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Ascanelli S, Marcello D, Soliani G, Feo CV, De Troia A, Campagnaro A, Carcoforo P. Intraoperative Laparoscopic Fixation Sutures to Prevent Neorectal Prolapse After Transanal Total Mesorectal Excision. Dis Colon Rectum 2024; 67:e3-e4. [PMID: 37646648 DOI: 10.1097/dcr.0000000000002735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Simona Ascanelli
- Department of Morphology, Surgery and Experimental Medicine, Section of General Surgery, University of Ferrara, Ferrara, Italy
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2
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Landen S. Neorectal prolapse following proctectomy: a novel application of mesh sacral pexy. Tech Coloproctol 2023; 27:947-949. [PMID: 37210428 DOI: 10.1007/s10151-023-02805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 05/22/2023]
Abstract
Neorectal prolapse following proctectomy for cancer has seldom been reported and treatment has mostly consisted in the resection of the prolapse via a perineal approach. Management of a patient with neorectal J-pouch prolapse using mesh sacral pexy via an abdominal approach is reported. By analogy with native rectal prolapse due to pelvic static disorders, laparoscopic mesh sacral pexy is likely to afford the same advantages of low morbidity and durability when applied to neorectal prolapse following rectal cancer surgery.
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Affiliation(s)
- Serge Landen
- Department of Surgery, CHIREC Delta Hospital, Boulevard du Triomphe 201, 1160, Brussels, Belgium.
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3
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Baltazar JPA, Lopez MPJ, Onglao MAS. Neorectum prolapse after rectal cancer surgery corrected with perineal stapled prolapse resection. BMJ Case Rep 2022; 15:e246356. [PMID: 34983809 PMCID: PMC8728451 DOI: 10.1136/bcr-2021-246356] [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] [Accepted: 12/10/2021] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old woman developed neorectal prolapse after laparoscopic low anterior resection, total mesorectal excision with partial intersphincteric resection and handsewn coloanal anastomosis for rectal cancer. She presented with a 3 cm full thickness reducible prolapse, with associated anal pain and bleeding. A perineal stapled prolapse resection was performed to address the rectal prolapse, with satisfactory results.
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Affiliation(s)
- Joanna Pauline A Baltazar
- Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Marc Paul J Lopez
- Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Mark Augustine S Onglao
- Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
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Varela C, Kim NK. Surgical Treatment of Low-Lying Rectal Cancer: Updates. Ann Coloproctol 2021; 37:395-424. [PMID: 34961303 PMCID: PMC8717072 DOI: 10.3393/ac.2021.00927.0132] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023] Open
Abstract
Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.
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Affiliation(s)
- Cristopher Varela
- Coloproctology Unit, Department of General Surgery, Hospital Dr. Domingo Luciani, Caracas, Venezuela
| | - Nam Kyu Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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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: 0.8] [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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Maldonado Marcos E, Planellas Giné P, Gil Garcia J, Farrés Coll R, Codina Cazador A. Altemeier procedure for rectal prolapse after intersphincteric low anterior resection with transanal total mesorrectal excision. Cir Esp 2020; 99:389-391. [PMID: 32564876 DOI: 10.1016/j.ciresp.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Eloy Maldonado Marcos
- Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Servicio de Cirugía General y del Aparato Digestivo, Universidad de Girona, Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España.
| | - Pere Planellas Giné
- Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Servicio de Cirugía General y del Aparato Digestivo, Universidad de Girona, Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
| | - Júlia Gil Garcia
- Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Servicio de Cirugía General y del Aparato Digestivo, Universidad de Girona, Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
| | - Ramon Farrés Coll
- Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Servicio de Cirugía General y del Aparato Digestivo, Universidad de Girona, Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
| | - Antoni Codina Cazador
- Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Servicio de Cirugía General y del Aparato Digestivo, Universidad de Girona, Instituto de Investigación Biomédica de Girona (IdIBGi), Girona, España
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HARATA K, HARUKI N, MIZOGUCHI K, KATO T, DENDA Y, FUJITA K. A Case of Mucosal Prolapse Performed by Delorme Procedure after Laparoscopic Intersphincteric Resection. ACTA ACUST UNITED AC 2019. [DOI: 10.3919/jjsa.80.1352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Koshiro HARATA
- Department of Digestive Surgery, Toyota Memorial Hospital
| | | | - Koji MIZOGUCHI
- Department of Digestive Surgery, Toyota Memorial Hospital
| | - Tomokatsu KATO
- Department of Digestive Surgery, Toyota Memorial Hospital
| | - Yuki DENDA
- Department of Digestive Surgery, Toyota Memorial Hospital
| | - Kohei FUJITA
- Department of Digestive Surgery, Toyota Memorial Hospital
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Robotic Posterior Suturepexy for Colonic Prolapse Two Years After Transanal Total Mesorectal Excision for Low Rectal Cancer. Dis Colon Rectum 2018; 61:1454. [PMID: 30399050 DOI: 10.1097/dcr.0000000000001197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Manceau G, Tan V, Ahmed O, Siksik JM, Vaillant JC, Karoui M. How I do a colonic J-pouch prolapse repair after coloanal anastomosis with an aponeurotic graft. ANZ J Surg 2018; 89:115-116. [PMID: 30277294 DOI: 10.1111/ans.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/07/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Gilles Manceau
- Assistance Publique Hôpitaux de Paris, Medecine Sorbonne University (Paris VI), Paris, France.,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France
| | - Viriane Tan
- Assistance Publique Hôpitaux de Paris, Medecine Sorbonne University (Paris VI), Paris, France.,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France
| | - Omar Ahmed
- Assistance Publique Hôpitaux de Paris, Medecine Sorbonne University (Paris VI), Paris, France.,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France
| | - Jean Michel Siksik
- Assistance Publique Hôpitaux de Paris, Medecine Sorbonne University (Paris VI), Paris, France.,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France
| | - Jean Christophe Vaillant
- Assistance Publique Hôpitaux de Paris, Medecine Sorbonne University (Paris VI), Paris, France.,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France
| | - Mehdi Karoui
- Assistance Publique Hôpitaux de Paris, Medecine Sorbonne University (Paris VI), Paris, France.,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris VI University Institute of Cancerology, Paris, France
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Guraieb-Trueba M, Helber AR, Marks JH. Full-thickness neorectal prolapse after transanal transabdominal proctosigmoidectomy for low rectal cancer: a cohort study. Colorectal Dis 2018; 20:593-596. [PMID: 29363246 DOI: 10.1111/codi.14030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/19/2017] [Indexed: 02/03/2023]
Abstract
AIM Transanal transabdominal proctosigmoidectomy (TATA) with a coloanal anastomosis is an alternative to abdominoperineal excision of the rectum (APR) for low rectal cancer. Neorectal prolapse is an unusual complication following TATA. This study aimed to determine the incidence of neorectal prolapse after TATA for low rectal cancer. METHOD This cohort study was conducted in a tertiary referral colorectal centre. From a prospectively maintained database including 1093 patients treated for rectal cancer between 1984 and 2016 we identified those who underwent sphincter-preserving surgery. Data regarding the incidence, management and outcomes of neorectal prolapse were analysed. RESULTS A total of 409 patients were identified, of whom 185 underwent open surgery and 224 a minimally invasive surgical procedure (MIS). All received neoadjuvant chemoradiation. Neorectal prolapse occurred in 4.6% (n = 19) with an incidence of 2.2% in the open and 6.7% in the MIS group (P = 0.023), with no difference between MIS techniques. There was one recurrence of neorectal prolapse (5.9%). The incidence of neorectal prolapse was higher in women (9.5%) than men (2.5%) (P = 0.011). There were no differences in local recurrence rates between the neorectal prolapse group (5.3%) and our population without prolapse (3.4%) (P = 0.79). CONCLUSION Neorectal prolapse is a rare occurrence following minimally invasive sphincter-saving surgical procedures performed for rectal cancer. It appears to be more frequent in patients who undergo MIS procedures and in women.
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Affiliation(s)
- M Guraieb-Trueba
- Escuela de Medicina, Tecnologico de Monterrey, Monterrey, NL, Mexico
| | - A R Helber
- Division of Colorectal Surgery, Lankenau Hospital and the Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - J H Marks
- Division of Colorectal Surgery, Lankenau Hospital and the Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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11
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Colonic conduit prolapse after transanal total mesorectal excision (taTME). Tech Coloproctol 2018; 22:475-477. [DOI: 10.1007/s10151-018-1798-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
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