosigmoidectomy, and abdominal procedures such as rectopexy with or without mesh and concomitant resection. The debate over these techniques regarding the lowest recurrence and morbidity rates, and the best functional outcomes for constipation or incontinence, has been going on for decades. The heterogeneity of available studies does not allow us to draw firm conclusions. This article aims to review the surgical techniques for complete rectal prolapse based on the current evidence base regarding surgical and functional outcomes.
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Attaallah W, Menek G, Aleyna Erdaş F, Yusuf İnceoğlu İ, Pervin Kankılıç M, Hakan Yılmazer A, Yeğen B. An experimental study on the pathophysiology of rectal prolapse. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.5188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: For decades, rectal prolapse has been hypothesized to be caused due to laxity or weakness of the pelvic floor muscles which is often sup- posed to be related to childbearing in females. However, 50% of females with rectal prolapse have been reported to be nulliparous and this hypothesis does not explain the incidence of rectal prolapse in males. The aim of this study was to evaluate the role of rectal redundancy in rectal prolapse patho- physiology.
Material and Methods: Nineteen female Sprague Dawley rats (250-300 g) at 16 weeks of age were obtained from the animal center. Rats were divided into two groups as rectal mobilization (study) group (n= 9) and sham-operated control (n= 10) group. In the study group, soft dissection was applied and rectum were mobilized up from the pelvic floor to create a redundant or hypermobilized rectum.The primary outcome was the rate of rectal pro- lapse after rectal mobilization.
Results: As compared to the sham-operated control group, in which none of the rats had rectal prolapse throughout the post-surgical period, rectal prolapse was observed in four of the rats in the rectal mobilization group (0% vs. 44%; p= 0.006). Being unable to increase the length of the rectums of the rats, but using only mobilization to create the redundancy, and the lack of data regarding any adhesions after surgery are the main limitations of this study.
Conclusion: This study showed the role of rectal redundancy on the rectal prolapse pathophysiology.
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Abstract
BACKGROUND Rectal prolapse has a diverse symptom profile that affects patients of all ages. OBJECTIVE We sought to identify bothersome symptoms and clinical presentation that motivated patients who have rectal prolapse to seek care, characterize differences in symptom severity with age, and determine factors associated with bothersome symptoms. DESIGN This study is a retrospective analysis of a prospectively maintained registry. SETTINGS This study was conducted at a tertiary referral academic center. PATIENTS Included were 129 consecutive women with full-thickness rectal prolapse. MAIN OUTCOME MEASURES The main outcomes measured were primary bothersome symptoms, 5-item Cleveland Clinic/Wexner Fecal Incontinence questionnaire, and the 5-item Obstructed Defecation Syndrome questionnaire. Patients were categorized by age <65 vs age ≥65 years. RESULTS Cleveland Clinic/Wexner Fecal Incontinence score >9 was more common in older patients (87% vs 60%, p = 0.002). Obstructed Defecation Syndrome score >8 was more common in younger patients (57% vs 28%, p < 0.001). Older patients were more likely than younger patients to report bothersome symptoms of pain (38% vs 19%, p = 0.021) and bleeding (12% vs 2%, p = 0.046). Mucus discharge was reported by most patients (older, 72% vs younger, 66%, p = 0.54) but was bothersome for only 18%, regardless of age. Older patients had more severe prolapse expression than younger patients (at rest, 33% vs 11%; during activity, 26% vs 19%; only with defecation, 40% vs 64%, p = 0.006). Older patients were more likely to seek care within 6 months of prolapse onset (29% vs 11%, p = 0.056). On multivariable regression, increasing age, narcotic use, and nonprotracting prolapse at rest were associated with reporting pain as a primary concern. LIMITATIONS This was a single-center study with a small sample size. CONCLUSIONS Rectal prolapse-related bothersome symptoms and health care utilization differ by age. Although rectal pain is often not commonly associated with prolapse, it bothers many women and motivates older women to undergo evaluation. Patient-reported functional questionnaires may not reflect patients' primary concerns regarding specific symptoms and could benefit from supplementation with questionnaires to elicit individualized symptom priorities. See Video Abstract at http://links.lww.com/DCR/B492. PROLAPSO DE RECTO INFLUENCIA DE LA EDAD EN DIFERENCIAS VINCULADAS CON LA PRESENTACIÓN CLÍNICA Y LOS SÍNTOMAS MAS DESAGRADABLES: El prolapso de recto tiene una gran variedad de síntomas que afectan a pacientes con edades diferentes.Identificar los síntomas mas molestos y la presentación clínica que motivaron a los pacientes con un prolapso de recto a consultar por atención médica, caracterizar las diferencias de gravedad de los síntomas con relación a la edad y determinar los factores asociados con los síntomas mas molestos.Análisis retrospectivo de un registro prospectivo.Centro académico de referencia terciaria.Consecutivamente 129 mujeres que presentaban un prolapso rectal completo.Síntomas y molestias primarias, cuestionario de incontinencia fecal de la Cleveland Clinic / Wexner de 5 ítems, cuestionario de síndrome de defecación obstruida de 5 ítems. Los pacientes fueron categorizados en < 65 años versus ≥ 65 años.El puntaje de incontinencia fecal de la Cleveland Clinic / Wexner > 9 fue más común en pacientes mayores (87% vs 60%, p = 0.002). La puntuación del síndrome de defecación obstructiva > 8 fue más común en pacientes más jóvenes (57% vs 28%, p <0,001). Los pacientes mayores fueron más propensos que los pacientes jóvenes a informar síntomas y molestias de dolor (38% vs 19%, p = 0.021) y sangrado (12% vs 2%, p = 0.046). La mayoría de los pacientes informaron secresión de moco (mayores, 72% frente a más jóvenes, 66%, p = 0,54), pero sólo el 18% tuvo molestias, independientemente de la edad. Los pacientes mayores tenían una exteriorización de prolapso más grave que los pacientes jóvenes (en reposo, 33% frente a 11%; durante la actividad, 26% frente a 19%; solo con defecación, 40% frente a 64%, p = 0,006). Los pacientes mayores tenían más probabilidades de buscar atención médica dentro de los 6 meses posteriores al inicio del prolapso (29% frente a 11%, p = 0.056). Tras la regresión multivariable, el aumento de la edad, el uso de narcóticos y el prolapso no prolongado en reposo se asociaron con la notificación de dolor como queja principal.Centro único; tamaño de muestra pequeño.Los síntomas y molestias relacionadas con el prolapso rectal y la solicitud de atención médica difieren según la edad. Aunque el dolor rectal a menudo no se asocia comúnmente con el prolapso, incomoda a muchas pacientes y motiva a las mujeres mayores a someterse a un examen médico. Los cuestionarios funcionales con las respuestas de las pacientes pueden no reflejar las preocupaciones principales de éstos con respecto a los síntomas específicos y podrían requerir cuestionarios complementarios para así obtener prioridades individualizadas con relación a los síntomas identificados. Consulte Video Resumen en http://links.lww.com/DCR/B492. (Traducción-Dr. Xavier Delgadillo).
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Clinical applications of pelvic floor imaging: opinion statement endorsed by the society of abdominal radiology (SAR), American Urological Association (AUA), and American Urogynecologic Society (AUGS). Abdom Radiol (NY) 2021; 46:1451-1464. [PMID: 33772614 DOI: 10.1007/s00261-021-03017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Pelvic floor dysfunction is prevalent, with multifactorial causes and variable clinical presentations. Accurate diagnosis and assessment of the involved structures commonly requires a multidisciplinary approach. Imaging is often complementary to clinical assessment, and the most commonly used modalities for pelvic floor imaging include fluoroscopic defecography, magnetic resonance defecography, and pelvic floor ultrasound. This collaboration opinion paper was developed by representatives from multiple specialties involved in care of patients with pelvic floor dysfunction (radiologists, urogynecologists, urologists, and colorectal surgeons). Here, we discuss the utility of imaging techniques in various clinical scenarios, highlighting the perspectives of referring physicians. The final draft was endorsed by the Society of Abdominal Radiology (SAR), American Urogynecologic Society (AUGS), and the American Urological Association (AUA).
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Yamamoto T, Hyakudomi R, Takai K, Taniura T, Uchida Y, Ishitobi K, Hirahara N, Tajima Y. Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report. World J Clin Cases 2021; 9:847-853. [PMID: 33585631 PMCID: PMC7852635 DOI: 10.12998/wjcc.v9.i4.847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.
CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse.
CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.
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Affiliation(s)
- Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Takahito Taniura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Liu W, Ren X, Jiang C, Qian Q. Role of laparoscopic implementation in perineal operations for clinical decision making in patients with rectal prolapse less than 5 cm. Int J Surg 2021; 86:5-6. [PMID: 33387665 DOI: 10.1016/j.ijsu.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Weicheng Liu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Congqing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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Fan K, Cao AM, Barto W, De Lacavalerie P. Perineal stapled prolapse resection for external rectal prolapse: a systematic review and meta-analysis. Colorectal Dis 2020; 22:1850-1861. [PMID: 32865320 DOI: 10.1111/codi.15338] [Citation(s) in RCA: 5] [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: 03/13/2020] [Accepted: 08/18/2020] [Indexed: 12/29/2022]
Abstract
AIM Rectal prolapse is an uncommon but debilitating pelvic floor disorder that significantly decreases the quality of life of affected patients. Perineal stapled prolapse resection is a relatively new perineal approach that offers an promising alternative technique in the surgical management of rectal prolapse. It appears to be a simple, reproducible and efficient method. However, long-term outcomes are limited. The aims of this review are to assess the safety and effectiveness of perineal stapled prolapse resection in the management of rectal prolapse. METHOD A systematic review of all articles describing this approach was searched using MEDLINE, Embase, PubMed, Cochrane, Scopus, Web of Science and China National Knowledge Infrastructure. Included in this review were all randomized and nonrandomized prospective and retrospective studies reporting patients (aged 16 years and older) with complete rectal prolapse who underwent perineal stapled prolapse resection for the surgical treatment of the rectal prolapse. RESULTS A total of 408 patients across 20 articles were included. There were 58 cases of recurrence out of 368 patients over a median length of follow-up of 18 months (interquartile range 12-34 months). The total weighted overall recurrence was 12%. There were 51 cases of postoperative complications in 350 cases, bleeding being the most common complication. CONCLUSION The recurrence rate is comparable to those of the well-established Altemeier and Delorme procedures. However, given the heterogeneity of studies and variations in lengths of follow-up, further randomized prospective studies are needed to adequately compare this technique against other procedures for complete rectal prolapse.
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Affiliation(s)
- K Fan
- Colorectal Surgery department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - A M Cao
- Colorectal Surgery department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - W Barto
- Colorectal Surgery department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - P De Lacavalerie
- Department of Surgery, Nepean Private Hospital, Kingswood, New South Wales, Australia
- University of Sydney Nepean Clinical School, Kingswood, New South Wales, Australia
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Yumiba T, Souma Y, Yasuda J, Ieda J, Ono T, Nezu R, Saito T. Laparoscopic ventral rectopexy using the transanal vacuum test for complete rectal prolapse. Surg Today 2020; 51:1246-1250. [PMID: 33106899 DOI: 10.1007/s00595-020-02168-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023]
Abstract
Laparoscopic ventral rectopexy was performed in 84 patients with complete rectal prolapse from January 2016 to December 2019. In the initial 27 cases, three cases had recurrence, especially in cases of a long rectal prolapse measuring over 10 cm. In order to avoid recurrence, the transanal vacuum test was performed following the dissection of the rectovaginal septum towards the pelvic floor. The disappearance of rectal prolapse is confirmed by the intraoperative transanal vacuum test. When the posterior wall of the rectum showed the presence of prolapse according to the transanal vacuum test, then laparoscopic ventral rectopexy was converted to laparoscopic posterior rectopexy. In 94 cases in which laparoscopic ventral rectopexy was attempted, laparoscopic ventral rectopexy was completed in 57 cases, while the procedure was converted to laparoscopic posterior rectopexy in 37 cases. The recurrence rate following laparoscopic ventral rectopexy decreased from 11.1% (3/27) to 1.7% (1/57) after beginning to use the transanal vacuum test. Laparoscopic ventral rectopexy using the transanal vacuum test is therefore considered to be a useful technique to reduce postoperative recurrence.
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Affiliation(s)
- Takeyoshi Yumiba
- Department of Surgery, Osaka Central Hospital, 3-3-30 Umeda, Kita-ku, Osaka, 530-0001, Japan.
| | - Yoshihito Souma
- Department of Surgery, Osaka Central Hospital, 3-3-30 Umeda, Kita-ku, Osaka, 530-0001, Japan
| | - Jun Yasuda
- Department of Surgery, Osaka Central Hospital, 3-3-30 Umeda, Kita-ku, Osaka, 530-0001, Japan
| | - Junji Ieda
- Department of Surgery, Osaka Central Hospital, 3-3-30 Umeda, Kita-ku, Osaka, 530-0001, Japan
| | - Tomojiro Ono
- Department of Surgery, Osaka Central Hospital, 3-3-30 Umeda, Kita-ku, Osaka, 530-0001, Japan
| | - Riichiro Nezu
- Department of Surgery, Osaka Central Hospital, 3-3-30 Umeda, Kita-ku, Osaka, 530-0001, Japan
| | - Toru Saito
- Department of Surgery, Osaka Central Hospital, 3-3-30 Umeda, Kita-ku, Osaka, 530-0001, Japan
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Narihiro S, Miura N, Nishizawa Y, Hasegawa H, Ikeda K, Teramura K, Tsukada Y, Sasaki T, Ito M. Delorme surgery for colonic mucosal prolapse after intersphincteric resection. Surg Today 2020; 51:916-922. [PMID: 33095327 DOI: 10.1007/s00595-020-02167-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Mucosal prolapse at the site of anastomosis is a long-term complication unique to ISR. It reduces the QOL of patients due to a worsened anal function and local symptoms around the anus. We herein sought to assess the surgical outcomes after Delorme surgery for these patients. METHODS ISR was performed in 720 patients with low rectal cancer between January 2001 and March 2019 at the National Cancer Center Hospital East. Among these patients, the 33 (4.5%) who underwent initial Delorme surgery for postoperative colonic mucosal prolapse were identified from the medical records and then were analyzed retrospectively. We estimated the anal function using Wexner's incontinence score and assessed whether local anal symptoms due to the prolapse improved postoperatively. RESULTS Stoma closure was performed before Delorme surgery in 15 (45.5%) patients, and we compared the preoperative and postoperative anal function in these patients. The average Wexner's incontinence score changed from 15.1 before to 12.9 after Delorme surgery. Local symptoms around the anus improved in all 33 (100%) patients. Recurrence of colonic mucosal prolapse occurred in 5 patients (15%), and Delorme surgery was reperformed in these cases. CONCLUSION Delorme surgery for colonic mucosal prolapse following ISR has clinical benefits for both improving anal local symptoms and slightly improving the anal function.
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Affiliation(s)
- Satoshi Narihiro
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Naoko Miura
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Abstract
Anorectal disorders encompass structural, neuromuscular, and functional disorders. They are common, often distressing, and in some cases debilitating, and significantly add to the health care burden. They present with multiple, overlapping symptoms that can often obscure the underlying pathology and can pose significant diagnostic and management dilemmas. A meticulous history and comprehensive digital rectal examination can provide clarity on the diagnosis, appropriate testing, and management of these conditions. Today, with the development of sophisticated diagnostic tools such as high-resolution and high-definition (3-D) anorectal manometry, 3-D anal ultrasonography, magnetic resonance defecography and imaging, and neurophysiological tests such as translumbosacral anorectal magnetic stimulation, it is possible to more accurately define and characterize the underlying structural and functional abnormalities. In this review, we present a succinct update on the latest knowledge with regards to the pathophysiology, diagnosis and management of anal fissure, hemorrhoids, rectal prolapse, intussusception, rectocele, solitary rectal ulcer syndrome, levator ani syndrome, dyssynergic defecation and fecal incontinence.
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Tsunoda A. Surgical Treatment of Rectal Prolapse in the Laparoscopic Era; A Review of the Literature. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:89-99. [PMID: 32743110 PMCID: PMC7390613 DOI: 10.23922/jarc.2019-035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/26/2020] [Indexed: 02/08/2023]
Abstract
Rectal prolapse is associated with debilitating symptoms including the discomfort of prolapsing tissue, mucus discharge, hemorrhage, and defecation disorders of fecal incontinence, constipation, or both. The aim of treatment is to eliminate the prolapse, correct associated bowel function and prevent new onset of bowel dysfunction. Historically, abdominal procedures have been indicated for young fit patients, whereas perineal approaches have been preferred in older frail patients with significant comorbidity. Recently, the laparoscopic procedures with their advantages of less pain, early recovery, and lower morbidity have emerged as an effective tool for the treatment of rectal prolapse. This article aimed to review the current evidence base for laparoscopic procedures and perineal procedures, and to compare the results of various techniques. As a result, laparoscopic procedures showed a relatively low recurrence rate than the perineal procedures with comparable complication rates. Laparoscopic resection rectopexy and laparoscopic ventral mesh rectopexy had a small advantage in the improvement of constipation or the prevention of new-onset constipation compared with other laparoscopic procedures. However, the optimal surgical repair has not been clearly demonstrated because of the significant heterogeneity of available studies. An individualized approach is recommended for every patient, considering age, comorbidity, and the underlying anatomical and functional disorders.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
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Mustain WC, Davenport DL, Parcells JP, Vargas HD, Hourigan JS. Abdominal versus Perineal Approach for Treatment of Rectal Prolapse: Comparable Safety in a Propensity-matched Cohort. Am Surg 2020. [DOI: 10.1177/000313481307900712] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abdominal operations for rectal prolapse are associated with lower recurrence rates than perineal procedures but presumed higher morbidity. Therefore, perineal procedures are recommended for patients deemed unfit for abdominal repair. Consequently, bias confounds retrospective comparisons of the two approaches. To clarify the impact of operative approach on outcomes, we analyzed abdominal and perineal procedures in a propensity score-matched analysis. We selected patients undergoing surgery for rectal prolapse from the American College of Surgeons National Surgical Quality Improvement Program data set from 2005 to 2010. We grouped procedures as abdominal or perineal. We identified preoperative variables predictive of complications and regressed against operative approach. The resulting propensity score was used to select a matched cohort with similar clinical risk. We identified 2188 patients (848 abdominal [38.8%]; 1340 perineal [61.2%]). Patients undergoing the perineal approach had higher rates of most risk variables. Propensity matching resulted in 563 matched pairs (1126 patients) with similar clinical risk. In this matched cohort, no significant difference was found in the rate of any complication between the operative approaches; mortality was 0.9 per cent in each group ( P = 1.0). Relative risk for major morbidity after abdominal approach was 1.39 (95% confidence interval, 0.92 to 2.10; P = 0.15). Although many patients with rectal prolapse are high risk for abdominal surgery, our study indicates that many patients treated by perineal repair could be safely treated with a more durable operation.
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Affiliation(s)
- W. Conan Mustain
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | | | | | - H. David Vargas
- Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
| | - Jon S. Hourigan
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
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Laparoscopic Pelvic Organ Prolapse Suspension (Pops) Versus Laparoscopic Ventral Mesh Rectopexy for Treatment of Rectal Prolapse: Prospective Cohort Study. World J Surg 2020; 44:3158-3166. [PMID: 32424455 DOI: 10.1007/s00268-020-05585-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to compare ventral mesh rectopexy (VMR) and pelvic organ prolapse suspension surgery (POPS) in management of patients presenting with rectal prolapse. METHODS Our study was a prospective cohort trial in which 120 female patients with complete rectal prolapse were included, 60 patients had had VMR and the other 60 had had POPS as a surgical management for complete rectal prolapse. Results had been compared 6 months postoperatively regarding operative time, postoperative pain, hospital stay, complications of surgery including recurrence of the rectal prolapse, the efficacy of each operation in treatment of rectal prolapse and associated symptoms. RESULTS The patients were assessed 6 months postoperatively. There was no significant statistical difference regarding hospital stay and postoperative pain. Operative time was significantly shorter in POPS in comparison with VMR (P value < 0.05). VMR showed slight improvement regarding constipation and continence scores; however, this was statistically significant. VMR showed less complications compared to POPS. Complications with rectopexy happened only with 4 patients compared to 24 patients in POPS groups, 2 cases of recurrence in rectopexy group compared to 6 cases of recurrence in POPS. CONCLUSION POPS is comparable to VMR in management of rectal prolapse and in improving the ODS symptoms. Thus, POPS can be used as easier, faster option to treat rectal prolapse in selected patients.
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Waller J, Lee D, Hong J. How to do a rectal prolapse reduction using intraluminal packing. ANZ J Surg 2020; 90:879-880. [PMID: 32189454 DOI: 10.1111/ans.15793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 11/29/2022]
Abstract
How to perform a rectal prolapse reduction using intraluminal packing.
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Affiliation(s)
- Jacob Waller
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan Hong
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The Institute of Academic Surgery at RPA, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney Central Clinical School, Sydney, New South Wales, Australia
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Transvaginal rectopexy using the Flex ® Colorectal Drive Robotic System: a proof-of-concept approach to rectal prolapse. Tech Coloproctol 2020; 24:471-474. [PMID: 32130545 DOI: 10.1007/s10151-020-02180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to demonstrate a proof-of-concept approach to rectopexy that would provide the durability of the transabdominal procedure through use of sacral rectopexy with the decreased morbidity of a perineal procedure. This was done by utilizing a transvaginal approach and developing the rectovaginal space to accommodate sacral rectopexy placement using the Flex® Colorectal Drive Robotic System by Medrobotics (Medrobotics Corp., Raynham, MA, USA). METHODS A fresh female cadaver was acquired and placed in the high lithotomy position. The rectovaginal space was developed to accommodate the trocar of the Flex robot using blunt and sharp dissection between the posterior vaginal wall and anterior rectum. A piece of mesh was introduced into the space and using an endoscopic tacker, which was secured to the sacral promontory. The mesh was secured to the anterior rectal wall using interrupted vicryl sutures. The purse string suture was removed and the rectovaginal orifice was closed using a running vicryl suture. At the completion of the procedure, a low midline laparotomy was conducted to verify anchoring of the mesh appropriately at the sacral promontory. RESULTS This proof-of-concept protocol is the first description of the Flex® Colorectal Drive being used successfully to perform a transvaginal rectopexy for rectal prolapse in a cadaver. This is also the first description of the Flex® Colorectal Drive robot being used transvaginally. CONCLUSIONS This proof-of-concept approach demonstrates that transvaginal rectopexy using the Flex® Colorectal Drive is a potential surgical option to address rectal prolapse that could provide patients the durability of a transabdominal approach with the decreased morbidity of a perineal approach. While early results are promising, additional cadaveric studies are required before this procedure can be attempted in vivo.
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Attaallah W. Update on the pathophysiology of rectal prolapse. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:1074-1075. [PMID: 31258139 DOI: 10.5152/tjg.2019.19196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wafi Attaallah
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
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Ng SC, Lior T. Unusual presentation of rectal prolapse. ANZ J Surg 2019; 90:621-622. [PMID: 31081277 DOI: 10.1111/ans.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Suat Chin Ng
- Colorectal Unit, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Tali Lior
- Colorectal Unit, Ballarat Base Hospital, Ballarat, Victoria, Australia
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Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol 2018; 22:919-931. [PMID: 30554284 DOI: 10.1007/s10151-018-1908-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022]
Abstract
Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
- Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Unit of General Surgery, Università della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - R Ghiselli
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - A Infantino
- Department of Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - F Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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Patcharatrakul T, Rao SS. Update on the Pathophysiology and Management of Anorectal Disorders. Gut Liver 2018; 12:375-384. [PMID: 29050194 PMCID: PMC6027829 DOI: 10.5009/gnl17172] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/05/2017] [Accepted: 06/10/2017] [Indexed: 12/11/2022] Open
Abstract
Anorectal disorders are common and present with overlapping symptoms. They include several disorders with both structural and functional dysfunction(s). Because symptoms alone are poor predictors of the underlying pathophysiology, a diagnosis should only be made after evaluating symptoms and physiologic and structural abnormalities. A detailed history, a thorough physical and digital rectal examination and a systematic evaluation with high resolution and/or high definition three-dimensional (3D) anorectal manometry, 3D anal ultrasonography, magnetic resonance defecography and neurophysiology tests are essential to correctly identify these conditions. These physiological and imaging tests play a key role in facilitating a precise diagnosis and in providing a better understanding of the pathophysiology and functional anatomy. In turn, this leads to better and more comprehensive management using medical, behavioral and surgical approaches. For example, patients presenting with difficult defecation may demonstrate dyssynergic defecation and will benefit from biofeedback therapy before considering surgical treatment of coexisting anomalies such as rectoceles or intussusception. Similarly, patients with significant rectal prolapse and pelvic floor dysfunction or patients with complex enteroceles and pelvic organ prolapse may benefit from combined behavioral and surgical approaches, including an open, laparoscopic, transabdominal or transanal, and/or robotic-assisted surgery. Here, we provide an update on the pathophysiology, diagnosis, and management of selected common anorectal disorders.
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Affiliation(s)
- Tanisa Patcharatrakul
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Augusta University, Augusta, GA,
USA
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok,
Thailand
| | - Satish S.C. Rao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Augusta University, Augusta, GA,
USA
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Martín Del Olmo JC, Toledano M, Martín Esteban ML, Montenegro MA, Gómez JR, Concejo P, Rodríguez de Castro M, Del Rio F. Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse. Surg Endosc 2018; 33:1075-1079. [PMID: 29998390 DOI: 10.1007/s00464-018-6357-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP. METHODS Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed. RESULTS The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%. CONCLUSIONS Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.
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Affiliation(s)
- J C Martín Del Olmo
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain. .,, Madrid, Spain.
| | - M Toledano
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - M L Martín Esteban
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - M A Montenegro
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - J R Gómez
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - P Concejo
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - M Rodríguez de Castro
- Department of Obstetrics and Gynecology, Medina del Campo Hospital, Valladolid, Spain
| | - F Del Rio
- Department of Urology, Medina del Campo Hospital, Valladolid, Spain
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Catanzarite T, Klaristenfeld DD, Tomassi MJ, Zazueta-Damian G, Alperin M. Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse. Dis Colon Rectum 2018; 61:861-867. [PMID: 29528907 PMCID: PMC5992067 DOI: 10.1097/dcr.0000000000001023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pelvic organ prolapse is prevalent among women with rectal prolapse. OBJECTIVE This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair. DESIGN A retrospective cohort. SETTING This study was performed at a single managed-care institution. PATIENTS Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURES Full-thickness rectal prolapse recurrence was compared between 4 groups: abdominal repair without pelvic organ prolapse (AR-POP); abdominal repair with pelvic organ prolapse (AR+POP); perineal repair without pelvic organ prolapse PR-POP; and perineal repair with pelvic organ prolapse (PR+POP). Recurrence-free period and hazard of recurrence were compared using Kaplan-Meier and Cox proportional hazards methods. To identify potential confounding risk factors for rectal prolapse recurrence, the characteristics of subjects with/without recurrence were compared with univariable and multivariable analyses. RESULTS Overall, pelvic organ prolapse was present in 33% of 112 women and was more prevalent among subjects with rectal prolapse recurrence (52.4% vs 28.6%, p = 0.04). Median follow-up was 42.5 months; rectal prolapse recurrence occurred in 18.8% at a median of 9 months. The rate of recurrence and the recurrence-free period differed significantly between groups: AR-POP 3.8%, 95.7 months; AR+POP 13.0%, 86.9 months; PR-POP 34.8%, 42.1 months; PR+POP 57.1%, 23.7 months (p < 0.001). Compared with AR-POP the HR (95% CI) of rectal prolapse recurrence was 3.1 (0.5-18.5) for AR+POP; 14.7 (3.0-72.9) for PR-POP and 31.1 (6.2-154.5) for PR+POP. Compared with AR+POP, PR+POP had a shorter recurrence-free period (p < 0.001) and a higher hazard of recurrence (HR, 10.2; 95% CI, 2.1-49.3). LIMITATIONS The retrospective design was a limitation of this study. CONCLUSIONS Pelvic organ prolapse was associated with a higher rectal prolapse recurrence rate and earlier recurrence in women undergoing perineal, but not abdominal, repairs. Multidisciplinary evaluation can facilitate individualized management of women with rectal prolapse. Abdominal repair should be considered in women with concomitant rectal and pelvic organ prolapse. See Video Abstract at http://links.lww.com/DCR/A513.
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Affiliation(s)
- Tatiana Catanzarite
- Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, San Diego, California
- Department of Obstetrics and Gynecology, Division of Urogynecology, Kaiser Permanente, San Diego, California
| | | | - Marco J. Tomassi
- Department of General Surgery, Kaiser Permanente, San Diego, California
| | - Gisselle Zazueta-Damian
- Department of Obstetrics and Gynecology, Division of Urogynecology, Kaiser Permanente, San Diego, California
| | - Marianna Alperin
- Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, San Diego, California
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Parés D, Abcarian H. Management of Common Benign Anorectal Disease: What All Physicians Need to Know. Am J Med 2018; 131:745-751. [PMID: 29499172 DOI: 10.1016/j.amjmed.2018.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/15/2022]
Abstract
Benign anorectal conditions produce anal pain, rectal bleeding, or discharge from the perianal region, which are highly prevalent symptoms in the general population. Hemorrhoidal disease, anal fissure, perianal abscess, proctalgia syndromes, and pruritus anii are the most common clinical disorders. Well-trained physicians, irrespective of their specialty, can treat most of these disorders and refer them to a specialist in proctology only when necessary. The aim of this review is to provide a practical guide to the management of benign anorectal disorders in terms of their initial management and the criteria for specialist referral.
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Affiliation(s)
- David Parés
- Department of Colon and Rectal Surgery, Hospital Germans Trias i Pujol, School of Medicine, Universitat Autónoma de Barcelona, Badalona, Spain.
| | - Herand Abcarian
- Division of Colon and Rectal Surgery, University of Illinois at Chicago
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Koizumi N, Kobayashi H, Fukumoto K. Massive chronic irreducible rectal prolapse successfully treated with Altemeier's procedure. J Surg Case Rep 2018; 2018:rjy064. [PMID: 29644045 PMCID: PMC5888366 DOI: 10.1093/jscr/rjy064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/15/2018] [Indexed: 01/21/2023] Open
Abstract
The guideline for the treatment of rectal prolapse recommends that surgeons select appropriate surgical procedures individually based on each patient's overall status. However, in cases of irreducible or incarcerated rectal prolapse, surgical options are quite limited. Here we present a case of an elderly woman with massive chronic irreducible rectal prolapse. An 87-year-old woman presented to our hospital with a complaint of massive rectal prolapse. The prolapsed rectum was over 20 cm long, and completely irreducible. She underwent perineal rectosigmoidectomy with levatorplasty known as Altemeier's procedure. More than 30 cm of rectosigmoid colon was resected. After the operation, rectal prolapse was resolved completely. Her postoperative course was uneventful, and her quality of life and bowel movements improved. She has since been healthy without recurrence for over 2 years. Altemeier's procedure is applicable even in cases of irreducible rectal prolapse and features acceptable safety and a satisfactory outcome.
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Affiliation(s)
- Noriaki Koizumi
- Department of Surgery, Nishijin Hospital, Kamigyo-ku, Kyoto 602-8319, Japan
| | - Hiroki Kobayashi
- Department of Surgery, Nishijin Hospital, Kamigyo-ku, Kyoto 602-8319, Japan
| | - Kanehisa Fukumoto
- Department of Surgery, Nishijin Hospital, Kamigyo-ku, Kyoto 602-8319, Japan
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Fowler GE, Baker DM, Lee MJ, Brown SR. A systematic review of online resources to support patient decision-making for full-thickness rectal prolapse surgery. Tech Coloproctol 2017; 21:853-862. [PMID: 29101494 PMCID: PMC5701040 DOI: 10.1007/s10151-017-1708-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022]
Abstract
Background The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery. Methods This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch–Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0). Results Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch–Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2–85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1–5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1–8). Conclusions Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.
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Affiliation(s)
- G E Fowler
- The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - D M Baker
- The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.,Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - M J Lee
- The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.,Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Yang SJ, Yoon SG, Lim KY, Lee JK. Laparoscopic Vaginal Suspension and Rectopexy for Rectal Prolapse. Ann Coloproctol 2017; 33:64-69. [PMID: 28503518 PMCID: PMC5426198 DOI: 10.3393/ac.2017.33.2.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/26/2017] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better functional outcome than perineal procedures. Nevertheless, ideal surgical methods are still not available. We propose a new surgical technique, laparoscopic vaginal suspension and rectopexy, for correcting a full-thickness rectal prolapse and/or middle-compartment prolapse. This study assessed the short-term outcomes for patients who underwent laparoscopic vaginal suspension and rectopexy. METHODS Between April 2014 and April 2016, 69 female patients underwent laparoscopic vaginal suspension and rectopexy to correct a rectal prolapse. Demographics, medical histories, and surgical and follow-up details were collected from their medical records. In addition to the clinical outcome, we repeated defecation proctography and a questionnaire regarding functional results three months after surgery. RESULTS No major morbidities or no mortalities occurred. The defecation proctography confirmed excellent anatomical result in all cases. Of 7 patients with combined middle-compartment prolapses, we observed good anatomical correction. During follow-up, full-thickness recurrence occurred in one patient. Preoperative fecal incontinence was improved significantly at 3 months (mean Wexner score: 12.35 vs. 7.71; mean FISI: 33.29 vs. 21.07; P < 0.001). Analysis of responses to the fecal incontinence quality of life (FIQOL) questionnaire showed overall improvement at 3 months compared to the preoperative baseline (mean pre- and postoperative FIQOL scores: 12.11 vs. 14.39; P < 0.004). CONCLUSION Laparoscopic vaginal suspension and rectopexy is a new combined procedure for the treatment of patients with rectal prolapses. It has excellent functional outcomes and minimal morbidity and can correct and prevent middlecompartment prolapses.
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Affiliation(s)
- Shi-Jun Yang
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Seo-Gue Yoon
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Ki-Yun Lim
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Jong-Kyun Lee
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
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Silveira RK, Domingie S, Kirzin S, de Melo Filho DA, Portier G. Comparative study of safety and efficacy of synthetic surgical glue for mesh fixation in ventral rectopexy. Surg Endosc 2017; 31:4016-4024. [DOI: 10.1007/s00464-017-5439-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/30/2017] [Indexed: 01/05/2023]
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Gado AS, Ebeid BA, Abdelmohsen AM, Gado TS, Axon AT. Quality of colonoscopy practice: a single-center experience in Egypt. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/1110-7782.200968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
Full-thickness rectal prolapse is a painful and debilitating condition that often responds well to surgical intervention. The best method of surgical repair is a matter of debate. Historically, perineal approaches have been thought to have inferior outcomes and were therefore reserved for elderly and unfit patients. Despite recent data calling that into question, perineal approaches are still commonly performed and have their role. We present risks and benefits along with a description of perineal approaches for surgical treatment of rectal prolapse.
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Affiliation(s)
- Louis R Barfield
- Baton Rouge Colon and Rectal Associates, Our Lady of the Lake Physicians Group, Baton Rouge, Louisiana; Department of Surgery, LSUHSC, New Orleans, Louisiana
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Zubieta-O'Farrill G, Ramírez-Ramírez M, Villanueva-Sáenz E. [Robot assisted Frykman-Goldberg procedure. Case report]. CIR CIR 2017; 85 Suppl 1:84-88. [PMID: 28104280 DOI: 10.1016/j.circir.2016.10.014] [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: 01/28/2016] [Revised: 09/26/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rectal prolapse is defined as the protrusion of the rectal wall through the anal canal; with a prevalence of less than 0.5%. The most frequent symptoms include pain, incomplete defecation sensation with blood and mucus, fecal incontinence and/or constipation. The surgical approach can be perineal or abdominal with the tendency for minimal invasion. Robot-assisted procedures are a novel option that offer technique advantages over open or laparoscopic approaches. CASE REPORT 67 year-old female, who presented with rectal prolapse, posterior to an episode of constipation, that required manual reduction, associated with transanal hemorrhage during defecation and occasional fecal incontinence. A RMI defecography was performed that reported complete rectal and uterine prolapse, and cystocele. A robotic assisted Frykman-Goldberg procedure wass performed. DISCUSSION There are more than 100 surgical procedures for rectal prolapse treatment. We report the first robot assisted procedure in Mexico. Robotic assisted surgery has the same safety rate as laparoscopic surgery, with the advantages of better instrument mobility, no human hand tremor, better vision, and access to complicated and narrow areas. CONCLUSION Robotic surgery as the surgical treatment is a feasible, safe and effective option, there is no difference in recurrence and function compared with laparoscopy. It facilitates the technique, improves nerve preservation and bleeding. Further clinical, prospective and randomized studies to compare the different minimal invasive approaches, their functional and long term results for this pathology are needed.
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Affiliation(s)
| | - Moisés Ramírez-Ramírez
- Cirugía general, SSA, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Estado de México, México
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Ramakrishnan K. Diseases of the Rectum and Anus. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Rectal prolapse is a debilitating condition with a complex etiology. Symptoms are most commonly prolapse of the rectum and pain with bowel movements or straining, with worsening fecal incontinence over time due to progressive stretching of the anal sphincters. Physical findings are fairly consistent from patient to patient-most notably diastasis of the levator ani muscles, deep pouch of Douglas, redundant sigmoid colon, a mobile mesorectum, and occasionally a solitary rectal ulcer. Evaluation includes a physical exam or imaging demonstrating the prolapse, and evaluating for other causes of pelvic floor dysfunction. Multiple surgical repairs are available, but treatment must be individualized based on patient symptoms and the presence or absence of constipation or other pelvic floor disorders. Mesh repairs have shown promising results, but carry the added risks of mesh erosion, infection, and mesh migration. The optimal repair has not been clearly demonstrated at this time.
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Affiliation(s)
- Kyla Joubert
- Division of Colon and Rectal Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jonathan A Laryea
- Division of Colon and Rectal Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Mistrangelo M, Tonello P, Brachet Contul R, Arnone G, Passera R, Grasso L, Rapetti L, Borroni R, Pozzo M, Roveroni M, Morino M, Perinotti R. Perineal stapled prolapse resection for full-thickness external rectal prolapse: a multicentre prospective study. Colorectal Dis 2016; 18:1094-1100. [PMID: 26969880 DOI: 10.1111/codi.13328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/11/2016] [Indexed: 02/08/2023]
Abstract
AIM Many different surgical techniques have been reported for the surgical treatment of full-thickness external rectal prolapse. Perianal stapled prolapse resection (PSP) is a relatively newly reported technique for full thickness external rectal prolapse. The aim of this prospective multicentre study was to evaluate the results of this procedure. METHOD Consecutive patients who underwent a PSP resection for full-thickness external rectal prolapse at five centres were recruited to the study. Median operating time, hospital stay, complications, recurrence and functional results according to the Wexner Incontinence Scale and obstructive defaecation syndrome score were recorded. RESULTS There were 27 patients treated by PSP. The median Wexner incontinence score improved from 10 presurgery to 5 after surgery (P < 0.001); the median obstructed defaecation syndrome score improved from 12 presurgery to 5 (range 4-10) after surgery (P < 0.001). A laparoscopically assisted procedure was performed in three patients (11.1%). The median number of cartridges used was six (range four to nine). The median operating time was 48 min. Early complications occurred in six patients (22.2%) and late complications in two (7.4%). The median length of hospital stay was 5 days. The recurrence rate at a median follow-up of 30.3 months was 14.8%. CONCLUSION PSP appears to be an easy, fast and safe procedure. Early functional results are good. The recurrence rate compares favourably with other perineal procedures like the Delorme or the Altemeier operations. Long-term functional results need to be investigated further.
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Affiliation(s)
- M Mistrangelo
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy.
| | - P Tonello
- Department of Surgery, Koelliker Hospital, Turin, Italy
| | | | - G Arnone
- Department of Surgery, Martini Hospital, Turin, Italy
| | - R Passera
- Nuclear Medicine Department, University of Turin, Turin, Italy
| | - L Grasso
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - L Rapetti
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - R Borroni
- Department of Surgery, Koelliker Hospital, Turin, Italy
| | - M Pozzo
- Department of Surgery, Biella Hospital, Biella, Italy
| | - M Roveroni
- Department of Surgery, Aosta Hospital, Aosta, Italy
| | - M Morino
- Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy
| | - R Perinotti
- Department of Surgery, Biella Hospital, Biella, Italy
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Molnar C, Tătaru OS, Butiurcă VO, Molnar VC. High Grade Uterine and Rectal Prolapse. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: Pelvic floor hernias are encountered especially in elderly women. A combined genital, bladder, and rectal prolapse poses treatment challenges in aged women.
Case presentation: We present the case of an 88 year-old patient, complaining of an intravaginal mass protruding for the last 3 months, rectal prolapse that occurred two weeks before admittance, accompanied by stress incontinence of urine and chronic constipation. Examination revealed a uterine prolapse with cystocele and a fourth grade rectal prolapse. We decided on a perianal and transvaginal approach, performing preliminary dilatation and curettage, cervix amputation, anterior colporrhaphy and colpoperineorrhaphy (Manchester procedure) with perineal rectosigmoidectomy using the LigaSure™ device, and coloanal manual anastomosis. Postoperatively the patient had no symptoms of stress urinary incontinence, bowel movement resumed in the fourth postoperative day, and the patient was discharged after seven days. One month after surgery the patient has both urinary and fecal continence, with no relapse in pelvic organ prolapse.
Conclusions: Encountering genital, bladder, and rectal prolapse in the same patient is quite rare, and its treatment can be difficult in aged women. Therefore, a less invasive surgical procedure, using the transvaginal approach, and a genital sparing surgery could be the key in cases like this.
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Affiliation(s)
- Călin Molnar
- Surgery Clinic No. I, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Octavian-Sabin Tătaru
- Urology Clinic, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Vlad-Olimpiu Butiurcă
- Surgery Clinic No. I, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Varlam-Claudiu Molnar
- Obstetrics and Gynecology Clinic No. 1, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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Abstract
Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexistence of vaginal prolapse, severe constipation, surgical fitness, and whether the patient has had a previous prolapse procedure. Consideration of a multidisciplinary approach is critical in patients with concomitant vaginal prolapse. Surgeons must weigh their familiarity with each approach and should have in their armamentarium both perineal and abdominal approaches. Previous barriers to abdominal procedures, such as age and comorbidities, are waning as minimally invasive approaches have gained acceptance. Laparoscopic ventral rectopexy is one such approach offering relatively low morbidity, low recurrence rates, and good functional improvement. However, proficiency with this procedure may require advanced training. Robotic rectopexy is another burgeoning approach which facilitates suturing in the pelvis. Successful rectal prolapse surgeries improve function and have low recurrence rates, though it is important to note that correcting the prolapse does not assure functional improvement.
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Affiliation(s)
- Jennifer Hrabe
- Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brooke Gurland
- Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
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Long-term outcome of perineal rectosigmoidectomy for rectal prolapse. Int J Surg 2016; 32:78-82. [DOI: 10.1016/j.ijsu.2016.06.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/10/2016] [Accepted: 06/20/2016] [Indexed: 11/21/2022]
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Chandra A, Kumar S, Maurya AP, Gupta V, Gupta V, Rahul. Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population. World J Gastrointest Surg 2016; 8:321-325. [PMID: 27152139 PMCID: PMC4840172 DOI: 10.4240/wjgs.v8.i4.321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/06/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse (CRP) in North Indian patients with inherent bulky and redundant colon.
METHODS: The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively.
RESULTS: Fifteen patients (9 female) with a median age of 50 years (range, 15-68) were included in the study. The median operative time was 200 min (range, 180-350 min) and the median post-operative stay was 4 d (range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo (range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17 (range, 5-24) to 6 (range, 0-23) (P < 0.001) and the fecal incontinence severity index score from 24 (range, 0-53) to 2 (range, 0-53) (P = 0.007). No de novo constipation or fecal incontinence was recorded during the follow-up. On personal conversation, all patients expressed satisfaction with the outcome of their treatment.
CONCLUSION: Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.
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