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Mustafa G, Asad A, tul Muntaha S. Comparison of 5% Phenol With Almond Oil Versus 15% Hypertonic Saline in Treatment of Pediatric Idiopathic Rectal Prolapse. Cureus 2022; 14:e23552. [PMID: 35399434 PMCID: PMC8986137 DOI: 10.7759/cureus.23552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 12/01/2022] Open
Abstract
Objective: The objective of the study was to compare the frequency of recurrence with 5% phenol in almond oil versus 15% hypertonic saline for pediatric idiopathic rectal prolapse. Methodology: An open-label, randomized clinical trial was conducted at the Department of Paediatric Surgery, Services Hospital, Lahore, Pakistan, over a period of one year from May 1, 2018 to April 30, 2019. Altogether, 120 patients with idiopathic rectal prolapse were included in this study. After obtaining approval from the hospital ethical committee, all patients fulfilling the inclusion criteria were admitted to the pediatric surgery inpatient department of Services Hospital, Lahore. Patients were randomized into two groups with an equal number of candidates using the lottery method. Group A consisted of patients who were administered 5% phenol in almond oil and group B consisted of patients who were administered 15% hypertonic saline. All procedures were performed by a single surgical operating team to control bias. Patients were followed up for three months after surgery to note whether recurrence occurred or not. Results: The mean age of the patients was 3.97 ± 2.68 years in group A and 2.87 ± 1.84 years in group B. Gender distribution showed male dominance (71.7% in group A and 73.3% in group B). Statistically significant difference was observed in terms of recurrence (50% in group A and 23.3% in group B) (p=0.002), while statistically insignificant differences were found in terms of postoperative faecal incontinence (2% in each group, p=0.6478) and anal stenosis (8% in group A and 2% in group B with p=0.2426). Conclusion: Thus, 15% hypertonic saline was noted to be a more effective sclerosing agent than 5% phenol in almond oil in the management of idiopathic rectal prolapse in children. It was also found to have a statistically comparable rate of complications, including fecal incontinence and anal stenosis.
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Zhou W, Shi Y, Zhang M, Li L. The Remission Effects of First Injection of Sclerotherapy for Pediatric Rectal Prolapse: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:835235. [PMID: 35284492 PMCID: PMC8907260 DOI: 10.3389/fsurg.2022.835235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/14/2022] Open
Abstract
Background Pediatric rectal prolapse is a common issue in clinical practice. Among various managements, sclerotherapy is an important method to successfully treat pediatric rectal prolapse, especially for the first injection. The knowledge of the first injection of sclerotherapy can be revealed by a systemic review and meta-analysis of randomized clinical trials. Methods We performed a systematic search and a meta-analysis for the retrospective clinical studies of sclerotherapy in pediatric rectal prolapse. The comparison between remission and recurrence after the first injection of sclerotherapy was performed to find if the first injection of sclerotherapy can treat rectal prolapse completely. After a restricted selection, 17 studies involving 1,091 pediatric rectal prolapse subjects with sclerotherapy were enrolled in a variety of classifications of injection agents. The focused outcome was to check whether the first injection of sclerotherapy can achieve a remission status. The meta-analysis was performed by Review Manager 5.4. Results Among the subjects receiving sclerotherapy, the meta-analysis favors the remission status after receiving the first injection of sclerotherapy. The meta-analysis results showed significant remission tests for the overall effect and significant heterogeneities in odds ratio and the fixed-effects model. The significant therapeutic effects remained, however, even after testing in the relative risk and the random-effects model. Conclusions Despite significant heterogeneity and relatively low quality of evidence, the first injection of sclerotherapy may conceivably demonstrate therapeutic effects to help the patients of pediatric rectal prolapse achieve a remission status.
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Affiliation(s)
- Weimo Zhou
- Department of Pediatric Surgery, Guigang City People's Hospital, Eighth Affiliated Hospital of Guangxi Medical University, Guigang, China
| | - Yingzuo Shi
- Department of Pediatric Surgery, Wuxi People's Hospital, Wuxi, China
| | - Ming Zhang
- Clinical Laboratory, Zhucheng Maternal and Child Health Hospital, Zhucheng, China
| | - Li Li
- The Department of Pediatrics, Ganzhou People's Hospital, Ganzhou, China
- *Correspondence: Li Li
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Ouzir M, Bernoussi SE, Tabyaoui M, Taghzouti K. Almond oil: A comprehensive review of chemical composition, extraction methods, preservation conditions, potential health benefits, and safety. Compr Rev Food Sci Food Saf 2021; 20:3344-3387. [PMID: 34056853 DOI: 10.1111/1541-4337.12752] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Almond oil, a rich source of macronutrients and micronutrients, is extracted for food flavorings and the cosmetics industry. In recent years, the need for high-quality and high-quantity production of almond oil for human consumption has been increased. The present review examines the chemical composition of almond oil, storage conditions, and clinical evidence supporting the health benefits of almond oil. From the reviewed studies, it appears that almond oil contains a significant proportion of poly and monounsaturated fatty acids, with oleic acid as the main compound, and an important amount of tocopherol and phytosterol content. Some variations in almond oil composition can be found depending on the kernel's origin and the extraction system used. Some new technologies such as ultrasonic-assisted extraction, supercritical fluid extraction, subcritical fluid extraction, and salt-assisted aqueous extraction have emerged as the most promising extraction techniques that allow eco-friendly and effective recovery of almond oil. This safe oil was reported by several clinical studies to have potential roles in cardiovascular risk management, glucose homeostasis, oxidative stress reduction, neuroprotection, and many dermatologic and cosmetic applications. However, the anticarcinogenic and fertility benefits of almond oil have yet to be experimentally verified.
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Affiliation(s)
- Mounir Ouzir
- Group of Research in Physiology and Physiopathology, Department of Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco.,Higher Institute of Nursing Professions and Health Techniques, ISPITS Beni Mellal, Beni Mellal, Morocco
| | - Sara El Bernoussi
- Laboratory of Materials, Nanotechnology and Environment (LMNE), Department of Chemistry, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohamed Tabyaoui
- Laboratory of Materials, Nanotechnology and Environment (LMNE), Department of Chemistry, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
| | - Khalid Taghzouti
- Group of Research in Physiology and Physiopathology, Department of Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
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Trappey AF, Galganski L, Saadai P, Stephenson J, Stark R, Farmer DL, Langer JC, Hirose S. Surgical management of pediatric rectal prolapse: A survey of the American Pediatric Surgical Association (APSA). J Pediatr Surg 2019; 54:2149-2154. [PMID: 30987759 DOI: 10.1016/j.jpedsurg.2019.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/19/2019] [Accepted: 02/17/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many management options exist for the treatment of refractory rectal prolapse (RP) in children. Our goal was to characterize current practice patterns among active members of APSA. METHODS A 23-item questionnaire assessed the management of full-thickness RP for healthy children who have failed medical management. The survey was approved by our IRB and by the APSA Outcomes committee. RESULTS 236 surgeons participated. The respondents were geographically dispersed (44 states, 5 provinces). 32% of respondents had twenty or more years of clinical experience. 71% evaluated 1-5 RP patients in the last 2 years, while 5% evaluated >10. 71% performed 0-1 procedure (operation or local therapy [LT]) for RP over 2 years. 59% would treat a 2-year-old patient differently than a 6-year-old with the same presentation, and were more likely to offer up-front surgery to a 6-year-old (26% vs 15%, p = 0.04), less likely to continue medical management indefinitely (2% vs 7%, p=0.01), and more likely to perform resection with rectopexy (30% vs. 15%, p=0.01). 71% perform LT as an initial intervention: injection sclerotherapy (59%), anal encirclement (8%), and sclerotherapy + anal encirclement (5%). 70% consider LT a failure after 1-3 attempts. If LT fails, surgical management consists of transabdominal rectopexy (46%), perineal proctectomy or proctosigmoidectomy (22%), transabdominal sigmoidectomy + rectopexy (22%), and posterior sagittal rectopexy (9%). CONCLUSIONS There is wide variability in the surgical management of pediatric rectal prolapse. This suggests a need for development of processes to identify best practices and optimize outcomes for this condition.
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Affiliation(s)
- Alfred Francois Trappey
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, David Grant Medical Center, Travis AFB, CA, 2425 Stockton Blvd., Sacramento, CA 25817.
| | - Laura Galganski
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Payam Saadai
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Jacob Stephenson
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, David Grant Medical Center, Travis AFB, CA, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Rebecca Stark
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Diana L Farmer
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Jacob C Langer
- Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Shinjiro Hirose
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
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Morrison ZD, LaPlant M, Hess D, Segura B, Saltzman D. A systematic review of management options in pediatric rectal prolapse. J Pediatr Surg 2019; 54:1782-1787. [PMID: 30905414 DOI: 10.1016/j.jpedsurg.2019.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/23/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Rectal prolapse is a relatively common condition in infants and young children with a multifactorial etiology. Despite its prevalence, there remains clinical equipoise with respect to secondary treatment in pediatric surgery literature. We conducted a systematic review to evaluate methods of secondary treatment currently used to treat rectal prolapse in children. METHODS We searched Pubmed, Medline, and Scopus with the terms "rectal prolapse" and "children" for papers published from 1990 to April 2017. Papers satisfying strict criteria were analyzed for patient demographics, intervention, efficacy, and complications. Procedures were grouped by like type. Pooled success rates were calculated. RESULTS Twenty-seven studies documenting 907 patients were included. Injection sclerotherapy had an overall initial success rate of 79.5%. Ethyl alcohol seemed the best sclerosing agent due to a high first-injection success rate, low complication rate, and ready accessibility. Several perineal repairs were found, with operative success rates ranging from 60.8%-100%. Laparoscopic rectopexy with mesh was the most commonly reported transabdominal procedure and had an overall success rate of 96.1%. Postoperative complications from all procedures were comparable. CONCLUSION Though many secondary treatment options have been reported for rectal prolapse, sclerotherapy and laparoscopic rectopexy predominate in contemporary literature and appear to have high success and low complication rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zachary D Morrison
- Marshfield Medical Center, Department of Surgery, 1000 N. Oak Ave., Marshfield, WI 54449, USA.
| | - Melanie LaPlant
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
| | - Donavon Hess
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
| | - Bradley Segura
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
| | - Daniel Saltzman
- University of Minnesota Medical School, Division of Pediatric Surgery, 2450 Riverside Ave., Minneapolis, MN 55454, USA
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Hintz GC, Zou VZ, Baird R. Sclerotherapy for rectal prolapse in children: A systematic review and meta-analysis. J Pediatr Surg 2019; 54:1083-1088. [PMID: 30782440 DOI: 10.1016/j.jpedsurg.2019.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sclerotherapy is a commonly utilized treatment for rectal prolapse in children. This study systematically evaluates the effectiveness and complications of various sclerosing agents in treating pediatric rectal prolapse. METHODS After protocol registration (CRD-42018088980), multiple databases were searched. Studies describing injection sclerotherapy for treatment of pediatric rectal prolapse were included, with screening and data abstraction duplicated. The methodological quality of included papers was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS Nineteen studies were identified, published between 1970 and 2017. Most studies were single institution case series, with median "N" 57+/-88.9 and mean MINORS score of 0.51+/-0.17 (perfect score = 1). 1510 patients with a mean age of 4.5 years were accounted for: 36.2% female, most without comorbidities. Mean follow up length was 30 months. The most common sclerosing agent described was ethanol (45%), followed by phenol (33%). The mean number of treatments per patient was 1.1+/-0.34. The overall success rate after a single sclerotherapy treatment was 76.9%+/-8.8%. The overall complication rate was 14.4%+/-2%. CONCLUSIONS Injection sclerotherapy appears effective and low-risk in the treatment of pediatric rectal prolapse and should be considered before more invasive surgical options. The available evidence is of relatively poor quality, and prospective comparative investigations are warranted. LEVEL OF EVIDENCE 3 (meta-analysis of level 3 studies).
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Affiliation(s)
- Graeme Charles Hintz
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada; Division of General Surgery, Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Vito Zhaoxin Zou
- MD Undergraduate Program, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - Robert Baird
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada.
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De la Torre L, Zornoza-Moreno M, Cogley K, Calisto JL, Wehrli LA, Ruiz-Montañez A, Santos-Jasso K. Transanal endorectal approach for the treatment of idiopathic rectal prolapse in children: Experience with the modified Delorme's procedure. J Pediatr Surg 2019; 54:857-861. [PMID: 30381137 DOI: 10.1016/j.jpedsurg.2018.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Persistent or recurrent idiopathic rectal prolapse in children requires surgical intervention. Several techniques have been used to repair this problem. However, recurrence and complications continue to be a challenge in the management of this condition. Here we report our experience in using the modified Delorme's procedure to treat such patients. METHODS We conducted a retrospective observational study of patients with idiopathic rectal prolapse who underwent the modified Delorme's procedure during 2013-2017. We analyzed the clinical characteristics of the patients and the recurrence and complication rates during a follow-up of 15-68 months. RESULTS We included 14 patients. The age at operation ranged from 2 to 17 years, and the length of the prolapse was 3-15 cm. There were no intraoperative or postoperative complications. All patients achieved postoperative fecal control, and there were no recurrences. CONCLUSION The modified Delorme's procedure was effective for the treatment of idiopathic rectal prolapse. There were no recurrences or complications. Because it is a perineal technique, the procedure avoids the risk of nerve injury that exists for transabdominal methods.
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Affiliation(s)
- Luis De la Torre
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - María Zornoza-Moreno
- Centro Colorrectal para Niños de México y Latinoamérica, Hospital Angeles Puebla, Puebla, Mexico..
| | - Kimberly Cogley
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - Juan L Calisto
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - Lea A Wehrli
- Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, USA.
| | - Alejandro Ruiz-Montañez
- Centro Colorrectal para Niños de México y Latinoamérica, Hospital Angeles Puebla, Puebla, Mexico..
| | - Karla Santos-Jasso
- Department of Pediatric Surgery, Instituto Nacional de Pediatría, Ciudad de México, Mexico..
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Dolejs SC, Sheplock J, Vandewalle RJ, Landman MP, Rescorla FJ. Sclerotherapy for the management of rectal prolapse in children. J Pediatr Surg 2017; 53:S0022-3468(17)30637-1. [PMID: 29103788 DOI: 10.1016/j.jpedsurg.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Rectal prolapse is a commonly occurring and usually self-limited process in children. Surgical management is indicated for failures of conservative management. However, the optimal approach is unknown. The purpose of this study is to determine the efficacy of sclerotherapy for the management of rectal prolapse. METHODS This was a retrospective review of children <18years with rectal prolapse who underwent sclerotherapy, predominantly with peanut oil (91%), between 1998 and 2015. Patients with imperforate anus or cloaca abnormalities, Hirschprung disease, or prior pull-through procedures were excluded. RESULTS Fifty-seven patients were included with a median age of 4.9years (interquartile range (IQR) 3.2-9.2) and median follow-up of 52months (IQR 8-91). Twenty patients (n=20/57; 35%) recurred at a median of 1.6months (IQR 0.8-3.6). Only 3 patients experienced recurrence after 4months. Nine of the patients who recurred (n=9/20; 45%) were re-treated with sclerotherapy. This was successful in 5 patients (n=5/9; 56%). Two patients (n=2/20; 10%) experienced a mucosal recurrence which resolved with conservative management. Forty-four patients were thus cured with sclerotherapy alone (n=44/57; 77%). No patients undergoing sclerotherapy had an adverse event. Thirteen patients (n=13/20; 65%) underwent rectopexy after failing at least one treatment of sclerotherapy. Three of these patients (n=3/13; 23%) recurred following rectopexy and required an additional operation. CONCLUSIONS Injection sclerotherapy for children with rectal prolapse resulted in a durable cure of prolapse in most children. Patients who recur following sclerotherapy tend to recur within 4months. Another attempt at sclerotherapy following recurrence is reasonable and was successful half of the time. Sclerotherapy should be the preferred initial treatment for rectal prolapse in children and for the initial treatment of recurrence. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Treatment Study.
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Affiliation(s)
- Scott C Dolejs
- Indiana University School of Medicine, Division of Pediatric Surgery
| | - Justin Sheplock
- Indiana University School of Medicine, Division of Pediatric Surgery
| | | | - Mathew P Landman
- Indiana University School of Medicine, Division of Pediatric Surgery
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Chauhan K, Gan RWC, Singh S. Successful treatment of recurrent rectal prolapse using three Thiersch sutures in children. BMJ Case Rep 2015; 2015:bcr-2015-211947. [PMID: 26607187 DOI: 10.1136/bcr-2015-211947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Many techniques are described to manage recurrent rectal prolapse in children, including repeated Thiersch stitch, phenol injections, Delorme and Altemeier procedures, and rectopexy. We describe a case of successful treatment of rectal prolapse by placing three Thiersch sutures circumferentially along the anal canal--a simple and novel modification of a well-known procedure. An 8-year-old boy with full-thickness rectal prolapse was treated with laxatives to no avail. He was subsequently treated with phenol-in-almond-oil injection and insertion of a 1/0PDS Thiersch suture. The effects were temporary with recurrence 3 months later. A further phenol-in-almond-oil injection was given and a 1/0PDS Thiersch suture placed, and the patient was discharged on laxatives. Recurrence occurred again at 3 months. This was treated with three circumferential Thiersch sutures along the anal canal--one Prolene 2/0 and two 1/0PDS. There has been no recurrence at follow-up. Placement of three sequential Thiersch sutures along the rectum is effective in treating recurrent rectal prolapse and a good alternative to major rectopexy.
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Affiliation(s)
- Kashif Chauhan
- Department of Paediatric Surgery, Queen's Medical Campus, Nottingham, UK
| | | | - Shailinder Singh
- Department of Paediatric Surgery, Queen's Medical Campus, Nottingham, UK
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La phénolisation : un nouveau traitement des chéloïdes. Ann Dermatol Venereol 2014; 141:493-9. [DOI: 10.1016/j.annder.2014.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/16/2014] [Accepted: 06/19/2014] [Indexed: 11/24/2022]
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Combined aluminum potassium sulfate and tannic acid sclerosing therapy and anal encirclement using an elastic artificial ligament for rectal prolapse. Dis Colon Rectum 2014; 57:653-7. [PMID: 24819107 DOI: 10.1097/dcr.0000000000000087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Aluminum potassium sulfate and tannic acid is a sclerosant used for sclerosing therapy in the treatment of hemorrhoids, and a Leeds-Keio artificial ligament is a new anal-encircling material for the management of rectal prolapse. OBJECTIVE The aim of this study was to evaluate clinical data and recurrence rates in patients with rectal prolapse undergoing combined aluminum potassium sulfate and tannic acid injection and anal encirclement using the Leeds-Keio artificial ligament. DESIGN This was a retrospective review of patients who underwent this procedure. SETTINGS This study was conducted at a community-based hospital within a specialized colorectal unit. PATIENTS A total of 23 patients (20 women; median age, 83 years) with full-thickness rectal prolapse underwent treatment between 2005 and 2010. MAIN OUTCOME MEASURES The main outcome measures were morbidity and recurrence rate. RESULTS The median duration of surgery was 36 minutes. Mean total injection dose of aluminum potassium sulfate and tannic acid was 30 mL. There were no postoperative deaths. Wound infection occurred in 2 patients (9%), and new or worsening symptoms of constipation after surgery occurred in 6 patients (26%). There were 3 recurrences at a median follow-up of 36 months (range, 7-86 months). Recurrence rate at 5 years was 14% (95% CI, 5%-35%). LIMITATIONS The limitations of this study include its retrospective nature, the potential for selection bias, and lack of a control group. CONCLUSIONS This procedure is quick and easy to perform, with no formidable morbidity, and the recurrence rate is reasonably low. Therefore, it seems to be a reasonable alternative for rectal prolapse in frail, elderly, and high-risk patients.
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Ezer SS, Kayaselçuk F, Oguzkurt P, Temiz A, Ince E, Hicsonmez A. Comparative effects of different sclerosing agents used to treat rectal prolapse: an experimental study in rats. J Pediatr Surg 2013; 48:1738-43. [PMID: 23932615 DOI: 10.1016/j.jpedsurg.2012.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Sclerosing agents injected into the rectal submucosal area produce an inflammatory response and scar that prevent rectal prolapse. This study aimed to investigate the histopathological changes following submucosal injection of different sclerosing agents in rats. METHODS Rats (n=35) were divided into control, sham, and five experimental groups, each treated with a different sclerosing agent: cow's milk, 30% saline solution, 30% dextrose solution, 70% ethyl alcohol, and 5% phenol in almond oil (PAO). All agents were injected into the submucosal area. After 4 weeks, all animals were sacrificed. Histopathological evaluation was performed according to a semi-quantitative fibrosis scoring system (grades 0 to 3), by using Masson trichrome and hematoxylin and eosin staining. RESULTS Histopathological changes in the 5% phenol in almond oil group were significantly different from other groups (p=0.0001). Prominent submucosal fibrosis (grade 3), lymphatic vascular dilation, foreign body reaction, and lipogranuloma were observed in the 5% PAO group (p=0.007). No significant histopathological differences were seen between the 30% saline, 30% dextrose, and 70% ethyl alcohol groups. Significantly increased mucosal fibroblast proliferation (grade 2) was seen in 60% rats of the 30% dextrose group (p=0.026). The cow's milk and ethyl alcohol groups had mucosal erosions and congestion (grade 1) which were significantly different from the control group (p=0.024). No statically significant difference was observed between the 30% saline group and the control group. CONCLUSIONS In this study we showed that 5% PAO can induce some histopathological changes in the submucosal area that increase the mucosal tightness of the mucosa, which are necessary for the treatment of rectal prolapse.
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Affiliation(s)
- Semire Serin Ezer
- Başkent University Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
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13
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Philip AT, Marraffa JM. Death following injection sclerotherapy due to phenol toxicity. J Forensic Sci 2012; 57:1372-5. [PMID: 22827471 DOI: 10.1111/j.1556-4029.2012.02224.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 04/18/2011] [Accepted: 05/01/2011] [Indexed: 11/30/2022]
Abstract
Prolapse rectum (PR) or protrusion of the rectum beyond the anus occurs frequently in populations at both extremes of age. In the pediatric population, in developed countries, the commonest cause for PR is thought to be cystic fibrosis (CF). Treatment options for CF include conservative management, surgical resection and fixation, suturing, and injection sclerotherapy (IS). The last is considered an attractive treatment option because it is minimally invasive. In this case report, the authors present the details about a 2-year-old female child, with PR and CF, who died after IS, using phenol as the sclerotherapeutic agent. Autopsy findings and toxicology tests performed to establish phenol toxicity are documented. The available literature is reviewed. This case report underscores the risks of using phenol for IS and emphasizes the point that the procedure is not innocuous and an adverse outcome including fatality is a possibility.
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Affiliation(s)
- Abraham T Philip
- Onondaga County Medical Examiner's Office, 100 Elizabeth Blackwell Street, Syracuse, NY, USA.
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14
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Abstract
Injection therapy is currently an important treatment choice for rectal prolapse. Frequently used drugs include alcohol, 50% glucose, phenol-almond oil, 5% sodium morrhuate, alum injection, peony-gallnut injection, and Xiaozhiling injection. Injection methods include rectal submucosal injection, perirectal injection, double-layer four-step injection, punctiform injection, columnar injection, and sector injection. Foreign scholars usually treat infants and patients with incomplete rectal prolapse by injection therapy, while domestic scholars often use this method to treat various kinds of rectal prolapse. Xiaozhiling injection is the most commonly used drug for rectal prolapse in China and is associated with a satisfactory short-term curative effect despite a low level of recurrence. Injection therapy has many advantages such as minimal invasiveness, low cost, good safety and efficacy, and simpleness, and is therefore a preferred treatment for rectal prolapse.
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Abstract
Rectal prolapse is a troublesome anorectal disorder. Surgical procedures for rectal prolapse contain transabdominal and transperineal approaches. There are hundreds of transabdominal approaches currently available for treatment of rectal prolapse. In contrast, only tens of transperineal approaches available for the disease, such as Delorme procedure, Altemeier prodecure, Thiersch prodecure and Gant-Miwa prodecure. Procedure for prolapse and hemorrhoids (PPH) represents the latest advance in transperineal treatment of rectal prolapse. Injection treatment is applied widely in China and has remarkable superiority. As each procedure has its strength and weakness, selection of appropriate procedure based on individual difference can greatly improve surgical outcome. Individualized diagnosis and treatment plan may represent a new direction for transperineal surgical treatment of rectal prolapse.
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Affiliation(s)
- James S Wu
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Mayfield Heights, Ohio, USA
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Zganjer M, Cizmic A, Cigit I, Zupancic B, Bumci I, Popovic L, Kljenak A. Treatment of rectal prolapse in children with cow milk injection sclerotherapy: 30-year experience. World J Gastroenterol 2008; 14:737-40. [PMID: 18205264 PMCID: PMC2684001 DOI: 10.3748/wjg.14.737] [Citation(s) in RCA: 16] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the role and our experience of injection sclerotherapy with cow milk in the treatment of rectal prolapse in children.
METHODS: In the last 30 years (1976-2006) we made 100 injections of sclerotherapy with cow milk in 86 children. In this study we included children who failed to respond to conservative treatment and we perform operative treatment.
RESULTS: In our study we included 86 children and in all of the patients we perform cow milk injection sclerotherapy. In 95.3% (82 children) of patients sclerotherapy was successful. In 4 (4.7%) patients we had recurrent rectal prolapse where we performed operative treatment. Below 4 years we had 62 children (72%) and 24 older children (28%). In children who needed operative treatment we performed Thiersch operation and without any complications.
CONCLUSION: Injection sclerotherapy with cow milk for treatment rectal prolapse in children is a simple and effective treatment for rectal prolapse with minimal complications.
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