|
1
|
Wu L, Wu H, Mu S, Li XY, Zhen YH, Li HY. Surgical approaches for complete rectal prolapse. World J Gastrointest Surg 2025; 17:102043. [PMID: 40162412 PMCID: PMC11948122 DOI: 10.4240/wjgs.v17.i3.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 12/02/2024] [Accepted: 01/11/2025] [Indexed: 02/24/2025] Open
Abstract
Complete rectal prolapse, characterized by the protrusion of the rectal wall layers through the anal canal, poses significant treatment challenges, particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system. This study comprehensively reviews the main surgical techniques for complete rectal prolapse, categorized as transabdominal and transperineal/transanal procedures. Despite various techniques, challenges persist, including high recurrence rates and potential complications. Factors influencing the choice of the surgical approach include patient characteristics, symptomatology, and surgical expertise. With advances in medical technology, laparoscopic and robotic surgeries offer promising avenues, albeit with considerations of cost and accessibility. Ultimately, treatment plans tailored to the individual needs of the patient and surgical expertise are essential. Although controversies remain, the continued refinement of surgical techniques holds promise for improving outcomes in complete rectal prolapse surgery.
Collapse
Affiliation(s)
- Long Wu
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Huan Wu
- Department of Infectious Disease, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Song Mu
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Xiao-Yun Li
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Yun-Huan Zhen
- Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Hai-Yang Li
- Key Laboratory of Hepatobiliary and Pancreatic Diseases Treatment and Bioinformatics Research Guizhou Medical University, Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| |
Collapse
|
|
2
|
Whitlock AE, Arndt KR, Allar BG, Fakler MN, Cataldo TE, Crowell KT, Fabrizio AC, Messaris E. Mental health disorders as a risk factor in young patients with rectal prolapse. Langenbecks Arch Surg 2024; 409:72. [PMID: 38393458 DOI: 10.1007/s00423-024-03262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Rectal prolapse (RP) typically presents in the elderly, though it can present in younger patients lacking traditional risk factors. The current study compares medical and mental health history, presentation, and outcomes for young and older patients with RP. METHODS This is a single-center retrospective review of patients who underwent abdominal repair of RP between 2005 and 2019. Individuals were dichotomized into two groups based on age greater or less than 40 years. RESULTS Of 156 patients, 25 were < 40. Younger patients had higher rates of diagnosed mental health disorders (80% vs 41%, p < 0.001), more likely to take SSRIs (p = .02), SNRIs (p = .021), anxiolytics (p = 0.033), and antipsychotics (p < 0.001). Younger patients had lower preoperative incontinence but higher constipation. Both groups had low rates of recurrence (9.1% vs 11.6%, p = 0.73). CONCLUSIONS Young patients with RP present with higher concomitant mental health diagnoses and represent unique risk factors characterized by chronic straining compared to pelvic floor laxity.
Collapse
Affiliation(s)
- Ashlyn E Whitlock
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Kevin R Arndt
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA.
| | - Benjamin G Allar
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Michelle N Fakler
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Thomas E Cataldo
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Kristen T Crowell
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Anne C Fabrizio
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| |
Collapse
|
|
3
|
Yamanaka S, Enomoto T, Moue S, Owada Y, Ohara Y, Oda T. Mesh erosion into the rectum after laparoscopic posterior rectopexy: A case report. Int J Surg Case Rep 2022; 95:107136. [PMID: 35576752 PMCID: PMC9118509 DOI: 10.1016/j.ijscr.2022.107136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Rectal prolapse typically presents in elderly women with protruding full-thickness rectum from the anus. Rectopexy using mesh is known to be a highly curative treatment for rectal prolapse, however, this procedure carries the risk of severe complication as mesh erosion. Presentation of case A 78-year-old woman who had undergone laparoscopic posterior rectopexy 4 years earlier visited the outpatient clinic with a complaint of bloody stool. A colonoscopy and computed tomography revealed that part of the mesh had migrated into the rectal lumen at 8 cm from the anal verge. Based on the above findings, a diagnosis of mesh erosion into the rectum was made. Complete removal of the mesh and tacker with rectal resection was performed. Before rectopexy, the patient had severe fecal incontinence, and her anal sphincter function was decreased, therefore, Permanent colostomy was indicated instead of anastomosis. In the resected specimen, the mesh was folded and placed in the mesenteric fat of the posterior wall of the rectum, with the corner of the edge of the mesh protruding into the inside lumen. Discussion Mesh erosion typically occurs when using mesh made of synthetic mesh and non-absorbable threads; it might induce chronic irritation and friction due to mesh shrinkage. Conclusion To prevent mesh erosion, it is important to pay attention to the mesh materials used and ensure secure fixation.
Mesh erosion into rectum after Laparoscopic posterior rectopexy was reported. Complete removal of the mesh and tacker with rectal resection was needed. Colostomy was made because of existence of severe fecal incontinence, preoperatively. Paying attention to the Shrinkage and secure fixation of synthetic mesh.
Collapse
Affiliation(s)
- Shun Yamanaka
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan
| | - Tsuyoshi Enomoto
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Shoko Moue
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Yohei Owada
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Yusuke Ohara
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Tatsuya Oda
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| |
Collapse
|
|
4
|
Alkatrani H, Basrah MM. Perineal Rectosigmoidal Resection for Complete Rectal Prolapse. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Rectal prolapse (RP) (rectal Providencia) is a disorder manifest by full-thickness intussusceptions of the rectal wall that protrudes externally through the anus.
AIM: A retrospective study was done to evaluate the outcome of rectosigmoidal resection for complete rectal prolapse (CRP) in our hospital from 2008 to 2020.
METHODS: This study analyzes the data of post-operative outcomes for 25 patients with CRP treated by perineal rectosigmoidal resection; eight patients were male and 17 were female.
RESULTS: A total of 25 patients enrolled with the median age of 50 years. There was an improvement in the general condition of patients regarding constipation, bleeding per rectum, incontinence, and perineal discomfort. There were no mortality, no major complication, and a low recurrence rate.
CONCLUSION: Altemier’s procedure for CRP improves patients’ general condition regarding constipation and incontinence, no mortality, low complication rate, and negligible rate of recurrence.
Collapse
|
|
5
|
Maeda Y, Espin-Basany E, Gorissen K, Kim M, Lehur PA, Lundby L, Negoi I, Norcic G, O'Connell PR, Rautio T, van Geluwe B, van Ramshorst GH, Warwick A, Vaizey CJ. European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery. Colorectal Dis 2021; 23:2228-2285. [PMID: 34060715 DOI: 10.1111/codi.15718] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 12/31/2022]
Abstract
This is a comprehensive and rigorous review of currently available data on the use of mesh in the pelvis in colorectal surgery. This guideline outlines the limitations of available data and the challenges of interpretation, followed by best possible recommendations.
Collapse
Affiliation(s)
- Yasuko Maeda
- Cumberland Infirmary and University of Edinburgh, Carlisle, UK
| | | | | | - Mia Kim
- Department of General, Gastrointestinal, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Lilli Lundby
- Department of Surgery Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ionut Negoi
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gregor Norcic
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - P Ronan O'Connell
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Tero Rautio
- Medical Research Center, University of Oulu, Oulu, Finland
| | | | | | - Andrea Warwick
- QEII Jubilee Hospital, Acacia Ridge, Queensland, Australia
| | | |
Collapse
|
|
6
|
Durbeck A, Johannessen HO, Drolsum A, Johnson E. Very long-term outcome after resection rectopexy for internal rectal intussusception. Scand J Gastroenterol 2021; 56:122-127. [PMID: 33253596 DOI: 10.1080/00365521.2020.1853221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Both at short- and long-term follow-up we have reported major improvement of the symptom of constipation in patients treated with resection rectopexy for internal rectal intussusception (IRI). The aim was to study whether this improvement also persisted in a cohort of these patients after very long-term follow-up. METHODS Observational and mainly prospective study of a cohort of 13 out of 48 patients with IRI who initially had ligament-preserving resection rectopexy with suture by laparoscopic (n = 11) or open (n = 2) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report and HRQL. RESULTS Thirteen out of the 48 initial patients (27%) reported data at very long-term follow-up. Months from preoperatively to short-, long- and very long-term follow-up were median 6, 76 and 159, respectively. Corresponding mean (95% CI) constipation scores were 11.5 (8.3-14.7), 4.2 (1.7-6.6) (p < .001), 5.3 (3.6-7.0) (p < .05) and 13.6 (8.2-19.0). Number of constipated patients were (score ≥ 10) were 8, 1, 0, 1 and 9, respectively. Scores for anal incontinence were 6.1 (2.4-11.4), 5.8 (2.0-9.5), 4.9 (0.9-9.0) and 7.9 (4.3-11.5), respectively. HRQL life was reduced for bodily pain, social functioning, mental health and general health perception. Percentage patients reporting symptomatic improvement were 100, 70 and 53, respectively. CONCLUSIONS Patients with IRI have a symptomatic relief for more than 6 years after resection rectopexy. The operation did not inflict permanent patient sequela. Motivated patients must be informed about very long-term deterioration of symptomatic relief.
Collapse
Affiliation(s)
- Annichen Durbeck
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.,Department of General Surgery, Diakonhjemmet Hospital, Oslo, Norway
| | - Hans-Olaf Johannessen
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Anders Drolsum
- Department of Radiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Egil Johnson
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
|
7
|
|
|
8
|
Grossi U, Knowles CH, Mason J, Lacy-Colson J, Brown SR. Surgery for constipation: systematic review and practice recommendations: Results II: Hitching procedures for the rectum (rectal suspension). Colorectal Dis 2017; 19 Suppl 3:37-48. [PMID: 28960927 DOI: 10.1111/codi.13773] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To assess the outcomes of rectal suspension procedures (forms of rectopexy) in adults with chronic constipation. METHOD Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level. RESULTS Eighteen articles were identified, providing data on outcomes in 1238 patients. All studies reported only on laparoscopic approaches. Length of procedures ranged between 1.5 to 3.5 h, and length of stay between 4 to 5 days. Data on harms were inconsistently reported and heterogeneous, making estimates of harm tentative and imprecise. Morbidity rates ranged between 5-15%, with mesh complications accounting for 0.5% of patients overall. No mortality was reported after any procedures in a total of 1044 patients. Although inconsistently reported, good or satisfactory outcome occurred in 83% (74-91%) of patients; 86% (20-97%) of patients reported improvements in constipation after laparoscopic ventral mesh rectopexy (LVMR). About 2-7% of patients developed anatomical recurrence. Patient selection was inconsistently documented. As most common indication, high grade rectal intussusception was corrected in 80-100% of cases after robotic or LVMR. Healing of prolapse-associated solitary rectal ulcer syndrome occurred in around 80% of patients after LVMR. CONCLUSION Evidence supporting rectal suspension procedures is currently derived from poor quality studies. Methodologically robust trials are needed to inform future clinical decision making.
Collapse
Affiliation(s)
- U Grossi
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - C H Knowles
- National Bowel Research Centre, Blizard Institute, Queen Mary University London, London, UK
| | - J Mason
- University of Warwick, Coventry, UK
| | | | - S R Brown
- Sheffield Teaching Hospitals, Sheffield, UK
| | -
- National Institute for Health Research: Chronic Constipation Treatment Pathway, London, UK
| | -
- Affiliate section of the Association of Coloproctology of Great Britain and Ireland, London, UK
| |
Collapse
|
|
9
|
Rickert A, Kienle P. Laparoscopic surgery for rectal prolapse and pelvic floor disorders. World J Gastrointest Endosc 2015; 7:1045-1054. [PMID: 26380050 PMCID: PMC4564831 DOI: 10.4253/wjge.v7.i12.1045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/22/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Abstract
Pelvic floor disorders are different dysfunctions of gynaecological, urinary or anorectal organs, which can present as incontinence, outlet-obstruction and organ prolapse or as a combination of these symptoms. Pelvic floor disorders affect a substantial amount of people, predominantly women. Transabdominal procedures play a major role in the treatment of these disorders. With the development of new techniques established open procedures are now increasingly performed laparoscopically. Operation techniques consist of various rectopexies with suture, staples or meshes eventually combined with sigmoid resection. The different approaches need to be measured by their operative and functional outcome and their recurrence rates. Although these operations are performed frequently a comparison and evaluation of the different methods is difficult, as most of the used outcome measures in the available studies have not been standardised and data from randomised studies comparing these outcome measures directly are lacking. Therefore evidence based guidelines do not exist. Currently the laparoscopic approach with ventral mesh rectopexy or resection rectopexy is the two most commonly used techniques. Observational and retrospective studies show good functional results, a low rate of complications and a low recurrence rate. As high quality evidence is missing, an individualized approach is recommend for every patient considering age, individual health status and the underlying morphological and functional disorders.
Collapse
|
|
10
|
Pucciani F, Altomare DF, Dodi G, Falletto E, Frasson A, Giani I, Martellucci J, Naldini G, Piloni V, Sciaudone G, Bove A, Bocchini R, Bellini M, Alduini P, Battaglia E, Galeazzi F, Rossitti P, Usai Satta P. Diagnosis and treatment of faecal incontinence: Consensus statement of the Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists. Dig Liver Dis 2015; 47:628-645. [PMID: 25937624 DOI: 10.1016/j.dld.2015.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/08/2015] [Accepted: 03/28/2015] [Indexed: 02/06/2023]
Abstract
Faecal incontinence is a common and disturbing condition, which leads to impaired quality of life and huge social and economic costs. Although recent studies have identified novel diagnostic modalities and therapeutic options, the best diagnostic and therapeutic approach is not yet completely known and shared among experts in this field. The Italian Society of Colorectal Surgery and the Italian Association of Hospital Gastroenterologists selected a pool of experts to constitute a joint committee on the basis of their experience in treating pelvic floor disorders. The aim was to develop a position paper on the diagnostic and therapeutic aspects of faecal incontinence, to provide practical recommendations for a cost-effective diagnostic work-up and a tailored treatment strategy. The recommendations were defined and graded on the basis of levels of evidence in accordance with the criteria of the Oxford Centre for Evidence-Based Medicine, and were based on currently published scientific evidence. Each statement was drafted through constant communication and evaluation conducted both online and during face-to-face working meetings. A brief recommendation at the end of each paragraph allows clinicians to find concise responses to each diagnostic and therapeutic issue.
Collapse
Affiliation(s)
- Filippo Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Italy.
| | | | - Giuseppe Dodi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
| | - Ezio Falletto
- I Division of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Alvise Frasson
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy
| | - Iacopo Giani
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | - Jacopo Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - Gabriele Naldini
- Proctological and Perineal Surgical Unit, University Hospital of Pisa, Italy
| | | | - Guido Sciaudone
- General and Geriatric Surgery Unit, School of Medicine, Second University of Naples, Italy
| | - Antonio Bove
- Gastroenterology and Endoscopy Unit, Department of Gastroenterology - AORN "A. Cardarelli", Naples, Italy
| | - Renato Bocchini
- Gastrointestinal Physiopathology, Gastroenterology Department, Malatesta Novello Private Hospital, Cesena, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Italy
| | - Pietro Alduini
- Digestive Endoscopy Unit, San Luca Hospital, Lucca, Italy
| | - Edda Battaglia
- Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy
| | | | - Piera Rossitti
- Gastroenterology Unit, S.M. della Misericordia University Hospital, Udine, Italy
| | | |
Collapse
|
|
11
|
|
|
12
|
Ding W, Jiang J, Feng X, Ni L, Li J, Li N. Clinical and pelvic morphologic correlation after subtotal colectomy with colorectal anastomosis for combined slow-transit constipation and obstructive defecation. Dis Colon Rectum 2015; 58:91-96. [PMID: 25489699 DOI: 10.1097/dcr.0000000000000222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The treatment of slow-transit constipation combined with outlet obstruction is controversial. Subtotal colectomy with colorectal anastomosis is regarded as a safe and effective surgical option for refractory constipation. PURPOSE The clinical and morphologic outcomes of patients who underwent subtotal colectomy with colorectal anastomosis for refractory mixed constipation were prospectively evaluated. DESIGN This study is a nonrandomized, prospective review of gathered data. SETTING This investigation was conducted at a tertiary-care GI surgical center in China. PATIENTS The study prospectively included 42 consecutive patients with refractory constipation who were diagnosed with obstructed defecation syndrome combined with slow colon transit. MAIN OUTCOME MEASURES The primary outcomes measured were the Longo obstructive defecation syndrome score and the Wexner constipation scale. The pelvic morphologic changes were determined with defecography before surgery and at 6 and 24 months after surgery. RESULTS A significant reduction in the Wexner constipation score was observed between baseline (median 24) and 6 months (median 10), which was maintained until 24 months (median 8, compared with baseline, p < 0.01). Improvement in the constipation score was matched by an overall improvement in the Longo obstructive defecation syndrome score at the 6- and 24-month follow-up times (compared with baseline, p < 0.01). In 17 of 21 patients, preexisting intussusception was no longer visible during defecography. Rectoceles were significantly reduced in depth, from 36 mm to 8 mm (p < 0.01), whereas the number of detectable rectoceles was also significantly decreased, from 29 to 7 (p < 0.01). Incomplete evacuation disappeared in 28 of 38 patients. No stenosis was observed at the colorectal posterior side-to-side anastomosis. Most complications were managed conservatively without significant events. LIMITATIONS This study was performed in selected patients with constipation and did not include a comparison group. CONCLUSIONS Subtotal colectomy with colorectal anastomosis can correct pelvic anatomical disorders in patients with mixed refractory constipation. The clinical improvement of obstructed defecation syndrome after subtotal colectomy with colorectal anastomosis is highly correlated with the morphologic correction of the rectal redundancy.
Collapse
Affiliation(s)
- Weiwei Ding
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | | | | | | | | | | |
Collapse
|
|
13
|
Mik M, Trzcinski R, Kujawski R, Dziki L, Tchorzewski M, Dziki A. Rectal Prolapse in Women-Outcomes of Perineal and Abdominal Approaches. Indian J Surg 2014; 77:1121-5. [PMID: 27011522 DOI: 10.1007/s12262-014-1196-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022] Open
Abstract
The aim of the study was to assess the clinical and functional results of surgical treatment of female patients with rectal prolapse. In the period of 2003-2010, the group of 86 female patients (mean age of 67 ± 10) underwent surgery due to rectal prolapse. The group of 24 patients (27.9 %) suffered from mild anal incontinence. They were operated on with open sutured rectopexy (18 pts), Altemeier (45 pts) and Delorme procedure (23 pts). Prior to surgery and after operation, clinical and function results were obtained. The follow-up period amounted to 32 ± 11 months. In perineal approaches, we found mortality in one patient (1.4 %, Delorme) and anastomotic leak in four patients (5.9 %). The recurrence rate in the perineal group was 11.8 % (eight patients). We noted one recurrence in the rectopexy group (5.6 %). The Altemeier procedure revealed the most significant impact on the function of the anal sphincter muscles and resting pressures (42 ± 7 vs 53 ± 9 cm H2O; p = 0.0082). If anterior levatoroplasty was added, the benefits referred also to squeeze pressures (41 ± 8 vs 58 ± 9 cm H2O; p = 0.006 and 42 ± 10 vs 56 ± 9 cm H2O; p = 0.01). In the treatment of rectal prolapse, there is still no consensus about the operation of choice. Selection of the appropriate method should be based on clinical findings and patients' comorbidities to obtain maximal benefits and minimize the postoperative risk and failures.
Collapse
Affiliation(s)
- Michal Mik
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Radzislaw Trzcinski
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Ryszard Kujawski
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Lukasz Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Marcin Tchorzewski
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| |
Collapse
|
|
14
|
Bajaj P, Wani S, Sheikh P, Patankar R. Perineal Stapled Prolapse Resection. Indian J Surg 2014; 77:1115-20. [PMID: 27011521 DOI: 10.1007/s12262-014-1190-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 10/28/2014] [Indexed: 01/28/2023] Open
Abstract
Perineal stapled prolapse resection is a new technique for external rectal prolapse introduced in 2007. We have done stapled perineal resection for 12 patients with full thickness rectal prolapse between January 2010 and April 2012. Elderly patients with comorbidities and young patients who want to avoid risk of nerve damage, with rectal prolapse up to 8-10 cms were included prospectively for perineal stapled rectal prolapse resection. Functional outcome, complications, operating time, and hospital stay were assessed in all patients. Perineal stapled prolapse resection was performed without major complications in a median operating time of 45 (range, 40-90) min and median Hospital stay was 3 days (3 to 11 days). Preoperative severe fecal incontinence and constipation improved postoperatively in 90 and 66 % of the patients, respectively, and there was no incidence of de novo onset or worsening of constipation in any of the patient. One patient developed small extra peritoneal collection which was managed by conservative treatment. No other complications occurred. At median follow-up of 36 months, all patients were well and showed no early recurrence of prolapse. Perineal stapled rectal prolapse resection is a new surgical procedure for external rectal prolapse, which is safe, easy, and quick to perform.
Collapse
Affiliation(s)
- Prasang Bajaj
- Department of GI and Minimal access surgery, Joy Hospital, 423 AB, 10th Road, Chembur, Mumbai, 400071 India
| | - Sachin Wani
- Department of GI and Minimal access surgery, Joy Hospital, 423 AB, 10th Road, Chembur, Mumbai, 400071 India
| | - Pervez Sheikh
- Department of GI and Minimal access surgery, Joy Hospital, 423 AB, 10th Road, Chembur, Mumbai, 400071 India
| | - Roy Patankar
- Department of GI and Minimal access surgery, Joy Hospital, 423 AB, 10th Road, Chembur, Mumbai, 400071 India
| |
Collapse
|
|
15
|
Lee JL, Yang SS, Park IJ, Yu CS, Kim JC. Comparison of abdominal and perineal procedures for complete rectal prolapse: an analysis of 104 patients. Ann Surg Treat Res 2014; 86:249-55. [PMID: 24851226 PMCID: PMC4024931 DOI: 10.4174/astr.2014.86.5.249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/06/2014] [Accepted: 02/04/2014] [Indexed: 12/14/2022] Open
Abstract
Purpose Selecting the best surgical approach for treating complete rectal prolapse involves comparing the operative and functional outcomes of the procedures. The aims of this study were to evaluate and compare the operative and functional outcomes of abdominal and perineal surgical procedures for patients with complete rectal prolapse. Methods A retrospective study of patients with complete rectal prolapse who had operations at a tertiary referral hospital and a university hospital between March 1990 and May 2011 was conducted. Patients were classified according to the type of operation: abdominal procedure (AP) (n = 64) or perineal procedure (PP) (n = 40). The operative outcomes and functional results were assessed. Results The AP group had the younger and more men than the PP group. The AP group had longer operation times than the PP group (165 minutes vs. 70 minutes; P = 0.001) and longer hospital stays (10 days vs. 7 days; P = 0.001), but a lower overall recurrence rate (6.3% vs. 15.0%; P = 0.14). The overall rate of the major complication was similar in the both groups (10.9% vs. 6.8%; P = 0.47). The patients in the AP group complained more frequently of constipation than of incontinence, conversely, in the PP group of incontinence than of constipation. Conclusion The two approaches for treating complete rectal prolapse did not differ with regard to postoperative morbidity, but the overall recurrence tended to occur frequently among patients in the PP group. Functional results after each surgical approach need to be considered for the selection of procedure.
Collapse
Affiliation(s)
- Jong Lyul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Soo Yang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Ja Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
16
|
Ribaric G, D'Hoore A, Schiffhorst G, Hempel E. STARR with CONTOUR® TRANSTAR™ device for obstructed defecation syndrome: one-year real-world outcomes of the European TRANSTAR registry. Int J Colorectal Dis 2014. [PMID: 24554148 DOI: 10.1007/s00384-014-1836-8;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Stapled transanal rectal resection (STARR) in patients with obstructive defecation syndrome (ODS) is limited by the capacity of the circular stapler used. This prospective cohort study was conducted to assess real-world clinical outcomes of STARR with the new CONTOUR® TRANSTAR™ device, shortly named TRANSTAR, at 12 months postoperatively. METHODS From January 2009 to January 2011, consecutive patients who underwent TRANSTAR in 22 European colorectal centers were enrolled in the study. Functional outcomes and quality of life were assessed by the changes in a number of scoring systems (Knowles-Eccersley-Scott-Symptom (KESS) score, ODS score, St. Mark's score, Euro Quality of Life-5 Dimension (EQ-5D) score, and Patient Assessment of Constipation-Quality of Life (PAC-QoL) score), at 12 months as compared to baseline. All complications were recorded and analyzed. RESULTS A total of 100 patients (98% female), mean age 60 years, were entered in the study. Statistically significant improvements were seen in the KESS (median 18 vs. 6; p < 0.01), ODS (median 15 vs. 4; p < 0.01), and PAC-Qol scores (median 2.10 vs. 0.86; p < 0.01). St. Mark's and EQ-5D scores improved nonsignificantly. Complications were reported in 11 % of patients, including bleeding (5%), staple line complications (3%), urinary retention (2%), and persistent pain (1%). No major complications or mortality occurred. CONCLUSION TRANSTAR facilitated a tailored, real circumferential full-thickness rectal resection, leading to improved patient functional and quality of life outcomes at 12 months postoperatively. It represents a safe and effective treatment for ODS in local clinical practice, although the sustainability of real-world results needs to be proven in the long-term follow-up.
Collapse
Affiliation(s)
- G Ribaric
- Clinical and Medical Affairs, Ethicon Endo-Surgery (Europe) GmbH, European Surgical Institute, Norderstedt/Hamburg, Germany,
| | | | | | | | | |
Collapse
|
|
17
|
Ribaric G, D'Hoore A, Schiffhorst G, Hempel E. STARR with CONTOUR® TRANSTAR™ device for obstructed defecation syndrome: one-year real-world outcomes of the European TRANSTAR registry. Int J Colorectal Dis 2014; 29:611-22. [PMID: 24554148 PMCID: PMC3996277 DOI: 10.1007/s00384-014-1836-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Stapled transanal rectal resection (STARR) in patients with obstructive defecation syndrome (ODS) is limited by the capacity of the circular stapler used. This prospective cohort study was conducted to assess real-world clinical outcomes of STARR with the new CONTOUR® TRANSTAR™ device, shortly named TRANSTAR, at 12 months postoperatively. METHODS From January 2009 to January 2011, consecutive patients who underwent TRANSTAR in 22 European colorectal centers were enrolled in the study. Functional outcomes and quality of life were assessed by the changes in a number of scoring systems (Knowles-Eccersley-Scott-Symptom (KESS) score, ODS score, St. Mark's score, Euro Quality of Life-5 Dimension (EQ-5D) score, and Patient Assessment of Constipation-Quality of Life (PAC-QoL) score), at 12 months as compared to baseline. All complications were recorded and analyzed. RESULTS A total of 100 patients (98% female), mean age 60 years, were entered in the study. Statistically significant improvements were seen in the KESS (median 18 vs. 6; p < 0.01), ODS (median 15 vs. 4; p < 0.01), and PAC-Qol scores (median 2.10 vs. 0.86; p < 0.01). St. Mark's and EQ-5D scores improved nonsignificantly. Complications were reported in 11 % of patients, including bleeding (5%), staple line complications (3%), urinary retention (2%), and persistent pain (1%). No major complications or mortality occurred. CONCLUSION TRANSTAR facilitated a tailored, real circumferential full-thickness rectal resection, leading to improved patient functional and quality of life outcomes at 12 months postoperatively. It represents a safe and effective treatment for ODS in local clinical practice, although the sustainability of real-world results needs to be proven in the long-term follow-up.
Collapse
Affiliation(s)
- G Ribaric
- Clinical and Medical Affairs, Ethicon Endo-Surgery (Europe) GmbH, European Surgical Institute, Norderstedt/Hamburg, Germany,
| | | | | | | |
Collapse
|
|
18
|
Abstract
Rectal prolapse continues to be problematic for both patients and surgeons alike, in part because of increased recurrence rates despite several well-described operations. Patients should be aware that although the prolapse will resolve with operative therapy, functional results may continue to be problematic. This article describes the recommended evaluation, role of adjunctive testing, and outcomes associated with both perineal and abdominal approaches.
Collapse
|
|
19
|
Mitchell N, Norris ML. Rectal prolapse associated with anorexia nervosa: a case report and review of the literature. J Eat Disord 2013; 1:39. [PMID: 24999417 PMCID: PMC4081793 DOI: 10.1186/2050-2974-1-39] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/03/2013] [Indexed: 01/27/2023] Open
Abstract
Anorexia nervosa is one of a few mental health diagnoses that affects every organ system. Patients with AN often present with multiple secondary effects of starvation at the time of first assessment, including gastrointestinal (GI) complaints. In extreme cases, severe GI complications such as rectal prolapse may be encountered as a consequence of the illness although formal studies investigating the frequency of such occurrences are lacking. We present the case of a 16 year old female previously diagnosed with anorexia nervosa that developed a rectal prolapse as a consequence of her disease as well as a detailed literature review investigating the frequency and prevalence of such occurrences in this population.
Collapse
Affiliation(s)
- Nadine Mitchell
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada
| | - Mark L Norris
- Division of Adolescent Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada ; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| |
Collapse
|
|
20
|
Johnson E, Kjellevold K, Johannessen HO, Drolsum A. Long-term outcome after resection rectopexy for internal rectal intussusception. ISRN GASTROENTEROLOGY 2012; 2012:824671. [PMID: 23346411 PMCID: PMC3546480 DOI: 10.5402/2012/824671] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/07/2012] [Indexed: 12/15/2022]
Abstract
Background and Aims. The optimal treatment of patients with internal rectal intussusception (IRI) is unresolved. The aim was to study the short- and long-term outcome of resection rectopexy in these patients. Methods. An observational and mainly prospective study of 48 patients (44 women) with IRI who had ligament-preserving suture rectopexy by laparoscopic (n = 25) or open (n = 23) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report, and health-related quality of life (HRQoL). Results. From preoperatively to a median of 6 months and 76 months postoperatively, constipation scores were reduced from a mean of (95% CI) 13.20 (11.41 to 15.00) to 6.91 (5.29 to 8.54) and 6.35 (4.94 to 7.76) (P < 0.0001). The number of constipated patients was reduced from 35 to eleven and eight, respectively, and none became constipated. Nine of ten symptoms of constipation improved. Corresponding scores for anal incontinence were 4.7 (2.4–7.0), 4.0 (2.4–5.7), and 4.1 (2.3–5.8), respectively. HRQoL at long-term followup compared to the general Norwegian population was reduced in four out of eight dimensions concerning physical factors. The patient-reported outcome at short- and long-term followup was improved by 85.4% and 75.0%, respectively. Conclusions. Resection rectopexy for IRI improved the outcome. HRQoL was reduced compared with the general population.
Collapse
Affiliation(s)
- Egil Johnson
- Department of Gastroenterological and Pediatric Surgery, Oslo University Hospital, Ulleval, Kirkeveien 166, 0407 Oslo, Norway ; Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway
| | | | | | | |
Collapse
|
|
21
|
Obstructive defecation syndrome: 19 years of experience with laparoscopic resection rectopexy. Tech Coloproctol 2012; 17:307-14. [PMID: 23152078 DOI: 10.1007/s10151-012-0925-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/01/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND In obstructive defecation syndrome (ODS) combinations of morphologic alterations of the pelvic floor and the colorectum are nearly always evident. Laparoscopic resection rectopexy (LRR) aims at restoring physiological function. We present the results of 19 years of experience with this procedure in patients with ODS. METHODS Between 1993 and 2012, 264 patients underwent LRR for ODS at our department. Perioperative and follow-up data were analyzed. RESULTS The female/male ratio was 25.4:1, mean age was 61.3 years (±14.3 years), and mean body mass index (BMI) was 25.2 kg/m(2) (±4.2 kg/m(2)). The pathological conditions most frequently found in combination were a sigmoidocele plus a rectocele (n = 79) and a sigmoidocele plus a rectal prolapse or intussusception (n = 69). The conversion rate was 2.3 % (n = 6). The mortality rate was 0.75 % (n = 2), the rate of complications requiring surgical re-intervention was 4.3 % (n = 11), and the rate of minor complications was 19.8 % (n = 51). Follow-up data were available for 161 patients with a mean follow-up of 58.2 months (±47.1 months). Long-term results showed that 79.5 % of patients (n = 128) reported at least an improvement of symptoms. In cases of a sigmoidocele (n = 63 available for follow-up) or a rectal prolapse II°/III° (n = 72 available for follow-up), the improvement rates were 79.4 % (n = 50) and 81.9 % (n = 59), respectively. CONCLUSIONS LRR is a safe and effective procedure. Our perioperative results and long-term functional outcome strengthen the evidence regarding benefits of LRR in patients with an outlet obstruction. However, careful patient selection is essential.
Collapse
|
|
22
|
Cadeddu F, Sileri P, Grande M, De Luca E, Franceschilli L, Milito G. Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature. Tech Coloproctol 2011; 16:37-53. [PMID: 22170252 DOI: 10.1007/s10151-011-0798-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 11/23/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there are few long-term follow-up and functional outcome data available. Using meta-analysis techniques, this study was designed to evaluate long-term results of open and laparoscopic abdominal procedures to treat full-thickness rectal prolapse in adults. METHODS A literature review was performed using the National Library of Medicine's PubMed database. All articles on abdominal rectopexy patients with a follow-up longer than 16 months were considered. The primary end point was recurrence of rectal prolapse, and the secondary end points were improvement in incontinence and constipation. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed. RESULTS Eight comparative studies, consisting of a total of 467 patients (275 open and 192 laparoscopic), were included. Analysis of the data suggested that there is no significant difference in recurrence, incontinence and constipation improvement between laparoscopic abdominal rectopexy and open abdominal rectopexy. Considering non-comparative trials, the event rate for recurrence was similar in open and laparoscopic suture rectopexy studies and in open and laparoscopic mesh rectopexy trials. Improvement in constipation after the intervention was not statistically significant except for open mesh repair; postoperative improvement in incontinence was statistically significant after laparoscopic procedures and open mesh rectopexy. CONCLUSIONS Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regard to recurrence, incontinence and constipation. However, large-scale randomized trials, with comparative, strong methodology, are still needed to identify outcome measures accurately.
Collapse
Affiliation(s)
- F Cadeddu
- Department of Surgery, University Hospital Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | | | | | | | | |
Collapse
|
|
23
|
|
|
24
|
Yoon SG. Rectal prolapse: review according to the personal experience. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:107-13. [PMID: 21829764 PMCID: PMC3145880 DOI: 10.3393/jksc.2011.27.3.107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 07/26/2010] [Indexed: 11/30/2022]
Abstract
The aim of treatment of rectal prolapse is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. Faced with a multitude of options, the choice of an optimal treatment is difficult. It is best tailored to patient and surgeon. Numerous procedures have been described and are generally categorized into perineal or abdominal approaches. In general, an abdominal procedure has associated with lower recurrence and better functional outcome than perineal procedures. The widespread success of laparoscopic surgery has led to the development of laparoscopic procedures in the treatment of complete rectal prolapse. In Korea, there has been a trend toward offering perineal procedures because of the high incidence of rectal prolapse in young males and its being a lesser procedure. Delorme-Thiersch procedure has appeal as a lesser procedure for patients of any age or risk category, especially for elderly low-risk patients, patients with constipation or evacuation difficulties, young males, and patients with symptomatic hemorrhoids or mucosal prolapse. Laparoscopic suture rectopexy is recommended for either low-risk female patients or patients who are concerned with postoperative aggravation of their incontinence.
Collapse
Affiliation(s)
- Seo-Gue Yoon
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| |
Collapse
|
|
25
|
Otto SD, Ritz JP, Gröne J, Buhr HJ, Kroesen AJ. Abdominal resection rectopexy with an absorbable polyglactin mesh: prospective evaluation of morphological and functional changes with consecutive improvement of patient's symptoms. World J Surg 2011; 34:2710-6. [PMID: 20703473 DOI: 10.1007/s00268-010-0735-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The pathophysiology of rectal prolapse and intussusception has not yet been clarified. This is reflected in the multiplicity of surgical procedures. The aim of this prospective study was to measure morphological and functional changes of the pelvic floor and the rectum before and after resection rectopexy. METHODS A total of 21 patients (mean age 60 years; 2 men, 19 women) with manifest rectal prolapse and rectoanal intussusception underwent sigmoidectomy and rectopexy with an absorbable polyglactin mesh graft. The following analyses were performed preoperatively and, on average, 15 months (range 6-21 month) postoperatively: radiologic defecography, rectal volumetry, sphincter manometry, and evaluation of clinical symptoms. RESULTS Postoperatively there was no patient with rectal prolapse, and only one with an intussusception. Rectal compliance increased from 6.4 to 10.2 ml/mmHg. Rectal volumetry showed a decrease of the thresholds for the sensation of "desire to defecate" and "maximal tolerated volume" (100-75 ml, 175-150 ml). Postoperatively, there was a higher level of the pelvic floor during contraction. The anorectal angle, vector volume, radial asymmetry, sphincter length, and resting and squeezing pressures were unchanged. Surgery improved rectal evacuation (p = 0.03), continence (p = 0.01), stool consistency (p = 0.03), and warning period (p = 0.01). Patients' personal assessment showed an improved overall satisfaction. CONCLUSIONS Resection rectopexy is a reliable method for treating rectal prolapse and rectoanal intussusception with clear improvement of the patient's clinical symptoms. The restored anorectal function can be attributed to improved rectal compliance, a lower sensory threshold, an elevation of the pelvic floor during squeezing, and an improved rectal evacuation.
Collapse
Affiliation(s)
- S D Otto
- Department of Surgery, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | | | | | | | | |
Collapse
|
|
26
|
|
|
27
|
Shin EJ. Surgical treatment of rectal prolapse. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:5-12. [PMID: 21431090 PMCID: PMC3053504 DOI: 10.3393/jksc.2011.27.1.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 08/06/2010] [Indexed: 12/12/2022]
Abstract
Rectal prolapse is defined as a protrusion of the rectum beyond the anus. Although rectal prolapse was recognized as early as 1500 BC, the optimal surgical procedure is still debated. The varied operative procedures available for treating rectal prolapsed can be confusing. The aim of treatment is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. In elderly and high-risk patients, perineal approaches, such as Delorme's operation and Altemeier's operation, have been preferred, although the incidence of recurrence and the rate of persistent incontinence seem to be high when compared with transabdominal procedures. Abdominal operations involve dissection and fixation of the rectum and may include a rectosigmoid resection. From the late twentieth century, the laparoscopic procedure has been applied to the treatment of rectal prolapse. Current laparoscopic surgical techniques include suture rectopexy, stapled rectopexy, posterior mesh rectopexy with artificial material, and resection of the sigmoid colon with colorectal anastomosis with or without rectopexy. The choice of surgery depends on the status of the patient and the surgeon's preference.
Collapse
Affiliation(s)
- Eung Jin Shin
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| |
Collapse
|
|
28
|
Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World J Surg 2010; 34:1116-22. [PMID: 20127331 DOI: 10.1007/s00268-010-0429-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We can divide surgery for rectal prolapse into two broad categories: abdominal and perineal. However, few studies compare the long-term outcomes and quality of life among operations for full-thickness rectal prolapse. The purpose of this study was to compare abdominal (AO) versus perineal (PO) procedures for the treatment of full-thickness rectal prolapse regarding recurrence rate, incontinence, constipation, and quality of life. METHODS Records of 177 operations from 1995 to 2001 were reviewed retrospectively. A telephone survey was attempted for all. Seventy-five (42%) responded to the Cleveland Clinic Incontinence Score (CCIS), KESS Constipation Score (KESS-CS), and SF-36 Quality of Life Score. Appropriate statistical analysis was performed. RESULTS For the 122 AO and 55 PO, there were no deaths. Mean follow-up was similar (PO 3.1 vs. AO 3.9 years; P = 0.306). As expected the PO patients were older (mean 69 vs. 55 years) and had higher ASA scores. Those undergoing PO had less procedural blood loss, operative time, hospital stay, and dietary restriction. The PO group also scored worse on the physical component of SF-36 (PO 33 vs. AO 39.6; P = 0.034). However, the rate of recurrent prolapse was significantly higher for the PO (PO 26.5% vs. AO 5.2%; P < 0.001). Complications, CCIS, KESS-CS, and SF-36 mental component were similar in both groups. CONCLUSIONS In full-thickness rectal prolapse, elderly, sick patients are selected for a perineal operation. The morbidity, functional outcomes, and quality of life are acceptable. However, the high recurrence rates make the perineal operation a second-best choice for younger, healthy patients.
Collapse
|
|
29
|
Abstract
The management of full-thickness rectal prolapse involves surgical intervention in the majority of cases. Many procedures have been described employing both perineal and abdominal approaches. Abdominal procedures result in more durable repair of the prolapse; however, the procedures require general anesthesia and are reserved for younger healthier patients. Laparoscopy has been utilized in the treatment of rectal prolapse since its introduction for colorectal procedures; recent studies have found equivalent long-term results and short-term outcomes.
Collapse
Affiliation(s)
- Bashar Safar
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | | |
Collapse
|
|
30
|
Wolff K, Marti L, Beutner U, Steffen T, Lange J, Hetzer FH. Functional outcome and quality of life after stapled transanal rectal resection for obstructed defecation syndrome. Dis Colon Rectum 2010; 53:881-8. [PMID: 20485001 DOI: 10.1007/dcr.0b013e3181cdb445] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Clinical studies have demonstrated that stapled transanal rectal resection with Contour Transtar (Transtar procedure) is a safe and effective treatment for patients with obstructive defecation syndrome. The aim of this study was to determine functional outcome and quality of life after the procedure. METHODS Female patients with obstructive defecation syndrome were enrolled prospectively for the Transtar procedure. Intussusception and anterior rectocele were confirmed by clinical investigation and by magnetic resonance defecography. Functional outcome was measured by obstructed defecation syndrome score, severity of symptoms score, and Wexner score preoperatively and postoperatively. Quality of life was assessed by the Cleveland Clinic constipation score, the fecal incontinence quality of life scale, and the SF-36v2 health survey. RESULTS Between January 2007 and November 2008, 52 consecutive patients (median age: 64 years) were included in the study. Before the surgery, 12 patients experienced fecal incontinence. Functional scores improved significantly: 6 weeks after surgery, the obstructed defecation syndrome score decreased from a median of 16 (range, 9-22) to 5 (range, 2-10) and the severity of symptoms score, from 16 (range, 9-21) to 4 (range, 0-9) (each P < .0001). After 6 weeks, 10 patients had fecal incontinence and 12 patients experienced fecal urgency. At 3 months, 6 patients were still incontinent, 3 of whom were treated successfully with sacral neuromodulation. Fecal urgency resolved in all cases after 6 months. Quality of life improved, particularly in the mental components. CONCLUSION Despite the described postoperative symptoms, most of which can be treated conservatively, the Transtar procedure is an effective treatment for patients with obstructive defecation syndrome and improves quality of life significantly.
Collapse
Affiliation(s)
- Katja Wolff
- Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | | | | | | | | |
Collapse
|
|
31
|
Forsgren C, Zetterström J, Zhang A, Iliadou A, Lopez A, Altman D. Anal incontinence and bowel dysfunction after sacrocolpopexy for vaginal vault prolapse. Int Urogynecol J 2010; 21:1079-84. [PMID: 20449566 DOI: 10.1007/s00192-010-1167-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study aimed to determine the prevalence of bowel dysfunction and anal incontinence in relation to vaginal vault prolapse surgery in women hysterectomized on benign indications. METHODS This is a case-control study where women having had sacrocolpopexy (n = 78) were compared with hysterectomized women without sacrocolpopexy (n = 233) using a bowel function questionnaire and the Cleveland Clinic Incontinence Score (CCIS). RESULTS Sacrocolpopexy was performed on average 13.7 years (+/-11.1 SD) after the hysterectomy. Sacrocolpopexy was associated with an increased prevalence of rectal emptying difficulties (p = 0.04), incomplete rectal evacuation (p < 0.001), digitally assisted rectal emptying (p < 0.001), and use of enemas (p = 0.001). There was no overall significant difference in mean CCIS when comparing women having had vaginal vault prolapse surgery (CCIS = 2.78 +/- 4.1 SD) with those without (CCIS = 2.1 +/- 3.3 SD, p = 0.1) CONCLUSIONS Abdominal sacrocolpopexy is associated with obstructed defecation but not anal incontinence when compared to hysterectomized controls without vaginal vault prolapse surgery.
Collapse
Affiliation(s)
- Catharina Forsgren
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | | | | | | | | | | |
Collapse
|
|
32
|
Hetzer FH, Roushan AH, Wolf K, Beutner U, Borovicka J, Lange J, Marti L. Functional outcome after perineal stapled prolapse resection for external rectal prolapse. BMC Surg 2010; 10:9. [PMID: 20205956 PMCID: PMC2843648 DOI: 10.1186/1471-2482-10-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 03/08/2010] [Indexed: 12/20/2022] Open
Abstract
Background A new surgical technique, the Perineal Stapled Prolapse resection (PSP) for external rectal prolapse was introduced in a feasibility study in 2008. This study now presents the first results of a larger patient group with functional outcome in a mid-term follow-up. Methods From December 2007 to April 2009 PSP was performed by the same surgeon team on patients with external rectal prolapse. The prolapse was completely pulled out and then axially cut open with a linear stapler at three and nine o'clock in lithotomy position. Finally, the prolapse was resected stepwise with the curved Contour® Transtar™ stapler at the prolapse's uptake. Perioperative morbidity and functional outcome were prospectively measured by appropriate scores. Results 32 patients participated in the study; median age was 80 years (range 26-93). No intraoperative complications and 6.3% minor postoperative complications occurred. Median operation time was 30 minutes (15-65), hospital stay 5 days (2-19). Functional outcome data were available in 31 of the patients after a median follow-up of 6 months (4-22). Preoperative severe faecal incontinence disappeared postoperatively in 90% of patients with a reduction of the median Wexner score from 16 (4-20) to 1 (0-14) (P < 0.0001). No new incidence of constipation was reported. Conclusions The PSP is an elegant, fast and safe procedure, with good functional results. Trial registration ISRCTN68491191
Collapse
Affiliation(s)
- Franc H Hetzer
- Department of Surgery, Cantonal Hospital, St. Gallen, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
|
33
|
Gurland B, Zutshi M. Overview of Pelvic Evacuation Dysfunction. SEMINARS IN COLON AND RECTAL SURGERY 2010. [DOI: 10.1053/j.scrs.2009.10.008] [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]
|
|
34
|
Collinson R, Wijffels N, Cunningham C, Lindsey I. Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results. Colorectal Dis 2010; 12:97-104. [PMID: 19788493 DOI: 10.1111/j.1463-1318.2009.02049.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Over the last 15 years, posterior rectopexy, which causes rectal autonomic denervation, was discredited for internal rectal prolapse because of poor results. The condition became medical, managed largely by biofeedback. We aimed to audit the short-term functional results of autonomic nerve-sparing laparoscopic ventral rectopexy (LVR) for internal rectal prolapse. METHOD Prospectively collected data on LVR for internal rectal prolapse were analysed. End-points were changes in bowel function (Wexner Constipation Score and Fecal Incontinence Severity Index) at 3 and 12 months. Analysis was performed using Mann-Whitney U-test for unpaired data and Wilcoxon signed rank test for paired data (two-sided p-test). Functional outcomes were compared with those achieved previously for external rectal prolapse (ERP). RESULTS Seventy-five patients underwent LVR (median age 58, range 25-88 years, median follow up was 12 months). Mortality (0%), major (0%) and minor morbidity (4%) were acceptably low. Median length of stay was 2 days. Preoperative constipation (median Wexner score 12) and faecal incontinence (median FISI score 28) improved significantly at 3 months (Wexner 4, FISI 8, both P < 0.0001) and 12 months (Wexner 5, FISI 8, both P < 0.0001). No patient had worse function. Functional outcomes were similar to those for ERP. CONCLUSION Laparoscopic ventral rectopexy for internal rectal prolapse improves symptoms of obstructed defaecation and faecal incontinence in the short-term. This establishes proof of concept for a nerve-sparing surgical treatment for internal rectal prolapse.
Collapse
Affiliation(s)
- R Collinson
- Oxford Pelvic Floor Centre, Department of Colorectal Surgery, Churchill Hospital, Oxford, UK
| | | | | | | |
Collapse
|
|
35
|
Knowles CH, Dinning PG, Pescatori M, Rintala R, Rosen H. Surgical management of constipation. Neurogastroenterol Motil 2009; 21 Suppl 2:62-71. [PMID: 19824939 DOI: 10.1111/j.1365-2982.2009.01405.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review addresses the range of operations suggested to be of contemporary value in the treatment of constipation with critical evaluation of efficacy data, complications, patient selection, controversies and areas for future research.
Collapse
Affiliation(s)
- C H Knowles
- Queen Mary University London, Barts and the London School of Medicine & Dentistry, London, UK.
| | | | | | | | | |
Collapse
|
|
36
|
Pescatori M, Milito G, Fiorino M, Cadeddu F. Complications and reinterventions after surgery for obstructed defecation. Int J Colorectal Dis 2009; 24:951-9. [PMID: 19165491 DOI: 10.1007/s00384-009-0639-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2009] [Indexed: 02/04/2023]
Abstract
PURPOSE Functional results following surgery for obstructed defecation (OD) have been widely investigated, but there are few reports aimed to analyze postoperative complications and re-interventions. This study investigates the adverse events requiring retreatment for obstructed defecation. METHODS We retrospectively analyzed the records of 203 patients operated on by a single surgeon, 20 transabdominally and 183 transperineally (159 manual and 24 stapled). Postoperative complications requiring retreatment and outcome of reinterventions were analyzed. RESULTS Adverse events requiring retreatment occurred in 14.3% more frequently after abdominal than after perineal procedures (20% vs. 13.7%), but the sample size of the two arms is different. Rectal bleeding and strictures were the most common adverse events (6.9%). Major complications, i.e., ischemic colitis requiring hemicolectomy and pelvic sepsis requiring colostomy also occurred (1%). The overall reintervention rate was 7.5%, (5% after abdominal and 7.6% after perineal surgery). Overall, 59% of the reoperated patients were still constipated at a median follow up of 2 years. CONCLUSIONS Complications requiring retreatment are not uncommon after surgery for OD and reinterventions are often unsuccessful. A careful preoperative evaluation and selection of patients should be undertaken in order to minimize adverse events.
Collapse
Affiliation(s)
- Mario Pescatori
- Coloproctology Unit, Ars Medica and Villa Flaminia Hospitals, Rome, Italy
| | | | | | | |
Collapse
|
|
37
|
Affiliation(s)
- James S Wu
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Mayfield Heights, Ohio, USA
| |
Collapse
|
|
38
|
Preservation of the continence function after intersphincteric resection using a prolapsing technique in the patients with low rectal cancer and its clinical prognosis. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200810020-00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
|
39
|
|
|
40
|
Hsu A, Brand MI, Saclarides TJ. Laparoscopic Rectopexy without Resection: A Worthwhile Treatment for Rectal Prolapse in Patients without Prior Constipation. Am Surg 2007. [DOI: 10.1177/000313480707300905] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anterior resection with rectopexy is considered by many to be the best operation for rectal prolapse. It is feared that if sigmoid redundancy created by rectal mobilization is not resected, colonic motility (specifically constipation) could be disabling. We contend that resection is not necessary in patients without preexisting constipation. We tested this hypothesis using a laparoscopic approach to minimize hospital stay. Twelve patients were treated (eight women); mean age was 45 years (range, 25–82 years). No patient had preexisting constipation; one had irritable bowel syndrome. Three patients had prior prolapse operations. Full rectal mobilization was undertaken down to the levator hiatus; neither the mesenteric vessels nor the lateral ligaments were divided. Rectopexy to the presacral fascia was done with one to two Nurolon sutures on either side of the rectum. There were no complications; mean hospital stay was 4 days. Mean follow up was 32 months (range; 3–75 months); there have been no recurrences. Only the patient with irritable bowel syndrome developed significant constipation. We conclude: 1) rectopexy can be safely done laparoscopically, 2) resection is not required in the absence of prior constipation, and 3) rectal mobilization and rectopexy does not predispose to future constipation in these selected patients.
Collapse
Affiliation(s)
- Allen Hsu
- Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois
| | - Marc I. Brand
- Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois
| | - Theodore J. Saclarides
- Department of General Surgery, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
|
41
|
Lundin E, Graf W, Karlbom U. Anorectal manovolumetry in the decision making before surgery for slow transit constipation. Tech Coloproctol 2007; 11:259-65. [PMID: 17676264 DOI: 10.1007/s10151-007-0361-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 06/26/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colectomy with ileorectal anastomosis for slow transit constipation (STC) is being challenged by other operations, such as segmental resections. The importance of preoperative anorectal physiology testing may therefore be increased. The aim of this study was to identify anorectal abnormalities in patients with STC, which may influence the surgical approach. METHODS Fifty consecutive patients with STC (43 women; median age, 49 years) and 28 controls (23 women; median age, 50 years) were examined with anorectal manovolumetry. Anal pressures and rectal volumes were recorded, at stepwise rectal distension. RESULTS Anal resting pressure was lower in patients (median, 54 cm H(2)O; range, 22-130) than in controls (median, 68 cm H(2)O; range, 35-100) (p<0.05). Squeeze pressure tended to be lower in patients (median, 147 cm H(2)O; range, 53-382) than in controls (median, 177 cm H(2)O; range, 65-423) (p=0.09). Rectal sensory thresholds did not differ significantly between patients and controls, although 10 patients had a threshold for filling above the 95(th) percentile of controls. Rectal compliance was increased in patients in the pressure interval 5-35 cm H(2)O (p<0.05-0.01). The threshold and amplitude of the recto-anal inhibitory reflex did not differ significantly, but the recovery of resting pressure after eliciting the reflex was lower in patients than in controls in the pressure interval 10-50 cm H(2)O (p<0.05-0.001). CONCLUSIONS More than half of the patients with STC deviated in some parameter. An impaired internal sphincter function and increased rectal compliance were seen. One fifth of the patients had impaired rectal sensation.
Collapse
Affiliation(s)
- E Lundin
- Department of Surgical Sciences Section of Surgery, University Hospital, SE-751 85, Uppsala, Sweden.
| | | | | |
Collapse
|
|
42
|
Johnson E, Stangeland A, Johannessen HO, Carlsen E. Resection rectopexy for external rectal prolapse reduces constipation and anal incontinence. Scand J Surg 2007; 96:56-61. [PMID: 17461314 DOI: 10.1177/145749690709600111] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS The main aim was to examine constipation and anal incontinence in patients before and after resection for external rectal prolapse. MATERIAL AND METHODS Twenty patients had ligament preserving suture rectopexy and sigmoid resection (resection rectopexy) for external rectal prolapse by laparoscopic (n = 15) or open (n = 5) technique during 2001-2005. They were prospectively evaluated for constipation and anal incontinence using validated incontinence and KESS-constipation scores. RESULTS AND CONCLUSIONS Constipation score was significantly reduced from mean 7.7 (5.4-9.9) to 4.5 (2.5-6.4) after median 4 months (1-19) and to 4.3 (2.2-6.3) after median 17 months (4-51). Six and four patients were constipated preoperatively and 17 months postoperatively, respectively. The four symptoms feeling incomplete evacuation of stool, minutes in lavatory per attempt, use of enemas/digitation and painful evacuation effort were significantly reduced, whilst stool consistency increased. Fourteen patients (70%) had anal incontinence. Corresponding and significant reduction in their scores were from mean 12.5 (9.4-15.5) to 5.1 (2.1-8.1) and to 3.6 (1.3-5.9). Incontinence was improved in 13 and unaltered in one patient(s). Two patients with worse outcome had increased stool consistency and constipation scores. Resection rectopexy for rectal prolapse reduced anal incontinence and constipation.
Collapse
Affiliation(s)
- E Johnson
- Department of Gastroenterological Surgery, Ulleval University Hospital, Oslo, Norway.
| | | | | | | |
Collapse
|
|
43
|
Abstract
INTRODUCTION Rectal prolapse, or procidentia, is defined as a protrusion of the rectum beyond the anus. It commonly occurs at the extremes of age. Rectal prolapse frequently coexists with other pelvic floor disorders, and patients have symptoms associated with combined rectal and genital prolapse. Few patients, a lack of randomized trials and difficulties in the interpretation of studies of anorectal physiology have made the understanding of this disorder difficult. METHODS OF TREATMENT Surgical management is aimed at restoring physiology by correcting the prolapse and improving continence and constipation, whereas in patients with concurrent genital and rectal prolapse, an interdisciplinary surgical approach is required. Operation should be reserved for those patients in whom medical treatment has failed, and it may be expected to relieve symptoms. Numerous surgical procedures have been suggested to treat rectal prolapse. They are generally classified as abdominal or perineal according to the route of access. However, the controversy as to which operation is appropriate cannot be answered definitively, as the extent of a standardized diagnostic assessment and the types of surgical procedures have not been identified in published series. LITERATURE REVIEW This review encompasses rectal prolapse, including aetiology, symptoms and treatment. The English-language literature about rectal prolapse was identified using Medline, and additional cited works not detected in the initial search were obtained. Articles reporting on prospective and retrospective comparisons and case reports were included.
Collapse
Affiliation(s)
- Stavros Gourgiotis
- Clinical Attachment in Division of General Surgery and Oncology, Royal Liverpool University Hospital, 21 Millersdale Road, Mossley Hill, L18 5HG, Liverpool, UK.
| | | |
Collapse
|
|
44
|
Dench JE, Scott SM, Lunniss PJ, Dvorkin LS, Williams NS. Multimedia article. External pelvic rectal suspension (the express procedure) for internal rectal prolapse, with or without concomitant rectocele repair: a video demonstration. Dis Colon Rectum 2006; 49:1922-6. [PMID: 17053866 DOI: 10.1007/s10350-006-0719-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Internal rectal prolapse has been proposed as a cause of symptomatic rectal evacuatory dysfunction. Abdominal rectopexy, the standard surgical approach, has significant attendant risk and does not address any concomitant rectocele. This video was designed to demonstrate a novel surgical method that uses porcine collagen implants (Permacol), designed to correct internal rectal prolapse, with or without rectocele. INCLUSION CRITERIA severe rectal evacuatory dysfunction refractory to maximal conservative therapy and full-thickness internal rectal prolapse impeding rectal emptying on defecography with or without associated functional rectocoele; normal colonic transit. Patients undergo comprehensive preoperative and postoperative symptomatic assessment and anorectal physiologic testing, including defecography. A crescenteric perineal skin incision allows development of the rectovaginal/rectoprostatic plane to Denonvilliers fascia, with rectal mobilization. A curved tunneller inserted via the perineal wound is guided retropubically to emerge through suprapubic wounds created on each side. Permacol T-strips are sutured to the anterolateral rectal wall bilaterally, upward traction exerted, and the stem of each T-strip is sutured to the suprapubic periosteum, suspending the rectum. Concomitant rectocele is repaired using a Permacol patch in the rectovaginal plane. RESULTS Short-term results for the "Express" are encouraging with improvement in evacuatory and prolapse symptoms and concomitant anatomic improvement at defecography. CONCLUSIONS This procedure promises to be an effective technique for managing patients with refractory evacuatory dysfunction secondary to internal rectal prolapse, with or without rectocele.
Collapse
Affiliation(s)
- Julia E Dench
- Centre for Academic Surgery, GI Physiology Unit, The Royal London Hospital, Whitechapel, London, United Kingdom
| | | | | | | | | |
Collapse
|
|
45
|
Andromanakos N, Skandalakis P, Troupis T, Filippou D. Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 2006; 21:638-46. [PMID: 16677147 DOI: 10.1111/j.1440-1746.2006.04333.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.
Collapse
Affiliation(s)
- Nikolaos Andromanakos
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, Athens, Greece
| | | | | | | |
Collapse
|
|
46
|
Muñoz F, del Valle E, Rodríguez M, Zorrilla J. [Rectal prolapse. Abdominal or perineal approach? Current situation]. Cir Esp 2006; 78 Suppl 3:50-8. [PMID: 16478616 DOI: 10.1016/s0009-739x(05)74644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Rectal prolapse is a major challenge for the surgeon who has to resolve the anatomical problem and the functional disturbances in the same procedure. Abdominal procedures are the most appropriate in young patients, and the most common technique is rectopexia with or without resection. The use of mesh or sutures provides the same results and the choice depends on the surgeon's preference. Laparoscopic surgery has been demonstrated to have similar efficacy to conventional surgery and may become the option of the future. The perineal approach is the best option in elderly patients and in those with associated morbidity; the Delorme technique is simple to carry out, but rectosigmoidectomy provides better results.
Collapse
Affiliation(s)
- Fernando Muñoz
- Unidad de Coloproctología, Cirugía General l, Hospital General Universitario Gregorio Marañón, 28033 Madrid, Spain.
| | | | | | | |
Collapse
|
|
47
|
Altman D, Zetterstrom J, Schultz I, Nordenstam J, Hjern F, Lopez A, Mellgren A. Pelvic organ prolapse and urinary incontinence in women with surgically managed rectal prolapse: a population-based case-control study. Dis Colon Rectum 2006; 49:28-35. [PMID: 16273329 DOI: 10.1007/s10350-005-0217-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to investigate the prevalence of genital prolapse surgery and urinary incontinence in female patients operated on for rectal prolapse compared with a matched control group without rectal prolapse. METHODS Fifty-two patients with a history of abdominal rectal prolapse surgery and 200 randomly selected age-matched and gender-matched control subjects without rectal prolapse received an extensive health care history survey. RESULTS Response rate in the patient group was 48 of 52 (92 percent) and 165 of 200 (82 percent) in the control group. Rectal prolapse was associated with an increased risk of surgery for uterine prolapse (odds ratio = 3.1; 95 percent confidence interval = 1.4-6.9) and vaginal wall prolapse (odds ratio = 3.2; 95 percent confidence interval = 1.3-7.8). Mean age at hysterectomy because of uterine prolapse was 54.7 years in the patient group compared with 62.6 years in the control group (P < 0.01). Mean age at vaginal wall prolapse surgery was 60.2 years in the patient group compared with 66.6 years in the control group (P < 0.05). There were no significant differences between the cohorts regarding prevalence or age at debut of urinary incontinence. CONCLUSION Our results indicate a strong association between rectal and genital prolapse surgery suggesting that diagnosis of rectal prolapse necessitating surgical intervention should prompt a multidisciplinary pelvic floor assessment.
Collapse
Affiliation(s)
- D Altman
- Division of Obstetrics and Gynecology, Pelvic Floor Center, Stockholm, Sweden.
| | | | | | | | | | | | | |
Collapse
|
|
48
|
Kariv Y, Delaney CP, Casillas S, Hammel J, Nocero J, Bast J, Brady K, Fazio VW, Senagore AJ. Long-term outcome after laparoscopic and open surgery for rectal prolapse: a case-control study. Surg Endosc 2005; 20:35-42. [PMID: 16374674 DOI: 10.1007/s00464-005-3012-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 08/26/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic repair (LR) of rectal prolapse is potentially associated with earlier recovery and lower perioperative morbidity, as compared with open transabdominal repair (OR). Data on the long-term recurrence rate and functional outcome are limited. METHODS Perioperative data on rectal prolapse in relation to all LRs performed between December 1991 and April 2004 were prospectively collected. The LR patients were matched by age, gender, and procedure type with OR patients who underwent surgery during the same period. Patients with previous complex abdominal surgery or a body mass index exceeding 40 were excluded from the study. Data on recurrence rate, bowel habits, continence, and satisfaction scores were collected using a telephone survey. RESULTS A total of 111 patients (age, 56.8 +/- 18.1 years; female, 87%) underwent attempted LR. An operative complication deferred repair in two cases. Among the 111 patients, 42 had posterior mesh fixation, and 67 had sutured rectopexy (32 patients with sigmoid colectomy for constipation). Eight patients (7.2%) had conversion to laparotomy. Matching was established for 86 patients. The LR patients had a shorter hospital stay (mean, 3.9 vs 6.0 days; p < 0.0001). The 30-day reoperation and readmission rates were similar for the two groups. The rates for recurrence requiring surgery were 9.3% for LR and 4.7% for OR (p = 0.39) during a mean follow-up period of 59 months. An additional seven patients in each group reported possible recurrence by telephone. Postoperatively, 35% of the LR patients and 53% of the OR patients experienced constipation (p = 0.09). Constipation was improved in 74% of the LR patients and 54% of the OR patients, and worsened, respectively, in 3% and 17% (p = 0.037). The postoperative incontinence rates were 30% for LR and 33% for OR (p = 0.83). Continence was improved in 48% of the LR patients and 35% of the OR patients, and worsened, respectively, in 9% and 18% (p = 0.22). The mean satisfaction rates for surgery (on a scale of 0 to 10) were 7.3 for the LR patients and 8.1 for the OR patients (p = 0.17). CONCLUSIONS The hospital stay is shorter for LR than for OR. Both functional results and recurrent full-thickness rectal prolapse were similar for LR and OR during a mean follow-up period of 5 years.
Collapse
Affiliation(s)
- Y Kariv
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
49
|
Dippolito A, Esser S, Reed J. Anterior Modification of Delorme Procedure Provides Equivalent Results to Delorme Procedure in Treatment of Rectal Outlet Obstruction. ACTA ACUST UNITED AC 2005; 62:609-12. [PMID: 16293495 DOI: 10.1016/j.cursur.2005.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study was designed to assess the results of the standard Delorme procedure versus an anterior modification of the Delorme procedure in the treatment of patients with rectal outlet obstruction secondary to internal intussusception with or without rectocele. STUDY DESIGN A descriptive retrospective study from October 1997 to May 2001 was undertaken. Twenty-seven patients with symptoms of rectal outlet obstruction assumed to be caused by internal rectal prolapse or a combination of internal rectal prolapse and rectocele underwent surgical repair. Twenty-two patients had preoperative defecography and anal manometry. Thirteen patients had an anterior Delorme repair; 14 patients had a standard Delorme repair. Selection of procedure was chronologic with the standard Delorme undertaken in the earlier group. Preoperative and operative data were collected retrospectively. RESULTS Twenty-seven women, aged 29 to 94 (mean, 62.0 for anterior Delorme, 66.3 for Delorme) years were followed up for the duration of the study (mean follow-up, 15.9 months for anterior Delorme and 32.1 months for Delorme). Twelve patients (92.3%) reported a good to excellent overall result after the anterior Delorme procedure versus 14 patients (100%) in the Delorme group. Symptomatic improvement was observed in 85.7% of patients who had incomplete evacuation in the anterior Delorme group versus 90.9% in the Delorme group. Symptoms of constipation, bleeding, and the need to manually assist in defecation by pushing in the perineum or vagina improved in 100% of patients in both groups. Discontinuation of laxative use after the procedure was reported by 75% of patients in the anterior Delorme group versus 100% in the Delorme group. Eight patients experienced minor complications, 4 of these being urinary retention. In the postoperative period, no patients in the modified group experienced incontinence. Sixty three percent of the Delorme group experienced some sort of incontinence within the first 2 to 3 months (p = 0.038). CONCLUSIONS An anterior modification of the Delorme procedure, which requires less operative dissection, can be performed with results nearly equivalent to those of the established Delorme procedure in the treatment of rectal outlet obstruction secondary to internal intussusception with or without rectocele.
Collapse
Affiliation(s)
- Anthony Dippolito
- Department of Surgery, St. Luke's Hospital & Health Network, Bethlehem, PA, USA
| | | | | |
Collapse
|
|
50
|
Marchal F, Bresler L, Ayav A, Zarnegar R, Brunaud L, Duchamp C, Boissel P. Long-term results of Delorme's procedure and Orr-Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 2005; 48:1785-90. [PMID: 15981056 DOI: 10.1007/s10350-005-0088-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to assess long-term outcome of Orr-Loygue rectopexy and Delorme's procedures in total rectal prolapse management. METHODS Data were collected retrospectively from 1978 to 2001. Statistical analysis was performed by chi-squared test and Student's t -test. RESULTS One hundred nine patients underwent either a Orr-Loygue rectopexy (49 patients) or a Delorme's procedure (60 patients). Mean follow-up was 88 (range, 1-300) months. In the rectopexy group, the overall complication rate and the recurrence rate were 33 percent and 4 percent, respectively. In patients with preoperative constipation, this symptom was improved or completely resolved in 33 percent and worsened in 58 percent postoperatively. Seventy-three percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. In Delorme's group, overall complication and recurrence rates were 15 percent and 23 percent, respectively. Mortality was 7 percent. In patients with preoperative constipation, this symptom was improved or completely resolved in 54 percent and worsened in 12.5 percent of patients postoperatively. Forty-two percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. CONCLUSIONS In this study, Orr-Loygue rectopexy had a lower long-term recurrence rate. However, this surgical procedure is associated with a higher complication rate. We believe that Delorme's procedure is still a valuable option in selected patients with postoperative minimal morbidity but higher recurrence rate.
Collapse
Affiliation(s)
- Frédéric Marchal
- Department of Surgery, Centre Alexis Vautrin, Vandoeuvre-Lès-Nancy, France.
| | | | | | | | | | | | | |
Collapse
|