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Neshatian L, Triadafilopoulos G, Wallace S, Jawahar A, Sheth V, Shen S, Gurland B. Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation. Am J Gastroenterol 2024; 119:946-956. [PMID: 37975595 DOI: 10.14309/ajg.0000000000002605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades. METHODS Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and magnetic resonance defecography was performed. Association of risk factors on increasing RI grades was assessed using logistic regression. RESULTS Analysis included a total of 238 women: 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age ( P = 0.017), vaginal delivery ( P = 0.008), and prior pelvic surgery ( P = 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades were associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion ( P < 0.05), linked to diminished anal sphincter. Indeed, increased RI grades were associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades. DISCUSSION Our data suggest that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades, a process that is independent of age, history of vaginal deliveries, and/or pelvic surgeries, and perhaps related to dyssynergic defecation.
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Affiliation(s)
- Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Shannon Wallace
- Women's Health Institute, Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anugayathri Jawahar
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Vipul Sheth
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Sa Shen
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | - Brooke Gurland
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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Chung JS, Ju JK, Kwak HD. Comparison of abdominal and perineal approach for recurrent rectal prolapse. Ann Surg Treat Res 2023; 104:150-155. [PMID: 36910558 PMCID: PMC9998957 DOI: 10.4174/astr.2023.104.3.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose Rectal prolapse is a benign disease in which the rectum protrudes below the anus. Although many studies have been reported on the treatment of primary rectal prolapse for many years, there is a lack of treatment or clinical research results on recurrent rectal prolapse. This study aimed to evaluate the outcomes of surgical approaches for recurrent rectal prolapse. Methods We studied patients who underwent surgical treatment for recurrent rectal prolapse disease from March 2016 to February 2021. We analyzed the previous operation methods in patients with recurrent rectal prolapse, as well as the operation time, complication rate, hospital stay, and re-recurrence rates in the perineal and abdominal approach groups. Results Out of a total of 239 patients, 41 patients who underwent surgery for recurrent rectal prolapse were retrospectively enrolled. Recurrent rectal prolapses were surgically treated either by the perineal approach (n = 25, 61.0%) or by the abdominal approach (n = 16, 39.0%). The operation times were significantly longer in the abdominal approach than in the perineal approach (98.44 minutes vs. 58.00 minutes, P = 0.001). Hospital stay was significantly longer in the abdominal approach than in the perineal approach (9.19 days vs. 6.00 days, P = 0.012). Re-recurrence rate after repeat repair was not significantly different between the 2 groups (P = 0.777). Conclusion Although the perineal approach shortened the operation time and hospital stay, there were no significant differences between the 2 groups in postoperative complications and re-recurrence rate. Both approaches can be good surgical options for the treatment of recurrent rectal prolapse.
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Affiliation(s)
- Jun Seong Chung
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.,Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.,Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Revels JW, Mansoori B, Fadl S, Wang SS, Olson MC, Moran SK, Terrazas MF, Fletcher JG, Perry WRG, Chernyak V, Mileto A. MR Defecating Proctography with Emphasis on Posterior Compartment Disorders. Radiographics 2023; 43:e220119. [DOI: 10.1148/rg.220119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Tunneling of Mesh during Ventral Rectopexy: Technical Aspects and Long-Term Functional Results. J Clin Med 2022; 12:jcm12010294. [PMID: 36615094 PMCID: PMC9821569 DOI: 10.3390/jcm12010294] [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: 10/13/2022] [Revised: 11/22/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
Avoiding the extensive damage of pelvic structures during ventral rectopexy could minimize secondary disfunctions. The objective of our observational study is to assess the safety and functional efficacy of a modified ventral rectopexy. In the modified ventral rectopexy, a retroperitoneal tunnel was created along the right side of rectum, connecting two peritoneal mini-incisions at the Douglas pouch and sacral promontory. The proximal edge of a polypropylene mesh, sutured over the ventral rectum, was pulled up through the retroperitoneal tunnel and fixed to the sacral promontory. In all patients, radiopaque clips were placed on the mesh, making it radiographically "visible". Before surgery and at follow up visits, Altomare, Longo, CCSS, PAC-SYM, and CCFI scores were collected. From March 2010 to September 2021, 117 patients underwent VR. Modified ventral rectopexy was performed in 65 patients, while the standard ventral rectopexy was performed in 52 patients. The open approach was used in 97 cases (55 and 42 patients in modified and standard VR, respectively), while MI surgery was used in 20 cases (10 and 10 patients in modified and standard VR, respectively). A slightly shorter operative time and hospital stay were observed following modified ventral rectopexy (though this was not statistically significant). Similar overall complication rates were registered in the modified vs. standard ventral rectopexies (4.6% vs. 5.8%, p = 0.779). At follow-up, the Longo score (14.0 ± 8.6 vs. 11.0 ± 8.2, p = 0.042) and "delta" values of Altomare (9.2 ± 6.1 vs. 5.9 ± 6.3, p = 0.008) and CCSS (8.4 ± 6.3 vs. 6.1 ± 6.1, p = 0.037) scores were significantly improved in the modified ventral rectopexy group. A similar occurrence of symptoms recurrence was diagnosed in the two groups. Radiopaque clips helped to accurately diagnose mesh detachment/dislocation. The proposed modified VR seems to be feasible and safe. Marking the mesh intraoperatively seems useful.
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Rectal Intussusception: Medical management and timing of the decision to operate. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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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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Du Y, Zhu J, Li H, Fu Z, He Z. Value of Defecography in the Diagnostic and Therapeutic Management of the Modified Wells Procedure for Rectal Prolapse. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2219330. [PMID: 35480080 PMCID: PMC9013572 DOI: 10.1155/2022/2219330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
The main aim of this study was to explore the role of defecography in the preoperative diagnosis and postoperative evaluation of rectal prolapse surgery (modified Wells procedure). We collected and summarized the X-ray performance and then analyzed the results of 107 patients with defecatory dysfunction who underwent defecography from January 2020 to March 2021. Furthermore, the preoperative and 6-month postoperative defecography results and clinical symptoms of 25 patients who underwent rectal prolapse surgery (modified Wells procedure) were compared. Results showed that among the 107 patients with defecation dysfunction, women had worse defecography results than men (P < 0.01). A total of 25 patients successfully completed the surgery without complications such as infection and intestinal fistula and there was no recurrence at 12 months of follow-up. Compared with the preoperative results, anorectal angle during defecation, the depth of rectocele, and perineal descent were significantly improved after the surgery (P < 0.01). Moreover, the patient's feeling of obstructed defecation and incomplete defecation was significantly relieved compared to that before the procedure (P < 0.01). In conclusion, defecography can be used to diagnose rectal prolapse preoperatively and evaluate the surgical effect combined with clinical symptoms postoperatively, which provides a clinical reference.
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Affiliation(s)
- Yangbin Du
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jinxin Zhu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hailun Li
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Zhiqiang Fu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Zhenyu He
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
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Chase C, Griffith S, Doyle A. The utility of the Altemeier procedure in strangulated rectal procidentia secondary to rectal cancer. A case report. Int J Surg Case Rep 2022; 90:106741. [PMID: 34995896 PMCID: PMC8741483 DOI: 10.1016/j.ijscr.2021.106741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/26/2021] [Accepted: 12/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Altemeier rectosigmoidectomy has been cited in the literature as a suitable approach for incarcerated rectal prolapse when a large segment of bowel is involved. However, the literature is devoid of cases that employed the technique as an oncological procedure for rectal carcinoma. For this reason, this case report heralds a new perspective on an old technique. Case presentation We describe the case of a male in his 6th decade who presented with stage four rectal cancer. Computed tomography imaging showed a rectal mass at the rectosigmoid junction with pelvic lymphadenopathy and a solitary hepatic lesion in segment two of the liver. While admitted to the hospital a 16 cm segment of bowel containing the mass prolapsed and became incarcerated, eventually becoming necrotic. A modification of the Altemeier procedure was performed along with a diverting ileostomy and hepatic wedge resection of the solitary metastases. Histological assessment of the surgical specimens confirmed that adequate resection margins were obtained with one of twenty-one lymph nodes positive for malignancy. He is currently being followed up in the outpatient oncology clinic and has commenced adjuvant chemotherapy. Clinical discussion Synchronous excision of rectal carcinoma with hepatic metastasectomy is a feasible surgery even in the emergency setting and can offer improved patient survival. Conclusion The combination of both an abdominal and perineal approach was suitable for this patient given his improved quality of life and negative pathological margins. Rectal prolapse can be the first presentation of rectal cancer. Strangulated rectal procidentia should be addressed by the perineal route. Altemeier procedure can be utilized for oncological resection of rectal cancer. Low volume liver resection is feasible without adjustment of central venous pressure.
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Affiliation(s)
| | - Sahle Griffith
- Caribbean Colon Cancer Initiative, St Michael, Barbados; Department of Surgery, Queen Elizabeth Hospital, St Michael, Barbados.
| | - Alex Doyle
- Caribbean Colon Cancer Initiative, St Michael, Barbados
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Ventral Prosthesis Rectopexy for obstructed defaecation syndrome: a systematic review and meta-analysis. Updates Surg 2021; 74:11-21. [PMID: 34665411 DOI: 10.1007/s13304-021-01177-2] [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: 05/23/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Obstructed Defecation Syndrome (ODS) is a rather complex entity concerning mainly females and causing primarily constipation. Surgical treatment in the form of Ventral Prosthesis Rectopexy (VPR) has been proposed and seems to have the best outcomes. However, the selection criteria of patients to undergo this kind of operation are not clear and the reported outcomes are mainly short-term and data on long-term outcomes is scarce. This study assesses new evidence on the efficacy of VPR for the treatment of ODS, specifically focusing on inclusion criteria for surgery and the long-term outcomes. A search was performed of MEDLINE, EMBASE, Ovid and Cochrane databases on all studies reporting on VPR for ODS from 2000 to March 2020. No language restrictions were made. All studies on VPR were reviewed systematically. The main outcomes were intra-operative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Fourteen studies including 963 patients were eligible for analysis. The immediate postoperative morbidity rate was 8.9%. A significant improvement in constipation symptoms was observed in the 12-month postoperative period for ODS (p < 0.0001). Current evidence shows that VPR offers symptomatic relief to the majority of patients with ODS, improving both constipation-like symptoms and faecal incontinence for at least 1-2 years postoperatively. Some studies report on functional results after longer follow-up, showing sustainable improvement, although in a lesser extent.
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Xu PP, Su YH, Zhang Y, Lu T. Modified Gant procedure for treatment of internal rectal prolapse in elderly women. World J Clin Cases 2021; 9:8702-8709. [PMID: 34734048 PMCID: PMC8546830 DOI: 10.12998/wjcc.v9.i29.8702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although rectal prolapse is not a life-threatening condition, it can cause defecation disorders, anal incontinence, sensory abnormalities, and other problems that can seriously affect quality of life.
AIM To study the efficacy of the modified Gant procedure for elderly women with internal rectal prolapse.
METHODS Sixty-three elderly female patients with internal rectal prolapse underwent the modified Gant procedure. The preoperative and postoperative anal symptoms, Patient Assessment of Constipation Quality of Life (PAC-QOL), Wexner incontinence score, incontinence quality of life score, and complications (massive hemorrhage, infection, anorectal stenosis, and anorectal fistula) were compared.
RESULTS The improvement rates of postoperative symptoms were defecation disorders (84.5%), anal distention (69.6%), defecation sensation (81.4%), frequent defecation (88.7%), and anal incontinence (42.9%) (P < 0.05). All dimensions and total scores of the PAC-QOL after the procedure were lower than those before the operation (P < 0.05). The postoperative anal incontinence score and Wexner score were significantly lower than those before the procedure (P < 0.05). The quality of life and total scores of postoperative anal incontinence were significantly higher than those before the procedure (P < 0.05). There were no serious complications and no deaths.
CONCLUSION The modified Gant procedure has significant advantages in the treatment of elderly women with internal rectal prolapse.
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Affiliation(s)
- Peng-Peng Xu
- Department of Anorectal, Shandong Provincial Hospital (Group) Huaiyin People’s Hospital, Jinan 250021, Shandong Province, China
| | - Yong-Hong Su
- Department of Anorectal, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
| | - Yan Zhang
- Department of Anorectal, Shanghe People’ Hospital, Shanghe 251600, Shandong Province, China
| | - Tong Lu
- Department of Anorectal, Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, Shandong Province, China
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A Rare Case of Rectal Prolapse Complicated by Maggot Infestation. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Formisano G, Ferraro L, Salaj A, Giuratrabocchetta S, Pisani Ceretti A, Opocher E, Bianchi PP. Update on Robotic Rectal Prolapse Treatment. J Pers Med 2021; 11:706. [PMID: 34442349 PMCID: PMC8399170 DOI: 10.3390/jpm11080706] [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: 06/13/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Rectal prolapse is a condition that can cause significant social impairment and negatively affects quality of life. Surgery is the mainstay of treatment, with the aim of restoring the anatomy and correcting the associated functional disorders. During recent decades, laparoscopic abdominal procedures have emerged as effective tools for the treatment of rectal prolapse, with the advantages of faster recovery, lower morbidity, and shorter length of stay. Robotic surgery represents the latest evolution in the field of minimally invasive surgery, with the benefits of enhanced dexterity in deep narrow fields such as the pelvis, and may potentially overcome the technical limitations of conventional laparoscopy. Robotic surgery for the treatment of rectal prolapse is feasible and safe. It could reduce complication rates and length of hospital stay, as well as shorten the learning curve, when compared to conventional laparoscopy. Further prospectively maintained or randomized data are still required on long-term functional outcomes and recurrence rates.
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Affiliation(s)
- Giampaolo Formisano
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Adelona Salaj
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Simona Giuratrabocchetta
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Andrea Pisani Ceretti
- Division of General and HPB Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (A.P.C.); (E.O.)
| | - Enrico Opocher
- Division of General and HPB Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (A.P.C.); (E.O.)
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
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Tanabe T, Yamaguchi E, Nakada T, Nishio R, Okamoto K, Yamana T. Longer Prolapsed Rectum Length Increases Recurrence Risk After Delorme's Procedure. Ann Coloproctol 2021; 38:314-318. [PMID: 34256427 PMCID: PMC9441539 DOI: 10.3393/ac.2020.01032.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/01/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Risk factors for recurrence of rectal prolapse after surgery remain unclear. Delorme’s procedure is often selected for relatively small-sized rectal prolapse, but there are few reports discussing the association between prolapsed rectum length and prolapse recurrence after Delorme’s procedure. We hypothesized that patients with longer rectal prolapses are at a higher risk of recurrence after Delorme’s procedure. Methods The study population comprised patients with rectal prolapse who underwent Delorme’s procedure between January 2014 and December 2019 at Tokyo Yamate Medical Center. We extracted data on patient age, sex, body mass index, previous history of anal surgery, previous history of surgery for rectal prolapse, and length of prolapse, to identify risk factors for prolapse recurrence. Results Altogether, 96 patients were eligible for analysis. The median length of the prolapsed rectum was 3.0 cm (range, 1.0–6.6 cm). Twenty-four patients (25.0%) experienced recurrence after Delorme’s procedure after a median of 7.5 months (interquartile range, 3.2–20.9 months). Multivariate analysis revealed that longer prolapsed rectum length increased the risk of recurrence after Delorme’s procedure (hazard ratio, 6.28; 95% confidence interval, 1.83–21.50; P<0.001). Conclusion The length of the prolapsed rectum should be measured before Delorme’s procedure for rectal prolapse, because length is associated with a risk of recurrence after the surgery.
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Affiliation(s)
- Taro Tanabe
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Emi Yamaguchi
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Takuya Nakada
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Risa Nishio
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Kinya Okamoto
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
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Meng J, Yin ZT, Zhang YY, Zhang Y, Zhao X, Zhai Q, Chen DY, Yu WG, Wang L, Wang ZG. Therapeutic effects of the TST36 stapler on rectocele combined with internal rectal prolapse. World J Gastrointest Surg 2021; 13:443-451. [PMID: 34122734 PMCID: PMC8167842 DOI: 10.4240/wjgs.v13.i5.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/15/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The most common causes of outlet obstructive constipation (OOC) are rectocele and internal rectal prolapse. The surgical methods for OOC are diverse and difficult, and the postoperative complications and recurrence rate are high, which results in both physical and mental pain in patients. With the continuous deepening of the surgeon’s concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC, the treatment concepts and surgical methods are continuously improved.
AIM To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.
METHODS From January 2017 to July 2019, 49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.
RESULTS Forty-five patients were cured, 4 patients improved, and the cure rate was 92%. The postoperative obstructed defecation syndrome score, the defecation frequency score, time/straining intensity, and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment, and the differences were statistically significant (P < 0.05). The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment, and the differences were statistically significant (P < 0.05). The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment, and the differences were statistically significant (P < 0.05). The postoperative ratings of rectocele, resting phase, and defecation phase in these patients were significantly decreased compared with those before treatment, and the differences were statistically significant (P < 0.05).
CONCLUSION The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.
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Affiliation(s)
- Jin Meng
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Zhi-Tao Yin
- Department of Anorectal Disease, Shenyang Hospital of Traditional Chinese Medicine, Shenyang 110000, Liaoning Province, China
| | - Ying-Yi Zhang
- First Department of General Surgery, The Third People’s Hospital of Dalian, Dalian 116000, Liaoning Province, China
| | - Yong Zhang
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Xiu Zhao
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Qing Zhai
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - De-Yu Chen
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Wei-Gang Yu
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Lei Wang
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
| | - Zhi-Gang Wang
- Department of Anorectal Disease, Shenyang Coloproctology Hospital, Shenyang 110000, Liaoning Province, China
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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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Boccasanta P, Venturi M, Agradi S, Calabrò G, Bordoni L, Missaglia C, Favetta U, Vergani C. Is it possible to reduce recurrences after Altemeier's procedure for complete rectal prolapse? Twenty-year experience in 130 consecutive patients. Langenbecks Arch Surg 2021; 406:1591-1598. [PMID: 33538872 DOI: 10.1007/s00423-021-02091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In the attempt to understand the reasons for and to find a solution to the high recurrence rate after perineal surgery for complete rectal prolapse, we retrospectively analysed the long-term results of Altemeier's procedure alone, or associated with Trans-Obturator Colonic Suspension (TOCS) in a large series of patients with a median interval of 84 months (range 6-258). METHODS Medical records of 110 patients undergoing Altemeier with levatorplasty (group 1) and 20 patients submitted to the same procedure associated with TOCS (group 2) for newly diagnosed complete rectal prolapse were reviewed. All patients had been recruited after preoperative clinical examination, SF-36 quality of life, continence score and colonoscopy. RESULTS Mortality was nil. The overall complication and the recurrence rates were 12.3%, and 15.0% (P= 0.769) and 24.6% and 5.0% (P=0.067) in group 1 and 2, respectively. Twelve patients of group 1 with a recurrence were submitted to a redo-Altemeier, 8 to a redo-Altemeier associated with TOCS, and 6 associated with an anterior coloplasty with a mesh. The only patient of group 2 with a recurrence was submitted to a Hartmann's operation. Preoperative vs postoperative mean (SD) continence score was 15.8 (3.1) and 15.6 (3.3) versus 4.1 (1.8) and 3.9 (1.9) in group 1 and 2, respectively (P < 0.001). All parameters of SF-36 improved after surgery (P<0.01) and no differences between the 2 groups were found CONCLUSIONS: Long-term results confirmed the safety and effectiveness of Altemeier's procedure for the treatment of complete rectal prolapse, with the limit of a non-negligible incidence of anastomotic complications and recurrences. The combination of Altemeier with TOCS showed a positive trend to a reduction of the recurrence rate, not worsening morbidity and outcomes.
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Affiliation(s)
- Paolo Boccasanta
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Marco Venturi
- Day Week Surgery Departmental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F Sforza 35, Milan, 20122, Italy. marvent-@virgilio.it.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy. marvent-@virgilio.it
| | - Sergio Agradi
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Giuseppe Calabrò
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Luca Bordoni
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Claudio Missaglia
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Umberto Favetta
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Contardo Vergani
- Day Week Surgery Departmental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F Sforza 35, Milan, 20122, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
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Maeda K, Katsuno H, Tsunoda A, Seki M, Takao Y, Mimura T, Yamana T, Yoshioka K. Japanese Practice Guidelines for Fecal Incontinence Part 3 -Surgical Treatment for Fecal Incontinence, Fecal Incontinence in a Special Conditions- English Version. J Anus Rectum Colon 2021; 5:84-99. [PMID: 33537503 PMCID: PMC7843139 DOI: 10.23922/jarc.2020-075] [Citation(s) in RCA: 3] [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: 10/01/2020] [Accepted: 10/30/2020] [Indexed: 12/04/2022] Open
Abstract
In Japan, the surgical treatment for fecal incontinence (FI) can be performed using minimally invasive surgery, such as anal sphincteroplasty and sacral neuromodulation (SNM), as well as antegrade continence enema (ACE), graciloplasty, and stoma construction. In addition, currently, several other procedures, including biomaterial injection therapy, artificial bowel sphincter (ABS), and magnetic anal sphincter (MAS), are unavailable in Japan but are performed in Western countries. The evidence level of surgical treatment for FI is generally low, except for novel procedures, such as SNM, which was covered by health insurance in Japan since 2014. Although the surgical treatment algorithm for FI has been chronologically modified, it should be sequentially selected, starting from the most minimally invasive procedure, as FI is a benign condition. Injuries to the neural system or spinal cord often cause disorders of the sensory and motor nerves that innervate the anus, rectum, and pelvic floor, leading to the difficulty in controlling bowel movement or FI and/or constipation. FI and constipation are closely associated; when one improves, the other tends to deteriorate. Patients with severe cognitive impairment may present with active soiling, referred to as "incontinence" episodes that occur as a consequence of abnormal behavior, and may also experience passive soiling.
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Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
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Wang L, Li CX, Tian Y, Ye JW, Li F, Tong WD. Abdominal ventral rectopexy with colectomy for obstructed defecation syndrome: An alternative option for selected patients. World J Clin Cases 2020; 8:5976-5987. [PMID: 33344596 PMCID: PMC7723726 DOI: 10.12998/wjcc.v8.i23.5976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/26/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal ventral rectopexy (AVR) with colectomy is controversial in the treatment of obstructed defecation syndrome (ODS). Literature data on this technique for ODS are very limited.
AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.
METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department. Patient demographics, perioperative surgical results, and postoperative follow-up outcomes were collected and analyzed. Long-term follow-up was evaluated with standardized questionnaires. The severity of symptoms was assessed by the objective Wexner Constipation Score (WCS) and ODS Score. The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score. Functional outcome was compared pre- and post-operatively for each patient. The primary outcomes were determined by the improvement in symptoms and quality of life. Secondary outcome measures were operating time, postoperative length of stay, morbidity and mortality, improvement of pelvic floor structure, and patient satisfaction.
RESULTS Four patients underwent robotic-assisted surgery, and two patients underwent a laparoscopic-assisted procedure. The mean operating time for the robotic approach was 243 min (range 160–300 min), and the mean operating time for the laparoscopic approach was 230 min (range 220-240 min). The mean postoperative length of stay was 8.2 d (range 6-12 d). There was no conversion to open procedure and no postoperative mortality. No urinary retention, wound infection, prolonged ileus, pelvic infection and anastomosis leakage occurred. Six patients were followed up for 36 mo. The WCS, ODS, and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively (P < 0.05). The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery. There was no recurrence or novel constipation after surgery. None of the patients used laxative medication.
CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS. However, comprehensive preoperative evaluation and careful patient selection are essential.
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Affiliation(s)
- Li Wang
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Chun-Xue Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yue Tian
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Jing-Wang Ye
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Wei-Dong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
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Wang L, Li CX, Tian Y, Ye JW, Li F, Tong WD. Abdominal ventral rectopexy with colectomy for obstructed defecation syndrome: An alternative option for selected patients. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Yang Y, Cao YL, Zhang YY, Shi SS, Yang WW, Zhao N, Lyu BB, Zhang WL, Wei D. Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Yang Y, Cao YL, Zhang YY, Shi SS, Yang WW, Zhao N, Lyu BB, Zhang WL, Wei D. Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females. World J Clin Cases 2020; 8:5876-5886. [PMID: 33344586 PMCID: PMC7723707 DOI: 10.12998/wjcc.v8.i23.5876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Internal rectal prolapse (IRP) is one of the most common causes of obstructive constipation. The incidence of IRP in women is approximately three times that in men. IRP is mainly treated by surgery, which can be divided into two categories: Abdominal procedures and perineal procedures. This study offers a better procedure for the treatment of IRP.
AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair (IPFLR) combined with a procedure for prolapse and hemorrhoids (PPH) and the laparoscopic IPFLR alone in the treatment of IRP in women.
METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014. The patients were divided into groups A and B. Group A had 63 patients who underwent laparoscopic IPFLR alone, and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH. The degree of internal rectal prolapse (DIRP), Wexner constipation scale (WCS) score, Wexner incontinence scale (WIS) score, and Gastrointestinal Quality of Life Index (GIQLI) score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.
RESULTS All laparoscopic surgeries were successful. The general information, number of bowel movements before surgery, DIRP, GIQLI score, WIS score, and WCS score before surgery were not significantly different between the two groups (all P > 0.05). The WCS score, WIS score, GIQLI score, and DIRP in each group 6 mo, and 2 years after surgery were significantly better than before surgery (P < 0.001). In group A, the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery (P < 0.001), and the GIQLI score progressively improved from 6 mo to 2 years after surgery (P < 0.05). In group B, the DIRP, WCS score and WIS score significantly improved from 6 mo to 2 years after surgery (P < 0.05), and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery (P < 0.05). The WCS score, WIS score, GIQLI score, and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery (all P < 0.001, Bonferroni) except DIRP at 2 years after surgery. There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery (P = 0.011). There was no significant difference in postoperative grade I-III complications between the two groups (P = 0.822).
CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.
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Affiliation(s)
- Yang Yang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Yong-Li Cao
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Yuan-Yao Zhang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Shou-Sen Shi
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Wei-Wei Yang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Nan Zhao
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Bing-Bing Lyu
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Wen-Li Zhang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Dong Wei
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
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Xie Y, Fan Y, Yang C, Wan R, Cheng X, Yang X, Hu Y, Deng C. Efficacy and safety of Buzhong Yiqi decoction combined with surgery for rectal prolapse: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22732. [PMID: 33031344 PMCID: PMC7544326 DOI: 10.1097/md.0000000000022732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is extremely easy for rectal prolapse to relapse with surgery alone. Clinical practice indicates that Buzhong Yiqi decoction combined with surgery has certain therapeutic advantages, while there is a lack of evidence-based medicine support. This study aimed to systematically investigate the efficacy and safety of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse. METHODS The English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure [CNKI], Wanfang, China Science and Technology Journal Database [VIP], China Biology Medicine disc) were searched by computer. In addition, Baidu Scholar and Google Scholar were searched manually. A randomized controlled clinical study of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse was performed from the establishment of databases to September 2020. Two investigators independently conducted data extraction and assessed the literature quality of the included studies. The Revman5.3 software was used for meta-analysis of the included literature. RESULTS The efficacy and safety of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse were evaluated in terms of efficiency, symptom score, recurrence rate, adverse reaction rate, and so on. CONCLUSIONS Thisstudy provides reliable evidence-based support for the clinical application of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse. OSF REGISTRATION NUMBER DOI: 10.17605/OSF.IO/K3PJX.
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Affiliation(s)
- Yanpeng Xie
- Chengdu Anorectal Hospital, Chengdu, Sichuan Province
| | - Yihua Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion
| | - Chen Yang
- Tianjin University of Traditional Chinese Medicine
| | - Renhong Wan
- Tianjin University of Traditional Chinese Medicine
| | - Xiaoen Cheng
- School of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu
| | | | - Yuanzhang Hu
- School of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Changyou Deng
- Longwang Town Central Hospital, Guangyuan, Sichuan Province, China
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Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study. Dis Colon Rectum 2020; 63:1293-1301. [PMID: 32618619 DOI: 10.1097/dcr.0000000000001696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term data on robot-assisted sacrocolporectopexy for the treatment of multicompartment pelvic organ prolapse are scarce. With the rising prevalence of prolapse and increasing surgical repair, it is essential to evaluate long-term results. OBJECTIVE This study aimed to evaluate long-term functional and anatomic outcomes after sacrocolporectopexy. DESIGN This is a prospective, observational cohort study. SETTINGS This study was conducted at a teaching hospital with tertiary referral function for patients with gynecological/rectal prolapse. PATIENTS All patients undergoing robot-assisted sacrocolporectopexy from 2011 to 2012 were included. INTERVENTION Robot-assisted sacrocolporectopexy was performed. MAIN OUTCOME MEASURES The primary outcome was the anatomic cure rate after 1 and 4 years, defined as simplified pelvic organ prolapse quantification stage 1 vaginal apical prolapse and no external rectal prolapse or internal rectal prolapse present. Kaplan-Meier curves were used for determination of recurrence-free intervals. Secondary outcomes were functional pelvic floor symptoms (symptoms of bulge, obstructed defecation, fecal incontinence, urogenital distress inventory) and quality of life (Pelvic Floor Impact Questionnaire). RESULTS Fifty-three patients were included. After 12 and 48 months, the recurrence-free intervals based on Kaplan-Meier estimates were 100% and 90%. In total, there were 10 recurrences: 2 apical and 8 internal rectal prolapses. Symptoms of bulge (94%-12%; p < 0.0005), fecal incontinence (62%-32%; p < 0.0005), obstructed defecation (59%-24%; p = 0.008), and median Pelvic Floor Impact Questionnaire scores (124-5; p = 0.022) improved significantly at final follow-up. Median urogenital distress inventory scores showed improvement after 1 year (30-13; p = 0.021). LIMITATIONS This was an observational, single-center study with selective postoperative imaging. CONCLUSIONS Ninety percent of patients were recurrence free 48 months after robot-assisted sacrocolporectopexy. Symptoms of vaginal bulge, quality of life, constipation, and fecal incontinence improved significantly. However, a subgroup of patients showed persistent bowel complaints that underlie the complexity of multicompartment prolapse. See Video Abstract at http://links.lww.com/DCR/B265. RESULTADOS ANATÓMICOS Y FUNCIONALES A LARGO PLAZO DE LA CIRUGÍA DE PISO PÉLVICO ASISTIDA POR ROBOT EN EL TRATAMIENTO DEL PROLAPSO MULTICOMPARTIMENTAL: UN ESTUDIO PROSPECTIVO: Los datos a largo plazo sobre la sacrocolporectopexia asistida por robot para el tratamiento del prolapso multicompartimental de órganos pélvicos son escasos. Con el aumento de la prevalencia del prolapso y el aumento de la reparación quirúrgica, es esencial evaluar los resultados a largo plazo.Evaluar los resultados funcionales y anatómicos a largo plazo después de la sacrocolporectopexia.Estudio prospectivo observacional de cohorte.Hospital de enseñanza con función de referencia terciaria para pacientes con prolapso ginecológico/rectal.Todos los pacientes sometidos a sacrocolporectopexia asistida por robot en 2011-2012.Sacrocolporectopexia asistida por robot.El resultado primario fue la tasa de curación anatómica a uno y cuatro años, definida como etapa 1 de prolapso apical vaginal en la cuantificación del prolapso de órganos pélvicos simplificado, y sin prolapso rectal externo o prolapso rectal interno presentes. Se utilizaron curvas de Kaplan Meier para determinar los intervalos libres de recurrencia. Los resultados secundarios fueron síntomas funcionales del piso pélvico (síntomas de abultamiento, obstrucción defecatoria, incontinencia fecal, inventario de molestias urogenitales) y calidad de vida (cuestionario de impacto del piso pélvico).Se incluyeron 53 pacientes. Después de 12 y 48 meses, el intervalo libre de recurrencia basado en las estimaciones con método Kaplan Meier fue del 100% y 90%, respectivamente. En total hubo diez recurrencias: dos apicales y ocho prolapsos rectales internos. Los síntomas de abultamiento (94% a 12%; p <0.0005), incontinencia fecal (62% a 32%; p <0.0005), obstrucción defecatoria (59% a 24%; p = 0.008) y puntajes promedio del cuestionario de impacto del piso pélvico (124 a 5; p = 0.022) mejoraron significativamente en el seguimiento final. Las puntuaciones medias del inventario de molestias urogenitales mostraron una mejoría después de un año (30 a 13; p = 0.021).Estudio observacional de centro único con imagenología postoperatoria selectiva.Noventa por ciento de los pacientes estaban libres de recurrencia 48 meses después de la sacrocolporectopexia asistida por robot. Los síntomas de abultamiento vaginal, la calidad de vida, el estreñimiento y la incontinencia fecal mejoraron significativamente. Sin embargo, un subgrupo de pacientes mostró molestias intestinales persistentes que subrayan a la complejidad del prolapso multicompartimental. Consulte Video Resumen en http://links.lww.com/DCR/B265.
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Posterior pelvic tilt is a risk factor for rectal prolapse: a propensity score matching analysis. Tech Coloproctol 2020; 24:463-469. [PMID: 32170509 DOI: 10.1007/s10151-020-02179-9] [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: 07/17/2019] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is little evidence about possible effects of pelvic anatomical characteristics on proctological complications. The aim of our study was to investigate the potential correlation between sagittal pelvic position and rectal prolapse. METHODS A study was conducted on a proctology patients and patients without any specific history of proctological disorders who were divided into two groups according to the presence or the absence of rectal prolapse. In all cases, the pelvic angle was measured with a pelvic goniometer and categorized as posterior (< 10°), neutral (10°-15°), and anterior (> 15°). To minimize effects of potential confounders in the analysis, 3:1 nearest neighbor propensity score matching (PSM) method was implemented using age, sex, and diagnose of rectal disorders as confounding variables. RESULTS Among the 143 screened patients, posterior tilt was more frequent in the 19 patients with rectal prolapse than in those without prolapse (42 vs. 18%; p = 0.027). This result was also confirmed in the post-PSM analysis (42 vs. 14%; p = 0.036) using 35 propensity score (PS)-matched controls compared with the rectal prolapse group. Posterior tilt was associated with an increased risk of prolapse in both the unmatched population (odds ratio = 3.37; p = 0.020) and PS-matched subset (odds ratio = 4.36; p = 0.028). CONCLUSIONS A posterior pelvic angle was more frequently associated with the diagnosis of rectal prolapse. In both the entire population and in the PS-matched subset, posterior tilt was a significant risk factor for rectal prolapse. The easy-to-do investigation of the pelvic angle can provide several benefits in terms of rectal prolapse prevention and more precise management of post-surgical prolapse recurrence.
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Lee A, Kin C, Syan R, Morris A, Gurland B. Surgical decision-making for rectal prolapse: one size does not fit all. Postgrad Med 2019; 132:256-262. [PMID: 31525304 DOI: 10.1080/00325481.2019.1669330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgery remains the only known treatment option for rectal prolapse. Although over 100 abdominal and perineal procedures are available, there is no consensus as to which intervention is best suited for an individual. This retrospective cohort study describes the patient- and disease-related factors involved in making surgical recommendations around rectal prolapse in a single surgeon experience. METHODS 91 consecutive patients ≥18 years old diagnosed with external and/or high-grade internal rectal prolapse were assessed and were prospectively entered into an IRB approved registry. Information on patient symptoms, comorbidities, exam findings, surgeon judgment, and patient preference was collected. Treatment recommendations (abdominal, perineal, or no operation) were analyzed and compared. RESULTS Surgical intervention was recommended to 93% of patients. Of those, 66% were recommended robotic abdominal procedures: 75%, robotic ventral mesh rectopexies; 16%, resection rectopexies; and 9%, suture rectopexies. On univariate analysis, patients with older age, higher ASA scores, presence of cardiopulmonary morbidity, pain as a primary rectal prolapse symptom, rectal prolapse always descended, and surgeon concern for frailty and general anesthesia were associated with recommendations for perineal operations (p < 0.05 for all). However, on multivariate analysis, only age and concern over prolonged anesthesia remained correlated with a recommendation for perineal surgery. Of patients >80 years of age, 15% were recommended an abdominal approach. CONCLUSIONS With multiple options available for the treatment of rectal prolapse, treatment recommendations remain surgeon-dependent and may be influenced by many factors. In our practice, robotic ventral mesh rectopexy was the most commonly recommended operation and was offered to carefully selected patients of advanced age. Although robotic surgery and ventral mesh rectopexy may not be accessible to all patients and surgeons, this represents a single surgeon's practice bias. This study reinforces the importance of perineal procedures for higher-risk individuals.
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Affiliation(s)
- Angela Lee
- Stanford School of Medicine , Stanford, CA, USA
| | - Cindy Kin
- Stanford Department of General Surgery, Division of Colorectal Surgery , Stanford, CA, USA
| | - Raveen Syan
- Stanford Department of Urology , Stanford, CA, USA
| | - Arden Morris
- Stanford Department of General Surgery, Division of Colorectal Surgery , Stanford, CA, USA
| | - Brooke Gurland
- Stanford Department of General Surgery, Division of Colorectal Surgery , Stanford, CA, USA
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van Zanten F, van Iersel JJ, Paulides TJC, Verheijen PM, Broeders IAMJ, Consten ECJ, Lenters E, Schraffordt Koops SE. Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature. Int Urogynecol J 2019; 31:1423-1433. [PMID: 31222568 PMCID: PMC7306026 DOI: 10.1007/s00192-019-03990-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/16/2019] [Indexed: 01/25/2023]
Abstract
Introduction and hypothesis The use of synthetic mesh in transvaginal pelvic floor surgery has been subject to debate internationally. Although mesh erosion appears to be less associated with an abdominal approach, the long-term outcome has not been studied intensively. This study was set up to determine the long-term mesh erosion rate following abdominal pelvic reconstructive surgery. Methods A prospective, observational cohort study was conducted in a tertiary care setting. All consecutive female patients who underwent robot-assisted laparoscopic sacrocolpopexy and sacrocolporectopexy in 2011 and 2012 were included. Primary outcome was mesh erosion. Preoperative and postoperative evaluation (6 weeks, 1 year, 5 years) with a clinical examination and questionnaire regarding pelvic floor symptoms was performed. Mesh-related complications were assessed using a transparent vaginal speculum, proctoscopy, and digital vaginal and rectal examination. Kaplan–Meier estimates were calculated for mesh erosion. A review of the literature on mesh exposure after minimally invasive sacrocolpopexy was performed (≥12 months’ follow-up). Results Ninety-six of the 130 patients included (73.8%) were clinically examined. Median follow-up time was 48.1 months (range 36.0–62.1). Three mesh erosions were diagnosed (3.1%; Kaplan–Meier 4.9%, 95% confidence interval 0–11.0): one bladder erosion for which mesh resection and an omental patch interposition were performed, and two asymptomatic vaginal erosions (at 42.7 and 42.3 months) treated with estrogen cream in one. Additionally, 22 patients responded solely by questionnaire and/or telephone; none reported mesh-related complaints. The literature, mostly based on retrospective studies, described a median mesh erosion rate of 1.9% (range 0–13.3%). Conclusions The long-term rate of mesh erosion following an abdominally placed synthetic graft is low. Electronic supplementary material The online version of this article (10.1007/s00192-019-03990-1) contains supplementary material, which is available to authorized users
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Affiliation(s)
- Femke van Zanten
- Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
- Faculty of Electrical Engineering, Mathematics & Computer Science, Twente University, Enschede, The Netherlands.
| | - Jan J van Iersel
- Faculty of Electrical Engineering, Mathematics & Computer Science, Twente University, Enschede, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Tim J C Paulides
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Ivo A M J Broeders
- Faculty of Electrical Engineering, Mathematics & Computer Science, Twente University, Enschede, The Netherlands
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Egbert Lenters
- Department of Gynecology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
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Gültekin FA. Short term outcome of laparoscopic ventral mesh rectopexy for rectal and complex pelvic organ prolapse: case series. Turk J Surg 2019; 35:91-97. [PMID: 32550312 DOI: 10.5578/turkjsurg.4157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
Objectives Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. LVMR also allows correction of coexisted pelvic organ prolapse. This study aimed to evaluate the safety, efficacy and functional outcome of LVMR for rectal and complex pelvic organ prolapse. Material and Methods All patients who underwent LVMR from February 2014 to October 2017 were included into the study. The patients were evaluated preoperatively and three months postoperatively. Surgical complications and functional results in terms of fecal incontinence (measured with the Wexner Incontinence Score= WIS) and constipation (measured with the Wexner Constipation Score= WCS) were analyzed. Results Thirty (4 males) patients underwent LVMR. Seventeen (56.6%) patients had complex pelvic organ prolapse according to MRI findings. Median operative time and postoperative stay were 110 minutes and 4 days, respectively. No mesh-related complication and recurrence were observed. Before surgery, 21 (70%) patients had complained about symptoms of obstructed defecation. WCS decreased significantly from median 19 to 6 (p <0.001). Preoperative median WIS of 9 patients was 14 and went down to 6 postoperatively (p= 0.008). WCS significantly improved after LVMR in patients with symptomatic rectocele combined with enterocele or sigmoidocele (p= 0.005), and significant improvement was also observed in patients with symptomatic rectocele combined with gynecologic organ prolapse, preoperative median WCS was 18 and the postoperative value fell to 8 (p= 0.005). Conclusion LVMR is an effective surgical option for rectal and complex pelvic organ prolapse with short-term follow-up.
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Affiliation(s)
- Fatma Ayça Gültekin
- Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Zonguldak, Türkiye
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Yagi Y, Tsunoda A, Takahashi T, Kusanagi H. Rectoanal intussusception is very common in patients with fecal incontinence. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 2:162-167. [PMID: 31559359 PMCID: PMC6752137 DOI: 10.23922/jarc.2017-048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022]
Abstract
Objectives: Fecal incontinence (FI) is a multifactorial disorder, the etiology of which is not fully understood. Recent data have shown the significance of rectoanal intussusception (RAI) in the evaluation of FI. The present study aimed to determine the incidence of RAI in patients with FI. Methods: Between June 2010 and February 2016, 74 patients, who were evaluated using evacuation proctography, anorectal manometry, ultrasound, and incontinence scores, were included in this study. RAI was diagnosed when the apex of the rectal intussusception (RI) impinged on the internal anal orifice or was intra-anal, based on the images taken during maximal straining defecation at evacuation proctography. The characteristics of RAI patients were further analyzed. Results: There were 59 women (80%) and 15 men, with a median age of 74 (52-93) years. Sixty patients (81%) had RI, and 56 (76%) showed RAI. The incidence of RAI among the 32 patients with FI alone and the 42 patients with FI and symptoms of obstructed defecation (OD) was 72% (23/32) and 79% (33/42), respectively. The incidence of RAI was not significantly different between the patients with normal manometry (maximum resting pressure [MRP] ≥55 cmH2O and maximum squeeze pressure [MSP] ≥150 cmH2O, n=26) and those with subnormal manometry (MRP <55 cmH2O and/or MSP <150 cmH2O, n=48). Conclusion: RAI is common in patients with FI. Evacuation proctography should be taken into account as a part of the regular study of FI patients.
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Affiliation(s)
- Yuma Yagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
| | - Tomoko Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Chiba, Japan
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El Akri M, Brochard C, Hascoet J, Jezequel M, Alimi Q, Khene ZE, Richard C, Bonan I, Kerdraon J, Gamé X, Manunta A, Siproudhis L, Peyronnet B. Risk of prolapse and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor using clean intermittent catheterization versus Valsalva voiding. Neurourol Urodyn 2018; 38:269-277. [PMID: 30311685 DOI: 10.1002/nau.23844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/15/2018] [Indexed: 01/15/2023]
Abstract
AIMS To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean-intermittent catheterization (CIC). METHODS We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow-up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectal and/or pelvic organ prolapse (POP) diagnosed during follow-up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure. RESULTS Fifty-five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%; P = 0.99), and rectal prolapse/intussusception (25.9% vs 21.4%; P = 0.76) were similar in both groups. After a median follow-up of 80.6 and 65.6 months, respectively (P = 0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group (32.1% vs 3.7%; P = 0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P = 0.29). CONCLUSIONS Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/intussusception. Overall, the prevalence of POP and rectal prolapse was high in both groups.
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Affiliation(s)
| | - Charlène Brochard
- Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Centre de Référence Spina Bifida, CHU Rennes, Rennes, France.,Equipe Thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Juliette Hascoet
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de Référence Spina Bifida, CHU Rennes, Rennes, France.,Equipe Thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Magali Jezequel
- Centre de Référence Spina Bifida, CHU Rennes, Rennes, France
| | - Quentin Alimi
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de Référence Spina Bifida, CHU Rennes, Rennes, France
| | | | | | - Isabelle Bonan
- Centre de Référence Spina Bifida, CHU Rennes, Rennes, France.,Service de Médecine Physique et Réadaptation, CHU Rennes, Rennes, France
| | - Jacques Kerdraon
- Centre de Référence Spina Bifida, CHU Rennes, Rennes, France.,Centre de Rééducation de Kerpape, Ploemeur, France
| | - Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
| | - Andrea Manunta
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de Référence Spina Bifida, CHU Rennes, Rennes, France
| | - Laurent Siproudhis
- Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Centre de Référence Spina Bifida, CHU Rennes, Rennes, France.,Equipe Thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Benoit Peyronnet
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de Référence Spina Bifida, CHU Rennes, Rennes, France.,Equipe Thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
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Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years. Tech Coloproctol 2018; 22:689-696. [PMID: 30288629 DOI: 10.1007/s10151-018-1860-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hemorrhoidal prolapse is a common benign disease. The introduction of circular-stapled hemorrhoidopexy as an alternative to the conventional hemorrhoidectomy led to a new spectrum of postoperative outcomes and complications. The aim of the present study was to evaluate long-term results after stapled hemorrhoidopexy. METHODS All the patients who had stapled hemorrhoidopexy using a PPH03 stapler, from January 2003 to December 2005, were retrospectively collected in a dedicated database. Between March and May 2016, all the patients were asked by phone to complete a questionnaire. The study evaluated anatomical recurrence, symptom recurrence and frequency, and satisfaction after surgery. The postoperative complications recorded were hemorrhage, hematoma, urinary retention, anastomotic stenosis, persistent anal pain, tenesmus, and impaired anal continence evaluated also with the Faecal Incontinence Severity Index score. RESULTS One hundred and ninety four patients were identified and 171 completed the questionnaire. The mean follow-up was 12 ± 0.8 years (range 11-13 years). Anatomical self-reported prolapse recurrence was 40.9% (n = 70). In 75.6% (n = 129) of patients, the severity and frequency of symptoms improved. The overall complication rate was 56.7% (n = 40) with a serious adverse event rate of 8.7% (n = 15). The overall tenesmus rate was 38.2% (n = 65) and the overall impaired continence rate was 39.1% (n = 67). Medical therapy was still required occasionally by 40.3% (n = 69) of the patients and 9.3% (n = 16) of the patients underwent surgery for recurrence. Patient satisfaction rate was good (≥ 3 on a scale of 1 to 5) in 81.2% (n = 139) of cases. CONCLUSIONS The study showed that stapled hemorrhoidopexy using the first-generation devices is safe and feasible but associated with a high recurrence and incontinence rate. More stringent selection criteria in association with the use of large volume devices can lead to better results in the future.
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Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol 2018; 22:589-596. [DOI: 10.1007/s10151-018-1830-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
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Gosselink MP. Commentary on 'Short- and long-term clinical and patient-reported outcomes following laparoscopic ventral mesh rectopexy using biological mesh for pelvic organ prolapse: a prospective cohort study of 224 consecutive patients'. Colorectal Dis 2018; 20:436-437. [PMID: 29717564 DOI: 10.1111/codi.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Otto S, Dizer AM, Kreis ME, Gröne J. Radiological Changes After Resection Rectopexy in Patients with Rectal Prolapse-Influence on Clinical Symptoms and Quality of Life. J Gastrointest Surg 2018; 22:731-736. [PMID: 29264767 DOI: 10.1007/s11605-017-3546-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 08/14/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Resection rectopexy is performed to correct the anatomic defect associated with rectal prolapse. The aim of the study was to determine whether the change in the radiological prolapse grade has an influence on patients' symptoms and quality of life. METHODS The study investigated 40 patients who underwent resection rectopexy for rectal prolapse. The following were determined before and after surgery: radiological prolapse grade, anorectal angle and pelvic floor position in defecography, clinical symptoms (Cleveland Clinic Incontinence and Constipation Scores, Kelly-Hohlschneider Score), quality of life. RESULTS Defecography revealed postoperative improvement in the prolapse grade and pelvic floor position (p < 0.05). The clinical symptoms and quality of life improved in both, the total population (n = 40) and in patients with improved radiological prolapse grade (n = 30): all clinical scores (p < 0.05), SF-36 (vitality, social role, mental health p < 0.05), and Fecal Incontinence Quality of Life Scale (lifestyle, coping, embarrassment p < 0.05). Patients without improved radiological findings showed no change in their symptoms or quality of life. CONCLUSION Our study demonstrates that the radiological prolapse grade is improved by resection rectopexy. Correction of the anatomic defect was associated with improvement in symptoms and quality of life. Defecography may therefore be useful in the postoperative assessment of persistent symptoms or reduced quality of life.
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Affiliation(s)
- Susanne Otto
- Department of General, Visceral and Vascular Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - A M Dizer
- Department of General, Visceral and Vascular Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - M E Kreis
- Department of General, Visceral and Vascular Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - J Gröne
- Department of General, Visceral and Vascular Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
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Robot-Assisted Ventral Mesh Rectopexy for Rectal Prolapse: A 5-Year Experience at a Tertiary Referral Center. Dis Colon Rectum 2017; 60:1215-1223. [PMID: 28991087 DOI: 10.1097/dcr.0000000000000895] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy is being increasingly performed internationally to treat rectal prolapse syndromes. Robotic assistance appears advantageous for this procedure, but literature regarding robot-assisted ventral mesh rectopexy is limited. OBJECTIVE The primary objective of this study was to assess the safety and effectiveness of robot-assisted ventral mesh rectopexy in the largest consecutive series of patients to date. DESIGN This study is a retrospective cross-sectional analysis of prospectively collected data. SETTINGS The study was conducted in a tertiary referral center. PATIENTS All of the patients undergoing robot-assisted ventral mesh rectopexy for rectal prolapse syndromes between 2010 and 2015 were evaluated. MAIN OUTCOME MEASURES Preoperative and postoperative (mesh and nonmesh) morbidity and functional outcome were analyzed. The actuarial recurrence rates were calculated using the Kaplan-Meier method. RESULTS A total of 258 patients underwent robot-assisted ventral mesh rectopexy (mean ± SD follow-up = 23.5 ± 21.8 mo; range, 0.2 - 65.1 mo). There were no conversions and only 5 intraoperative complications (1.9%). Mortality (0.4%) and major (1.9%) and minor (<30 d) early morbidity (7.0%) were acceptably low. Only 1 (1.3%) mesh-related complication (asymptomatic vaginal mesh erosion) was observed. A significant improvement in obstructed defecation (78.6%) and fecal incontinence (63.7%) were achieved for patients (both p < 0.0005). At final follow-up, a new onset of fecal incontinence and obstructed defecation was induced or worsened in 3.9% and 0.4%. The actuarial 5-year external rectal prolapse and internal rectal prolapse recurrence rates were 12.9% and 10.4%. LIMITATIONS This was a retrospective study including patients with minimal follow-up. No validated scores were used to assess function. The study was monocentric, and there was no control group. CONCLUSIONS Robot-assisted ventral mesh rectopexy is a safe and effective technique to treat rectal prolapse syndromes, providing an acceptable recurrence rate and good symptomatic relief with minimal morbidity. See Video Abstract at http://links.lww.com/DCR/A427.
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Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD. Perineal resectional procedures for the treatment of complete rectal prolapse: A systematic review of the literature. Int J Surg 2017; 46:146-154. [PMID: 28890414 DOI: 10.1016/j.ijsu.2017.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Several procedures for the treatment of complete rectal prolapse (CRP) exist. These procedures are performed via the abdominal or perineal approach. Perineal procedures for rectal prolapse involve either resection or suspension and fixation of the rectum. The present review aimed to assess the outcomes of the perineal resectional procedures including Altemeier procedure (AP), Delorme procedure (DP), and perineal stapled prolapse resection (PSR) in the treatment of CRP. PATIENTS AND METHODS A systematic search of the current literature for the outcomes of perineal resectional procedures for CRP was conducted. Databases queried included PubMed/MEDLINE, SCOPUS, and Cochrane library. The main outcomes of the review were the rates of recurrence of CRP, improvement in bowel function, and complications. RESULTS Thirty-nine studies involving 2647 (2390 females) patients were included in the review. The mean age of patients was 69.1 years. Recurrence of CRP occurred in 16.6% of patients. The median incidences of recurrence were 11.4% for AP, 14.4% for DP, and 13.9% for PSR. Improvement in fecal incontinence occurred in 61.4% of patients after AP, 69% after DP, and 23.5% after PSR. Complications occurred in 13.2% of patients. The median complication rates after AP, DP and PSR were 11.1%, 8.7%, and 11.7%, respectively. CONCLUSION Perineal resectional procedures were followed by a relatively high incidence of recurrence, yet an acceptably low complication rate. Definitive conclusions on the superiority of any procedure cannot be reached due to the significant heterogeneity of the studies.
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Affiliation(s)
- Sameh Hany Emile
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Hossam Elfeki
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Mostafa Shalaby
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt; Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Ahmad Sakr
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, United States.
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Albayati S, Morgan MJ, Turner CE. Laparoscopic ventral rectopexy for rectal prolapse and rectal intussusception using a biological mesh. Colorectal Dis 2017; 19:857-862. [PMID: 28371010 DOI: 10.1111/codi.13671] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022]
Abstract
AIM Laparoscopic ventral rectopexy (LVR) is a nerve-sparing technique for the treatment of rectal prolapse. Concerns about the use of synthetic meshes in the pelvis and the associated risk of erosion have led to the recent use of biological meshes in some colorectal units. This retrospective study aims to assess the outcomes of patients undergoing LVR using a noncross-linked nondermal biological mesh. METHOD The medical notes of all patients who underwent LVR between 1 December 2011 and 31 May 2014 were reviewed. The rate of obstructed defaecation before surgery was retrospectively determined from medical records using the Rome III criteria. The rates of obstructed defaecation and faecal incontinence following surgery were determined using a self-reported questionnaire. RESULTS A total of 51 patients had LVR between 1 December 2011 and 31 May 2014. Their mean age was 57.3 ± 2.5 years and the mean follow-up was 23 ± 1 months. There were seven (13.7%) postoperative complications. In total, 45 (88%) patients completed the functional outcome questionnaires. Before surgery, 33 (73.3%) patients complained of symptoms of obstructed defaecation. At the end of follow-up, 22 (48.8%, P = 0.001) patients continued to have some symptoms of obstructed defaecation. Before surgery, 12 (26.7%) patients complained of faecal incontinence. At the end of follow-up, only three (6.7%, P = 0.004) patients reported faecal incontinence. At the end of follow-up, recurrence of symptoms had occurred in six (13.3%) patients. CONCLUSION LVR using a biological mesh is safe and results in significant reduction in symptoms associated with external rectal prolapse and rectal intussusception.
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Affiliation(s)
- S Albayati
- Department of Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
| | - M J Morgan
- Department of Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
| | - C E Turner
- Department of Surgery, Bankstown Hospital, Sydney, New South Wales, Australia
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Operative Therapie des äußeren Rektumprolapses mit dem Stapler. COLOPROCTOLOGY 2017. [DOI: 10.1007/s00053-017-0188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Emile SH, Elbanna H, Youssef M, Thabet W, Omar W, Elshobaky A, Abd El-Hamed TM, Farid M. Laparoscopic ventral mesh rectopexy vs Delorme's operation in management of complete rectal prolapse: a prospective randomized study. Colorectal Dis 2017; 19:50-57. [PMID: 27225971 DOI: 10.1111/codi.13399] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/11/2016] [Indexed: 02/08/2023]
Abstract
AIM Various surgical operations have been devised for the treatment of rectal prolapse, yet no ideal procedure has been described. The present study aims to compare the clinical and functional outcome of laparoscopic ventral mesh rectopexy (LVMR) and Delorme's operation for complete rectal prolapse. METHOD Fifty patients with complete rectal prolapse were enrolled in this study. Patients were randomly selected to undergo either LVMR or Delorme's procedure after clinical, manometric and radiological evaluation. Patient characteristics, operative data, postoperative complications, recurrence of rectal prolapse and continence state were evaluated. Patients were followed for a mean duration of 18 months. RESULTS Thirty-one (62%) patients were women and 19 (38%) patients were men with a mean age of 39.7 ± 6.9 years. Patients were allocated into two equal groups: LVMR group and Delorme's group. Thirty-three (66%) complained of faecal incontinence preoperatively. Patients were followed for 18 months. There was no major postoperative complication or treatment death. Improvement in continence was reported in 80.9% of patients (83.3% in group 1 vs 71.4% in group 2). Recurrent prolapse was observed in 16% of patients in group 2 and 8% in group 1 (P = 0.66). The operation time was significantly greater in group 1 and the length of stay greater in group 2. There was no difference in the fall of constipation score between the groups. CONCLUSION There was no statistically significant difference in the incidence of recurrence of complete rectal prolapse or postoperative improvement of symptoms between the two groups. Hospital stay was longer after Delorme's procedure but the operation time was shorter. Neither procedure proved definite superiority regarding the clinical and functional outcome at 18 months of follow-up.
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Affiliation(s)
- S H Emile
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - H Elbanna
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - M Youssef
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - W Thabet
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - W Omar
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - A Elshobaky
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - T M Abd El-Hamed
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - M Farid
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
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Abstract
Rectoanal intussusception is an invagination of the rectal wall into the lumen of the rectum. Patients may present with constipation, incomplete evacuation, incontinence, or may be asymptomatic. Defecography has been the gold standard for detection. Magnetic resonance imaging defecography and dynamic anal endosonography are alternatives to conventional defecography. However, both methods are not as sensitive as conventional defecography. Treatment options range from conservative/medical treatment such as biofeedback to surgical procedures such as Delorme, rectopexy, and stapled transanal rectal resection. Recent studies conducted after a trial of failed nonoperative management show adequate results with operations performed for rectal intussusception with or without rectocele if other causes of constipation are not present.
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Affiliation(s)
- Kristen Blaker
- Department of Surgery, Division of General Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joselin L Anandam
- Department of Surgery, Division of General Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Cariou de Vergie L, Venara A, Duchalais E, Frampas E, Lehur PA. Internal rectal prolapse: Definition, assessment and management in 2016. J Visc Surg 2016; 154:21-28. [PMID: 27865742 DOI: 10.1016/j.jviscsurg.2016.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Internal rectal prolapse (IRP) is a well-recognized pelvic floor disorder mainly seen during defecatory straining. The symptomatic expression of IRP is complex, encompassing fecal continence (56%) and/or evacuation disorders (85%). IRP cannot be characterized easily by clinical examination alone and the emergence of dynamic defecography (especially MRI) has allowed a better comprehension of its pathophysiology and led to the proposition of a severity score (Oxford score) that can guide management. Decision for surgical management should be multidisciplinary, discussed after a complete work-up, and only after medical treatment has failed. Information should be provided to the patient, outlining the goals of treatment, the potential complications and results. Stapled trans-anal rectal resection (STARR) has been considered as the gold standard for IRP treatment. However, inconsistent results (failure observed in up to 20% of cases, and fecal incontinence occurring in up to 25% of patients at one year) have led to a decrease in its indications. Laparoscopic ventral mesh rectopexy has substantial advantages in solving the functional problems due to IRP (efficacy on evacuation and resolution of continence symptoms in 65-92%, and 73-97% of patients, respectively) and is currently considered as the gold standard therapy for IRP once the decision to operate has been made.
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Affiliation(s)
- L Cariou de Vergie
- Clinique de chirurgie digestive et endocrinienne, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Maternité, hôpital Mère-Enfant, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - A Venara
- Clinique de chirurgie générale et digestive, 49000 Angers, France
| | - E Duchalais
- Clinique de chirurgie digestive et endocrinienne, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - E Frampas
- Radiologie centrale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - P A Lehur
- Clinique de chirurgie digestive et endocrinienne, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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Siddika A, Saha S, Siddiqi S. Evolution of male rectal prolapse surgery and initial experience of robotic rectopexy in men. J Robot Surg 2016; 11:311-316. [PMID: 27830430 DOI: 10.1007/s11701-016-0656-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/29/2016] [Indexed: 02/06/2023]
Abstract
Laparoscopic ventral mesh rectopexy (LVMR) has proven benefit in the treatment of external rectal prolapse and symptomatic internal rectal prolapse in women. However, there is a recurrence rate of 4-50% depending on indication. Some of this recurrence is attributable to persistent lateral and posterior prolapses. Modifications of LVMR (modified Orr-Loygue rectopexies) describe an additional narrow posterior rectal mesh fixed to the mesorectal fat, which is inherently insecure. Additional complications in men include sexual dysfunction caused by nerve damage from the ventral rectal dissection. There is one case series in men, published by a surgeon with an unusually large practice, showing LVMR to have a good success rate with low rates of sexual dysfunction. Other series have contained small numbers of men, but subgroup analysis to determine success and complication rates is not possible. Robotic surgery is more precise than laparoscopic surgery, allows stereotactic vision, and has a stable platform. We have developed a robotic modified Orr-Loygue rectopexy in an attempt to deal with the persistent components of posterior rectal prolapse by placing a mesh posteriorly through a narrow dissection and securing the mesh to the distal rectal muscle tube. Mesh-to-muscle fixation is more secure than mesh-to-mesorectal fat fixation. The robotic platform also improves the accuracy of ventral dissection and reduces the risk of sexual dysfunction in men. Our initial results indicate that robotic modified Orr-Loygue rectopexy is a safe and feasible option for rectal prolapse in men, with no more complications or recurrences than the best published outcomes for LVMR.
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Affiliation(s)
- Arifa Siddika
- Broomfield Hospital, Mid Essex NHS Trust, Chelmsford, Essex, CM1 7ET, UK.
| | - Sunita Saha
- Broomfield Hospital, Mid Essex NHS Trust, Chelmsford, Essex, CM1 7ET, UK
| | - Shahab Siddiqi
- Broomfield Hospital, Mid Essex NHS Trust, Chelmsford, Essex, CM1 7ET, UK
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Al-Ameen WM, Privitera A, Al-Ayed A, Sabr K. Laparoscopic-Assisted Altemeier's Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:827-829. [PMID: 27811832 PMCID: PMC5098925 DOI: 10.12659/ajcr.900243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Female, 39 Final Diagnosis: Recurrent strangulated rectal prolapse Symptoms: Chronic constipation • painful rectal mass • irreducible rectal prolapse Medication: — Clinical Procedure: Operation Specialty: Surgery
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Affiliation(s)
- Wael M Al-Ameen
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Antonio Privitera
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amal Al-Ayed
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Khalid Sabr
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Abstract
External rectal prolapse is a rare condition, which is more common in old and multimorbid women. In recent years five surgical methods have become established from among the multitude of operative procedures which have been described. One of the most recent techniques is perineal stapled prolapse resection (PSP) which is described in this article. After complete eversion of the rectal prolapse it is resected into 2 halves using a linear cutter by incisions at 3 o'clock and 9 o'clock lithotomy positions, followed by stepwise resection with a curved cutter along the ventral and dorsal circumference. There is low evidence for the treatment of external rectal prolapse. For PSP only case series exist with results that are similar to those from other techniques; however, comparative studies are nearly completely lacking. The PSP is a relatively new surgical technique for the treatment of external rectal prolapse. It is a safe surgical procedure. Due to the lack of evidence it should remain reserved for old and/or multimorbid patients.
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Affiliation(s)
- R Scherer
- Zentrum für Darm- und Beckenbodenchirurgie, Krankenhaus Waldfriede, Argentinische Allee 40, 14163, Berlin, Deutschland.
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van Iersel JJ, Paulides TJC, Verheijen PM, Lumley JW, Broeders IAMJ, Consten ECJ. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse. World J Gastroenterol 2016; 22:4977-4987. [PMID: 27275090 PMCID: PMC4886373 DOI: 10.3748/wjg.v22.i21.4977] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/15/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
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Mishra A, Prapasrivorakul S, Gosselink MP, Gorissen KJ, Hompes R, Jones O, Cunningham C, Matzel KE, Lindsey I. Sacral neuromodulation for persistent faecal incontinence after laparoscopic ventral rectopexy for high-grade internal rectal prolapse. Colorectal Dis 2016; 18:273-8. [PMID: 26391837 DOI: 10.1111/codi.13125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/05/2015] [Indexed: 02/08/2023]
Abstract
AIM Internal rectal prolapse is recognized as an aetiological factor in faecal incontinence. Patients found to have a high-grade internal rectal prolapse on routine proctography are offered a laparoscopic ventral rectopexy after failed maximum medical therapy. Despite adequate anatomical repair, faecal incontinence persists in a number of patients. The aim of this study was to evaluate the outcome of sacral neuromodulation in this group of patients. METHOD Between August 2009 and January 2012, 52 patients who underwent a laparoscopic ventral rectopexy for faecal incontinence associated with high-grade internal rectal prolapse had persistent symptoms of faecal incontinence and were offered sacral neuromodulation. Symptoms were evaluated before and after the procedure using the Fecal Incontinence Severity Index (FISI) and the Gastrointestinal Quality of Life Index (GIQLI). RESULTS Temporary test stimulation was successful in 47 (94%) of the patients who then underwent implantation of a permanent pulse generator. The median FISI score 1 year after sacral neuromodulation was lower than the median score before [34 (28-59) vs. 19 (0-49); P < 0.01], indicating a significant improvement in faecal continence. Quality of life (GIQLI) was significantly better after starting sacral neuromodulation [78 (31-107) vs. 96 (55-129); P < 0.01]. CONCLUSION Patients may benefit from sacral neuromodulation for persisting faecal incontinence after laparoscopic ventral rectopexy.
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Affiliation(s)
- A Mishra
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
| | - S Prapasrivorakul
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
| | - M P Gosselink
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
| | - K J Gorissen
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
| | - O Jones
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
| | - K E Matzel
- Department of Surgery, University Erlangen, Erlangen, Germany
| | - I Lindsey
- Department of Colorectal Surgery, Oxford Pelvic Floor Centre, Oxford University Hospitals, Oxford, UK
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Eftaiha S, Nordenstam J. Ventral rectopexy for rectal procidentia. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2015.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tsunoda A, Takahashi T, Ohta T, Fujii W, Kiyasu Y, Kusanagi H. Anterior intussusception descent during defecation is correlated with the severity of fecal incontinence in patients with rectoanal intussusception. Tech Coloproctol 2016; 20:171-6. [PMID: 26754652 DOI: 10.1007/s10151-015-1423-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/11/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rectoanal intussusception (RAI) is a common finding on evacuation proctography in patients with defecation disorders. However, it remains unclear whether intussusception morphology affects the severity of fecal incontinence (FI). The aim of this study was to examine the effect of morphology during defecation on the severity of FI in patients with RAI. METHODS We included 80 patients with FI who were diagnosed as having RAI on evacuation proctography. Various morphological parameters were measured, and the level of RAI was divided by the extent of descent onto (level I) or into (level II) the anal sphincter. FI symptoms were documented using the FI Severity Index (FISI). RESULTS Twenty-eight patients had level I and 52 had level II RAI. The mean (range) FISI score was 24.0 (8-47). FISI scores tended to be significantly higher in level II than in level I [26.3 (10-47) vs. 21.8 (8-42); p = 0.05]. The mean anterior intussusception descent was significantly greater in level II than in level I [24.2 (9.2-39.5) vs. 17.7 (7.8-39.4) mm; p < 0.0001]. Regression analysis showed that anterior intussusception descent was predictive of increased FISI scores. CONCLUSIONS The severity of FI may be affected by anterior intussusception descent in patients with RAI.
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Affiliation(s)
- A Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
| | - T Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - T Ohta
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - W Fujii
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - Y Kiyasu
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - H Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
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Bloemendaal A, Buchs N, Prapasrivorakul S, Cunningham C, Jones O, Hompes R, Lindsey I. High-grade internal rectal prolapse: Does it explain so-called “idiopathic” faecal incontinence? Int J Surg 2016; 25:118-22. [DOI: 10.1016/j.ijsu.2015.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/01/2015] [Indexed: 12/16/2022]
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The single pile classification: a new tool for the classification of haemorrhoidal disease and the comparison of treatment results. Updates Surg 2015; 67:421-6. [DOI: 10.1007/s13304-015-0333-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 10/04/2015] [Indexed: 12/29/2022]
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