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Miura Y, Funahashi K, Kurihara A, Kagami S, Suzuki T, Yoshida K, Ushigome M, Kaneko T. The Predictive Risk Factor of Postoperative Recurrence Following Altemeier's and Delorme's Procedures for Full-thickness Rectal Prolapse: An Analysis of 127 Japanese Patients in a Single Institution. J Anus Rectum Colon 2024; 8:171-178. [PMID: 39086885 PMCID: PMC11286377 DOI: 10.23922/jarc.2023-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/07/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives We aimed to identify risk factors for postoperative recurrence (PR) after Altemeier's and Delorme's procedures for full-thickness rectal prolapse (FTRP). Methods We enrolled 127 patients who underwent Altemeier's and Delorme's procedures for FTRP between April 2008 and September 2021. We divided the 127 patients into recurrence and non-recurrence groups and conducted univariate and multivariate analyses. We used six independent variables: age, body mass index (BMI), history of surgical repair for FTRP, coexistence of prolapse in other organs, poor fixation of the rectum on defecography before surgery, length of the prolapsed rectum, and type of surgical procedure (Altemeier's or Delorme's procedures). Results PR developed in 51 (40.1%) patients during a mean follow-up period of 453 (range, 9-3616) days. Comparing the recurrence group (n=51) with the non-recurrence group (n=76), significant difference was observed regarding the coexistence of prolapse in other organs (p=0.017) in the univariate analysis. In the multivariate analysis, significant differences were observed in BMI (OR 1.18, 95% CI 1.030-1.350, p=0.020), coexistence of prolapse in other organs (OR 3.38, 95% CI 1.200-9.500, p=0.021), length of the prolapsed rectum (OR 1.030, 95% CI 1.010-1.060, p=0.015), poor fixity of the rectum on defecography (OR 0.332, 95% CI 0.129-0.852, p=0.022), and surgical procedures (OR 0.192, 95% CI 0.064-0.573, p=0.003). Conclusions The study suggested that increasing BMI, coexistence of prolapse in other organs, length of the prolapsed rectum, poor fixation of the rectum on defecography before surgery, and types of surgical procedure might be risk factors of PR after perineal surgery for FTRP.
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Affiliation(s)
- Yasuyuki Miura
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Akiharu Kurihara
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Satoru Kagami
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Takayuki Suzuki
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kimihiko Yoshida
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Mitsunori Ushigome
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Tomoaki Kaneko
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
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Marra AA, Simonelli I, Parello A, Litta F, De Simone V, Campennì P, Ratto C. Analysis of factors that indicated surgery in 400 patients submitted to a complete diagnostic workup for obstructed defecation syndrome and rectal prolapse using a supervised machine learning algorithm. Tech Coloproctol 2024; 28:73. [PMID: 38918256 DOI: 10.1007/s10151-024-02951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/25/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Patient selection is extremely important in obstructed defecation syndrome (ODS) and rectal prolapse (RP) surgery. This study assessed factors that guided the indications for ODS and RP surgery and their specific role in our decision-making process using a machine learning approach. METHODS This is a retrospective analysis of a long-term prospective observational study on female patients reporting symptoms of ODS who underwent a complete diagnostic workup from January 2010 to December 2021 at an academic tertiary referral center. Clinical, defecographic, and other functional tests data were assessed. A supervised machine learning algorithm using a classification tree model was performed and tested. RESULTS A total of 400 patients were included. The factors associated with a significantly higher probability of undergoing surgery were follows: as symptoms, perineal splinting, anal or vaginal self-digitations, sensation of external RP, episodes of fecal incontinence and soiling; as physical examination features, evidence of internal and external RP, rectocele, enterocele, or anterior/middle pelvic organs prolapse; as defecographic findings, intra-anal and external RP, rectocele, incomplete rectocele emptying, enterocele, cystocele, and colpo-hysterocele. Surgery was less indicated in patients with dyssynergia, severe anxiety and depression. All these factors were included in a supervised machine learning algorithm. The model showed high accuracy on the test dataset (79%, p < 0.001). CONCLUSIONS Symptoms assessment and physical examination proved to be fundamental, but other functional tests should also be considered. By adopting a machine learning model in further ODS and RP centers, indications for surgery could be more easily and reliably identified and shared.
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Affiliation(s)
- A A Marra
- Proctology and Pelvic Floor Surgery Unit, Center of Excellence for Gastrointestinal and Endocrine-Metabolic Diseases, Isola Tiberina - Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - I Simonelli
- Biostatistical Service, Clinical Trial Center, Isola Tiberina - Gemelli Isola Hospital, Rome, Italy
| | - A Parello
- Proctology and Pelvic Floor Surgery Unit, Center of Excellence for Gastrointestinal and Endocrine-Metabolic Diseases, Isola Tiberina - Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - F Litta
- Proctology and Pelvic Floor Surgery Unit, Center of Excellence for Gastrointestinal and Endocrine-Metabolic Diseases, Isola Tiberina - Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - V De Simone
- Proctology and Pelvic Floor Surgery Unit, Center of Excellence for Gastrointestinal and Endocrine-Metabolic Diseases, Isola Tiberina - Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - P Campennì
- Proctology and Pelvic Floor Surgery Unit, Center of Excellence for Gastrointestinal and Endocrine-Metabolic Diseases, Isola Tiberina - Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186, Rome, Italy
| | - C Ratto
- Proctology and Pelvic Floor Surgery Unit, Center of Excellence for Gastrointestinal and Endocrine-Metabolic Diseases, Isola Tiberina - Gemelli Isola Hospital, Via di Ponte Quattro Capi, 39, 00186, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
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Habeeb TAAM, Podda M, Chiaretti M, Kechagias A, Lledó JB, Kalmoush AE, Mustafa FM, Nassar MS, Labib MF, Teama SRA, Elshafey MH, Elbelkasi H, Alsaad MIA, Sallam AM, Ashour H, Mansour MI, Mostafa A, Elshahidy TM, Yehia AM, Rushdy T, Ramadan A, Hamed AEM, Yassin MA, Metwalli AEM. Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates-a retrospective cohort study. Tech Coloproctol 2024; 28:48. [PMID: 38619626 PMCID: PMC11018677 DOI: 10.1007/s10151-024-02919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/16/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. METHODS We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. RESULTS LVMR was associated with fewer postoperative complications (p < 0.001), lower prolapse recurrence (p < 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare's score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery-recurrence interval (p < 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p < 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03-0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036-1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197-1.655, p < 0.001). CONCLUSIONS LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes. TRIAL REGISTRATION Clinical Trial.gov (NCT05915936), retrospectively registered on June 14, 2023.
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Affiliation(s)
- T A A M Habeeb
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt.
| | - M Podda
- Department of Surgical Science, Cagliari University Hospital, Monserrato, 09042, Cagliari, Italy
| | - M Chiaretti
- Paride Stefanini General and Specialist Surgery Department, Sapienza University of Rome IT, Rome, Italy
| | - A Kechagias
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland
| | - J B Lledó
- Department of Surgery, La Fe University Hospital, Valencia, Spain
| | | | - Fawzy M Mustafa
- General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | | | - Mohamed Fathy Labib
- General Surgery Department, Faculty of Medicine, Al-Azher University, Cairo, Egypt
| | | | | | - Hamdi Elbelkasi
- General Surgery Department, Mataryia Teaching Hospital (GOTHI), Cairo, Egypt
| | | | - Ahmed M Sallam
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Hassan Ashour
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Mohamed Ibrahim Mansour
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abdelshafy Mostafa
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Tamer Mohamed Elshahidy
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Ahmed M Yehia
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Tamer Rushdy
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Alaaedin Ramadan
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abd Elwahab M Hamed
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Mahmoud Abdou Yassin
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
| | - Abd-Elrahman M Metwalli
- Department of General Surgery, Faculty of Medicine, Zagazig University, 1 Faculty of Medicine Street, Zagazig, Sharqia, Egypt
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Schabl L, Hull T, Erozkan K, Alipouriani A, Ban KA, Steele SR, Spivak AR. Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes. Langenbecks Arch Surg 2024; 409:49. [PMID: 38305915 PMCID: PMC10837248 DOI: 10.1007/s00423-024-03227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure. METHODS We queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier's perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy. RESULTS Ten women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m2 (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred. CONCLUSION Mesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.
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Affiliation(s)
- Lukas Schabl
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Tracy Hull
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Kamil Erozkan
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Ali Alipouriani
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Kristen A Ban
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Scott R Steele
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA
| | - Anna R Spivak
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
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Tsunoda A, Matsuda S, Kusanagi H. Comparison of Safety and Efficacy between Laparoscopic Ventral Rectopexy and Delorme's Procedure for External Rectal Prolapse in Nonagenarians. J Anus Rectum Colon 2024; 8:24-29. [PMID: 38313744 PMCID: PMC10831977 DOI: 10.23922/jarc.2023-053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/20/2023] [Indexed: 02/06/2024] Open
Abstract
Objectives This study evaluates the safety and efficacy of laparoscopic ventral rectopexy (LVR) in nonagenarian patients with external rectal prolapse (ERP) compared to Delorme's procedure. Methods We conducted a retrospective analysis of prospectively collected data, including nonagenarian patients who underwent either LVR or Delorme's procedure, comparing outcomes such as morbidity, length of hospital stay (LOS), and recurrence rates. Results Between September 2009 and August 2023, 22 patients (median age 91, range 90-94 years) underwent LVR, while 12 patients (median age 91, range 90-96 years) received Delorme's procedure. Baseline characteristics, including sex ratio, parity, American Society of Anesthesiology grade, and Body Mass Index, did not significantly differ between the groups. LVR had a significantly longer operating time but lower blood loss than Delorme's procedure. Postoperative LOS was significantly shorter for LVR patients (median 1, range 1-3 days) compared to Delorme's procedure patients (median 2.5, range 1-13 days; P = 0.001). Notably, no significant morbidity occurred in the LVR group, while one case of delirium and another of solitary rectal ulcer syndrome were observed in the Delorme's procedure group. Recurrence rates were lower in the LVR group, with no recurrences during a median follow-up of 23 months (range 1-65 months), compared to one recurrence at 2 months during a median follow-up of 34 months (range 1-96 months) in the Delorme's procedure group. Conclusions LVR is a safe and effective surgical option for nonagenarian ERP patients, showing favorable outcomes in terms of morbidity, LOS, and recurrence rates compared to Delorme's procedure.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Satoshi Matsuda
- Department of Pediatric Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
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Emile SH, Khan SM, Garoufalia Z, Silva-Alvarenga E, Gefen R, Horesh N, Freund MR, Wexner SD. A network meta-analysis of surgical treatments of complete rectal prolapse. Tech Coloproctol 2023; 27:787-797. [PMID: 37150800 DOI: 10.1007/s10151-023-02813-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI). METHODS A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI. RESULTS Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47 months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant. CONCLUSIONS Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.
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Affiliation(s)
- S H Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - S M Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Z Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - E Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - R Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - N Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - M R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA.
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Drissi F, Rogier-Mouzelas F, Fernandez Arias S, Podevin J, Meurette G. Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series. J Clin Med 2023; 12:5751. [PMID: 37685818 PMCID: PMC10488879 DOI: 10.3390/jcm12175751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Introduction: Laparoscopic ventral mesh rectopexy (VMR) is the standard procedure for the treatment of posterior pelvic organ prolapse. Despite significant functional improvement and anatomical corrections, severe complications related to mesh augmentation can occur in a few proportions of patients. In order to decrease the number of rare but severe complications, we developed a variant of the conventional VMR without any rectal fixation and using a robotic approach with biological mesh. The aim of this study was to compare the results of laparoscopic ventral rectopexy with synthetic mesh (LVMRS) to those of robotic ventral rectopexy with biological mesh (RVMRB). Methods: Between 2004 and 2021, patients operated on for VMR in our unit were identified and separated into two groups: LVMRS and RVMRB. The surgical technique for both groups consisted of VMR without any rectal fixation, with mesh distally secured on the levator ani muscles. Results: 269 patients with a mean age of 62 years were operated for posterior pelvic floor disorder: rectocele (61.7%) and external rectal prolapse (34.6%). 222 (82.5%) patients received LVMRS (2004-2015), whereas 47 were operated with RVMRB (2015-2021). Both groups slightly differed for combined anterior fixation proportion (LVMRS 39% vs. RVMRB 6.4%, p < 0.001). Despite these differences, the length of stay was shorter in the RVMRB group (2 vs. 3 days, p < 0.001). Postoperative complications were comparable in the two groups (1.8 vs. 4.3%, p = 0.089) and mainly consisted of minor complications. Functional outcomes were favorable and similar in both groups, with an improvement in bulging, obstructed defecation symptoms, and fecal incontinence (NS in subgroup analysis). In the long term, there were no mesh erosions reported. The overall recurrence rate was 11.9%, and was comparable in the two groups (13% LVMRS vs. 8.5, p = 0.43). Conclusions: VMR without rectal fixation is a safe and effective approach in posterior organ prolapse management. RVMRB provides comparable results in terms of recurrence and functional results, with avoidance of unabsorbable material implantation.
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Affiliation(s)
- Farouk Drissi
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | - Fabien Rogier-Mouzelas
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | | | - Juliette Podevin
- Department of Digestive Surgery, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44093 Nantes, France
| | - Guillaume Meurette
- Division of Digestive Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland;
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8
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Tunneling of Mesh during Ventral Rectopexy: Technical Aspects and Long-Term Functional Results. J Clin Med 2022; 12:jcm12010294. [PMID: 36615094 PMCID: PMC9821569 DOI: 10.3390/jcm12010294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/22/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
Avoiding the extensive damage of pelvic structures during ventral rectopexy could minimize secondary disfunctions. The objective of our observational study is to assess the safety and functional efficacy of a modified ventral rectopexy. In the modified ventral rectopexy, a retroperitoneal tunnel was created along the right side of rectum, connecting two peritoneal mini-incisions at the Douglas pouch and sacral promontory. The proximal edge of a polypropylene mesh, sutured over the ventral rectum, was pulled up through the retroperitoneal tunnel and fixed to the sacral promontory. In all patients, radiopaque clips were placed on the mesh, making it radiographically "visible". Before surgery and at follow up visits, Altomare, Longo, CCSS, PAC-SYM, and CCFI scores were collected. From March 2010 to September 2021, 117 patients underwent VR. Modified ventral rectopexy was performed in 65 patients, while the standard ventral rectopexy was performed in 52 patients. The open approach was used in 97 cases (55 and 42 patients in modified and standard VR, respectively), while MI surgery was used in 20 cases (10 and 10 patients in modified and standard VR, respectively). A slightly shorter operative time and hospital stay were observed following modified ventral rectopexy (though this was not statistically significant). Similar overall complication rates were registered in the modified vs. standard ventral rectopexies (4.6% vs. 5.8%, p = 0.779). At follow-up, the Longo score (14.0 ± 8.6 vs. 11.0 ± 8.2, p = 0.042) and "delta" values of Altomare (9.2 ± 6.1 vs. 5.9 ± 6.3, p = 0.008) and CCSS (8.4 ± 6.3 vs. 6.1 ± 6.1, p = 0.037) scores were significantly improved in the modified ventral rectopexy group. A similar occurrence of symptoms recurrence was diagnosed in the two groups. Radiopaque clips helped to accurately diagnose mesh detachment/dislocation. The proposed modified VR seems to be feasible and safe. Marking the mesh intraoperatively seems useful.
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9
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Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy. Tech Coloproctol 2022; 26:953-962. [DOI: 10.1007/s10151-022-02679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
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10
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Abdelnaby M, Emile SH, Fathy M, Balata M, Arnous M, Elfeki H. Laparoscopic Ventral Mesh Rectopexy with Resection of Dolichocolon for Treatment of Obstructed Defecation Syndrome: Technical Report. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Abstract
BACKGROUND Correct tack placement at the sacral promontory for mesh fixation in ventral mesh rectopexy is crucial to avoid bleeding, nerve dysfunction, and spondylodiscitis. OBJECTIVE The present cadaver study was designed to assess the true location of tacks after mesh fixation during laparoscopic ventral mesh rectopexy in relation to vascular and nerve structures and bony landmarks. DESIGN This was an interventional cadaver study. SETTING This study was conducted after laparoscopic mesh fixation detailed pelvic dissection was performed following a standardized protocol. In addition, 64-row multidetector computed tomography was conducted to further define lumbosacral anatomy and tack positioning. PATIENTS Eighteen fresh cadavers (10 female, 8 male) were included in this study. MAIN OUTCOME MEASURES True tack position and vascular and neuronal involvement served as outcome measures. RESULTS A total of 52 tacks were deployed (median 3, range 2-3 tacks). Median tack distance to the midsacral promontory was 16.1 mm (0.0-54.2). Only a total of 22 tacks (42.3%) were found on the right surface of the S1 vertebra, correlating with the planned deployment area. In 7 cadavers (38.8%), all tacks were deployed on the planned deployment area. The median distance to the major vessels was 10.5 mm (0.0-35.0), which was the internal iliac artery in half of the cases. Median distance of tacks to the right ureter was 32.1 mm (7.5-46.1). Neither major vessels nor the ureter was injured. Dissection of the hypogastric plexus was undertaken in 14 cadavers, and in each cadaver, tacks affected the hypogastric nerve plexus. LIMITATIONS This study was limited by the moderate number of cadavers. CONCLUSIONS Tack placement showed significant variation in our specimen, emphasising the need for reliable anatomic landmarks and sufficient exposure during ventral mesh rectopexy. Hypogastric nerve plexus involvement is common, thus detailed functional assessment after surgery is required. It also points out the importance of cadaver studies before implementing new surgical techniques into clinical practice. See Video Abstract at http://links.lww.com/DCR/B827. FIJACIN LAPAROSCPICA DE MALLA SACRA PARA RECTOPEXIA VENTRAL IMPLICACIONES CLNICAS DE UN ESTUDIO SOBRE CADAVERS ANTECEDENTES:La colocación correcta de la tachuela en el promontorio sacro para la fijación de la malla en la rectopexia con malla ventral es crucial para evitar hemorragias, disfunción nerviosa y espondilodiscitis.OBJETIVO:El presente estudio en cadáveres fue diseñado para evaluar la verdadera ubicación de las tachuelas después de la fijación de la malla durante la rectopexia laparoscópica con malla ventral en relación con las estructuras vasculares y nerviosas y los puntos de referencia óseos.DISEÑO:Estudio intervencionista de cadáveres.AJUSTE:Después de la fijación laparoscópica de la malla, se realizó una disección pélvica detallada siguiendo un protocolo estandarizado. Además, se realizó una tomografía computarizada multidetector de 64 cortes para definir mejor la anatomía lumbosacra y la posición de la tachuela.PACIENTES:Se incluyeron en este estudio dieciocho cadáveres frescos (10 mujeres, 8 hombres).PRINCIPALES MEDIDAS DE RESULTADO:Posición real de tachuela y compromiso vascular y neuronal.RESULTADOS:Se utilizaron un total de 52 tachuelas (mediana 3, 2-3 tachuelas). La distancia media de tachuela al promontorio sacro medio fue de 16,1 mm (0,0-54,2). Solo se encontraron un total de 22 tachuelas (42,3%) en la superficie derecha de la vértebra S1, correlacionándose con el área planificada. En siete cadáveres (38,8%) todas las tachuelas se utilizaron en el área de planificada. La distancia media a los vasos principales fue de 10,5 mm (0,0-35,0), que era la arteria ilíaca interna en la mitad de los casos. La distancia media de las tachuelas al uréter derecho fue de 32,1 mm (7,5-46,1). No se lesionó ni los grandes vasos ni el uréter. La disección del plexo hipogástrico se realizó en 14 cadáveres y en cada cadáver, las tachuelas afectaron el plexo nervioso hipogástrico.LIMITACIONES:Número moderado de cadáveres incluidos en el estudio.CONCLUSIONES:La colocación de tachuelas mostró una variación significativa en nuestra muestra, enfatizando la necesidad de puntos de referencia anatómicos confiables y una exposición suficiente durante la rectopexia con malla ventral. La afectación del plexo nervioso hipogástrico es común, por lo que se requiere una evaluación funcional detallada después de la cirugía. También destaca la importancia de los estudios sobre cadáveres antes de implementar nuevas técnicas quirúrgicas en la práctica clínica. Consulte Video Resumen en http://links.lww.com/DCR/B827. (Traducción-Dr Yolanda Colorado).
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Tacking the Mesh on the Sacral Promontory in Laparoscopic Ventral Mesh Rectopexy: It's Anatomy That Matters! Dis Colon Rectum 2022; 65:615-616. [PMID: 34840305 DOI: 10.1097/dcr.0000000000002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Ng YYR, Tan EJKW, Fu CWP. Trends in the surgical management of rectal prolapse: An Asian experience. Asian J Endosc Surg 2022; 15:110-120. [PMID: 34448361 DOI: 10.1111/ases.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Posterior compartment pelvic floor prolapse (PCPFP) leads to anatomical distortion and functional impairment. Definitive management involves surgery. Ventral mesh rectopexy (VMR) has gained increasing popularity in the West as it emerges as a durable approach. Existing literature and evidence on safety and efficacy of PCPFP surgery in the Asian population remains sparse. Our study aims to review our institution's experience in surgery for PCPFP. METHODS All cases of PCPFP surgery in Singapore General Hospital between 2014 to 2019 were studied. RESULTS Eighty-three patients had surgery performed for PCPFP, with the majority (83%) in the last 3 years. Median age was 63 years and 92% were female. Most patients (64%) had obstructive defecation symptoms, while the remaining had fecal incontinence, rectal bleeding, or anal discomfort. Main anatomical indication for surgery was external rectal prolapse (48%). Other indications were rectocele and/or rectal intussusception. The majority (66%) had abdominal rectopexy, while 28 underwent Delorme's procedure. Forty-five of the 50 VMRs were minimally invasive. Patients undergoing rectopexy were observed to be younger. Median length of stay was 3 days. Nine patients had early operative complications of which ileus was most common. Median length of follow-up was 12 months. The majority (93%) had initial symptom satisfaction. Eleven patients had anatomical recurrence with a median length of 9 months to development. There was no significant difference in outcomes between abdominal vs perineal approach, or laparoscopic vs robotic VMR. CONCLUSION Surgery for PCPFP has gained acceptance in our Asian institution with good symptom improvement, alongside low morbidity and recurrence.
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Affiliation(s)
- Yvonne Ying-Ru Ng
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Ju J, Kwak H, Chung J. A comparative study on the surgical options for male rectal prolapse. J Minim Access Surg 2022; 18:426-430. [PMID: 35708386 PMCID: PMC9306117 DOI: 10.4103/jmas.jmas_214_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: Rectal prolapse is known to be a rare condition in males compared to females. This study aimed to analyse the frequency of male rectal prolapse and compare the results of different surgical approaches performed at a single centre. Patients and Methods: The authors included patients who underwent surgical treatment for rectal prolapse from March 2016 to February 2021. The proportion of males, mean age and recurrence rates were calculated. Patients were divided into two groups, transanal approach and laparoscopic abdominal approach group, to identify the para-operative parameters including functional tests. Results: A total of 56 males, comprising 23.7% (56/236) of all patients. The mean age was 60.8 years, with a recurrence rate of 7 cases (12.5%) during 7.2 months of follow-up. Forty patients underwent transanal procedures, and fifteen underwent laparoscopic abdominal procedures. The mean operative time was longer in the laparoscopic group (transanal vs. abdominal, 57.5 vs. 70.6 min, P < 0.003), and intra-operative bleeding was greater in the transanal group (12.4 vs. 3.4 ml, P < 0.001). Full-layer prolapse (36.8 vs. 81.2% P = 0.003) and longer length (5.6 vs. 7.8 cm, P = 0.048) were more common in laparoscopic group. Time to feeding resumption was shorter after the transanal group (1.2 vs. 1.7 days, P = 0.028). There was no difference between the groups in terms of post-operative complications and recurrence rates. Both Wexner's constipation and incontinence scores showed significant improvement postoperatively. Conclusion: The frequency of male rectal prolapse was 23.7%, and perioperative factors differed between transanal and abdominal approaches, but recurrence rates and functional test results did not differ significantly.
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van der Schans EM, Verheijen PM, Broeders IAMJ, Consten ECJ. Ninety-day morbidity of robot-assisted redo surgery for recurrent rectal prolapse, mesh erosion and pelvic pain: lessons learned from 9 years' experience in a tertiary referral centre. Colorectal Dis 2021; 23:3205-3212. [PMID: 34741395 PMCID: PMC9299011 DOI: 10.1111/codi.15979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/24/2021] [Accepted: 11/01/2021] [Indexed: 12/22/2022]
Abstract
AIM With increasing follow-up of patients treated with minimally invasive ventral mesh rectopexy (VMR) more redo surgery can be expected for recurrent rectal prolapse, mesh erosion and pelvic pain. The aim of this study is to evaluate the 90-day morbidity of robot-assisted redo interventions. METHOD All robot-assisted redo interventions after primary transabdominal repair of rectal prolapse between 2011 and 2019 were retrospectively analysed and compared with the results for patients after primary robot-assisted VMR during the same period. The redo interventions were divided into groups based on the indication for surgery (recurrent prolapse, mesh erosion, pelvic pain). Intraoperative complications and 90-day postoperative morbidity were evaluated. RESULTS Three hundred and fifty nine patients were treated with primary VMR, with 73 for recurrent rectal prolapse, 12 for mesh erosion and 14 for pelvic pain. Complications of recurrent prolapse surgeries were comparable to those of primary VMR (p > 0.05). More intraoperative complications, minor and major complications were seen in redo surgery for erosion compared with primary VMR (23% vs. 3%, p = 0.01; 31% vs. 11%, p = 0.055; and 38% vs. 1%, p < 0.01 respectively). The frequency of intraoperative complications after redo surgery for pelvic pain was 7% with minor and major morbidity rates of 14% and 7% (p > 0.05). Half of the patients with pelvic pain experienced relief of their symptoms. CONCLUSION Redo surgery for management of recurrent rectal prolapse is safe. Redo surgery for mesh erosion is associated with high morbidity rates. Redo surgery for pelvic pain can have major complications and is only effective in half of the cases.
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Affiliation(s)
- Emma M. van der Schans
- Department of SurgeryMeander Medical CentreAmersfoortThe Netherlands,Faculty of Electrical Engineering, Mathematics and Computer ScienceInstitute of Technical MedicineUniversity of TwenteEnschedeThe Netherlands,Department of SurgeryUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Paul M. Verheijen
- Department of SurgeryMeander Medical CentreAmersfoortThe Netherlands
| | - Ivo A. M. J. Broeders
- Department of SurgeryMeander Medical CentreAmersfoortThe Netherlands,Faculty of Electrical Engineering, Mathematics and Computer ScienceInstitute of Technical MedicineUniversity of TwenteEnschedeThe Netherlands
| | - Esther C. J. Consten
- Department of SurgeryMeander Medical CentreAmersfoortThe Netherlands,Department of SurgeryUniversity Medical Centre GroningenGroningenThe Netherlands
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Tsunoda A, Takahashi T, Matsuda S, Kusanagi H. Predictive Factors for Recurrence of External Rectal Prolapse after Laparoscopic Ventral Rectopexy. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:376-385. [PMID: 34746502 PMCID: PMC8553359 DOI: 10.23922/jarc.2021-024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
Objectives: This study aimed to evaluate factors that contribute to the recurrence of external rectal prolapse (ERP) following laparoscopic ventral rectopexy (LVR). Methods: All patients who underwent LVR using synthetic meshes between 2011 and 2018 were prospectively included. A standard questionnaire including the Fecal Incontinence Severity Index (FISI) and Constipation Scoring System (CSS) was administered preoperatively and postoperatively. Defecography was performed 6 months postoperatively. Univariate and backward stepwise multivariate Cox analysis was performed to determine the prognostic factors of recurrence. Results: In total, 132 patients with a median follow-up of 46 months were included. The overall recurrence rate was 6.8% (n = 9), as confirmed by defecography at 6 months in six of the patients. None of the patients developed mesh erosion. FISI and CSS scores were significantly reduced at 3 months and remained significantly reduced for 3 years. Multivariate analyses revealed that the predictors of recurrence included male sex (hazards ratio, 11.3; 95% confidence interval, 3.0-43.0) and age >80 years (hazards ratio, 10.7; 95% confidence interval, 1.3-86.3). Eight patients with recurrence underwent surgery via Delorme's procedure (n = 7) and posterior rectopexy (n = 1). Two patients with new-onset rectoanal intussusception and one with uncorrected sigmoidocoele underwent repeat LVR. Conclusions: LVR is effective in treating ERP with low morbidity and low recurrence. Male patients and patients older than 80 years are at increased risk of recurrence. Hence, the LVR technique should be modified or coupled with other perineal procedures when treating ERP, especially in male patients.
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Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Tomoko Takahashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Satoshi Matsuda
- Department of Pediatric Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
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Akingboye AA, Khalid S, Broggi R, Scorza A, Todero S, Sileri P, Di Saverio S. Perineal stapled prolapse resection (PSPR) for full thickness external large rectal prolapse in a frail elderly patient; An easy to teach and reproducible novel technique - a video vignette. Colorectal Dis 2021; 23:3040-3041. [PMID: 34449955 DOI: 10.1111/codi.15883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Akinfemi A Akingboye
- Department of Surgery, Addenbrookes Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Khalid
- Department of Surgery, Addenbrookes Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Riccardo Broggi
- Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy
| | - Antonella Scorza
- Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy
| | - Sofia Todero
- Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy
| | | | - Salomone Di Saverio
- Department of Surgery, Addenbrookes Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.,Department of General surgery/Transplant Ospedale di Cirolo, Universita degli studi dell' insubria, varese, Italy.,General Surgery Department, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto, Italy.,General Surgery, Dipartimento di Chirurgia Generale e Specialistica, Paride Stefanini La Sapienza University of Rome, Rome, Italy
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ACG Clinical Guidelines: Management of Benign Anorectal Disorders. Am J Gastroenterol 2021; 116:1987-2008. [PMID: 34618700 DOI: 10.14309/ajg.0000000000001507] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/09/2021] [Indexed: 12/11/2022]
Abstract
Benign anorectal disorders of structure and function are common in clinical practice. These guidelines summarize the preferred approach to the evaluation and management of defecation disorders, proctalgia syndromes, hemorrhoids, anal fissures, and fecal incontinence in adults and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations Assessment, Development and Evaluation process. When the evidence was not appropriate for Grading of Recommendations Assessment, Development and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.
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Shalaby M, Omar W, Elfeki H. How to treat rectal prolapse in a male patient with faecal incontinence: Delorme's procedure combined with levatorplasty - a video vignette. Colorectal Dis 2021; 23:1939. [PMID: 33817945 DOI: 10.1111/codi.15666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Mostafa Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University, Mansoura, Egypt
| | - Waleed Omar
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University, Mansoura, Egypt
| | - Hossam Elfeki
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University, Mansoura, Egypt
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Anatomo-functional outcomes of the laparoscopic Frykman-Goldberg procedure for rectal prolapse in a tertiary referral centre. Updates Surg 2021; 73:1819-1828. [PMID: 34138448 DOI: 10.1007/s13304-021-01114-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
Rectal prolapse is a common disorder that represents a burden for patients due to the associated symptoms that may include both incontinence and constipation. Currently, a huge variation in techniques exist. The aim of this study was to evaluate the anatomo-functional results of the laparoscopic Frykman-Goldberg procedure (LFGP) for the treatment of both internal (IRP) and complete rectal prolapse (CRP). Between July 2004 and October 2019, 45 patients with IRP and CRP underwent a LFGP. The Cleveland Clinic Constipation Score (CCCS), Obstructed Defecation Syndrome Score (ODSS) and Vaizey Score (VS) were assessed preoperatively, 3 months before the procedure, 12 months after the procedures and at the final follow-up visit. The patients' mean age was 51.4 ± 17.9 (15-93) years, and the mean follow-up was 9.24 ± 4.57 (1.6-16.3) years. The VS, CCCS and ODSS significantly improved (p = 0.008; p < 0.001; p < 0.001) from median preoperative values of 3, 20 and 18 to 2, 6 and 5, respectively. Furthermore, the improvements in scores during follow-up remained constant and significant over time when considering the two groups separately (time effect for ODSS p < 0.001, for VS p = 0.026, for CCCS p < 0.001) and when the patients were divided by age (< 40, 41-60 and > 60; p < 0.001). The overall complication rate was 8.9% (4/45), and no intraoperative complications or anastomotic leakage occurred. Conversion to the open approach was not necessary in any case. The overall success rate was 97.7%, and only one recurrence in the IRP group occurred after 14 months. LRGP can be considered a safe, effective and long-lasting procedure in young patients with IRP or CRP, a history of ODS and a redundant sigmoid colon.
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Baracy Jr MG, Richardsona C, Mackeya KR, Hagglund KH, Aslam MF. Does ventral mesh rectopexy at the time of sacrocolpopexy prevent subsequent posterior wall prolapse? J Turk Ger Gynecol Assoc 2021; 22:174-180. [PMID: 34109716 PMCID: PMC8420747 DOI: 10.4274/jtgga.galenos.2021.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine whether ventral mesh rectopexy at the time of sacrocolpopexy reduces the rate of future posterior wall prolapse. Material and Methods: This was a retrospective cohort study of women with pelvic organ prolapse (POP) who underwent sacrocolpopexy or without concomitant rectopexy at a single community hospital from December 1, 2015 to June 30, 2019. Preoperative pelvic organ prolapse quantification (POP-Q) and urodynamic testing was used in evaluation of POP. Patients were followed for 12-weeks postoperatively and a 12-week postoperative POP-Q assessment was completed. The incidence of new or recurrent posterior prolapse was compared between cohorts. Results: Women with POP (n=150) were recruited, of whom 41 (27.3%) underwent sacrocolpopexy while the remainder (n=109, 72.7%) did not receive rectopexy. Patient demographics did not statistically differ between cohorts. Post-surgical posterior wall prolapse was reduced in the robotic assisted sacrocolpopexy (RASC) + rectopexy group compared to RASC alone, however this did not reach statistical significance. There were no patients who underwent concomitant rectopexy and RASC that needed recurrent posterior wall prolapse surgery, compared to eight-percent of patients that underwent isolated RASC procedures. Conclusion: Our findings suggest a reduction in the need for subsequent posterior wall surgery when rectopexy is performed at the time of sacrocolpopexy. In our study, no future surgery for POP was found in the concomitant sacrocolpopexy and rectopexy group, while a small proportion of the RASC only group required future POP surgery. Our study, however, was underpowered to elucidate a statistically significant difference between groups. Future larger studies are needed to confirm a reduced risk of posterior wall prolapse in patients who undergo concomitant RASC and rectopexy.
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Affiliation(s)
- Michael G. Baracy Jr
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Casey Richardsona
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Kyle R. Mackeya
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Karen H. Hagglund
- Department Biomedical Investigations and Research, Ascension St. John Hospital, Michigan, United States of America
| | - Muhammad Faisal Aslam
- Department of Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Michigan, United States of America,Department of Female Pelvic Medicine and Reconstructive Surgery, Michigan State University, Michigan, United States of America
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Toda K, Aoyama T, Hirai K, Uemura T, Fujita H, Okabe A, Ohe H, Tachibana T, Mitsuyoshi A. Laparoscopic approach to recurrence following multiple surgeries for external rectal prolapse: a case report. Surg Case Rep 2021; 7:71. [PMID: 33742270 PMCID: PMC7979842 DOI: 10.1186/s40792-021-01154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/10/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction The optimal procedure for recurrent external rectal prolapse remains unclear, particularly in laparoscopic approach. In addition, pelvic organ prolapse (POP) is sometimes concomitant with rectal prolapse. We present a case who underwent laparoscopic procedure for the recurrence of full-thickness external rectal prolapse coexisting POP. Case presentation An 81-year-old parous female had a 10-cm full-thickness external rectal prolapse following the two operations: the first was perineal recto-sigmoidectomy and the second was laparoscopic posterior mesh rectopexy. Imaging study revealed that the recurrent rectal prolapse was concomitant with both cystocele and exposed vagina, what we call POP. We planned and successfully performed laparoscopic ventral mesh rectopexy (LVMR) with laparoscopic sacrocolpopexy (LSC) using self-cut meshes without any perioperative complication. Conclusion This is the first report of LVMR and LSC for recurrent rectal prolapse with POP following the perineal recto-sigmoidectomy and laparoscopic posterior mesh rectopexy. Even for recurrent rectal prolapse with POP, our experience suggests that LVMR and LSC could be utilized.
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Affiliation(s)
- Kosuke Toda
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan.
| | - Taro Aoyama
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Kenjiro Hirai
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Taisuke Uemura
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Haruku Fujita
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Asami Okabe
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Hidenori Ohe
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Tsuyoshi Tachibana
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
| | - Akira Mitsuyoshi
- Department of Surgery, Otsu City Hospital, 2-9-9 Motomiya, Otsu, Shiga, 520-0804, Japan
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Boccasanta P, Venturi M, Agradi S, Calabrò G, Bordoni L, Missaglia C, Favetta U, Vergani C. Is it possible to reduce recurrences after Altemeier's procedure for complete rectal prolapse? Twenty-year experience in 130 consecutive patients. Langenbecks Arch Surg 2021; 406:1591-1598. [PMID: 33538872 DOI: 10.1007/s00423-021-02091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In the attempt to understand the reasons for and to find a solution to the high recurrence rate after perineal surgery for complete rectal prolapse, we retrospectively analysed the long-term results of Altemeier's procedure alone, or associated with Trans-Obturator Colonic Suspension (TOCS) in a large series of patients with a median interval of 84 months (range 6-258). METHODS Medical records of 110 patients undergoing Altemeier with levatorplasty (group 1) and 20 patients submitted to the same procedure associated with TOCS (group 2) for newly diagnosed complete rectal prolapse were reviewed. All patients had been recruited after preoperative clinical examination, SF-36 quality of life, continence score and colonoscopy. RESULTS Mortality was nil. The overall complication and the recurrence rates were 12.3%, and 15.0% (P= 0.769) and 24.6% and 5.0% (P=0.067) in group 1 and 2, respectively. Twelve patients of group 1 with a recurrence were submitted to a redo-Altemeier, 8 to a redo-Altemeier associated with TOCS, and 6 associated with an anterior coloplasty with a mesh. The only patient of group 2 with a recurrence was submitted to a Hartmann's operation. Preoperative vs postoperative mean (SD) continence score was 15.8 (3.1) and 15.6 (3.3) versus 4.1 (1.8) and 3.9 (1.9) in group 1 and 2, respectively (P < 0.001). All parameters of SF-36 improved after surgery (P<0.01) and no differences between the 2 groups were found CONCLUSIONS: Long-term results confirmed the safety and effectiveness of Altemeier's procedure for the treatment of complete rectal prolapse, with the limit of a non-negligible incidence of anastomotic complications and recurrences. The combination of Altemeier with TOCS showed a positive trend to a reduction of the recurrence rate, not worsening morbidity and outcomes.
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Affiliation(s)
- Paolo Boccasanta
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Marco Venturi
- Day Week Surgery Departmental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F Sforza 35, Milan, 20122, Italy. marvent-@virgilio.it.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy. marvent-@virgilio.it
| | - Sergio Agradi
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Giuseppe Calabrò
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Luca Bordoni
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Claudio Missaglia
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Umberto Favetta
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Contardo Vergani
- Day Week Surgery Departmental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F Sforza 35, Milan, 20122, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
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Shin JW, Hong KD, Lee DH, Kim DS, Lee DS. Laparoscopic Ventral Mesh Rectopexy (LVMR) for Internal and External Rectal Prolapse: An Analysis of 122 Consecutive Patients. Surg Laparosc Endosc Percutan Tech 2021; 31:479-484. [PMID: 34398130 DOI: 10.1097/sle.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Even though several reports have been published on the results of laparoscopic ventral mesh rectopexy (LVMR) in Asia, there are few mid-term or long-term results of LVMR. The authors aimed to evaluate the results of LVMR in patients with internal rectal prolapse (IRP) external rectal prolapse (ERP). MATERIALS AND METHODS From September 2013 to January 2019, 122 patients with IRP (n=48) or ERP (n=74) underwent LVMR. Constipation and fecal incontinence (FI) scores were evaluated using the Cleveland Clinic Florida score preoperatively and postoperatively. The questionnaire for the change of obstructed defecation or FI symptoms after surgery was also administered to grade the results as cured, improved, unchanged, or worsened for each survey. RESULTS The mean age of the patients was 61.9 years. The mean operation time was 116.5 minutes, and the mean hospital stay was 5.1 days. The mean follow-up was 42.1 months. There were no mesh-related complications. Eight patients (10.7%) among the ERP group required additional surgery for recurrent full-thickness prolapse. Eleven patients (14.7%) who had mucosal prolapse within 2 cm underwent stapled hemorrhoidopexy after LVMR. In the postoperative 6-month period, the overall constipation score (7.12) significantly improved compared with the preoperative score (13.03) (P<0.001), whereas the FI score significantly improved after surgery (12.16 to 8.92; P<0.001). CONCLUSION LVMR is a feasible and safe technique and favorable recurrence for ERP. Functional outcomes of obstructed defecation and FI were improved and the satisfaction of LVMR was high after the surgery. LVMR can be considered a recommended surgical option to treat ERP and IRP.
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Affiliation(s)
- Jae-Won Shin
- Department of Surgery, Colorectal Division, Daehang Hospital, Seoul
| | - Kwang-Dae Hong
- Department of Surgery, Colorectal Division, Korea University Ansan Hospital, Ansan, Korea
| | - Doo-Han Lee
- Department of Surgery, Colorectal Division, Daehang Hospital, Seoul
| | - Do-Sun Kim
- Department of Surgery, Colorectal Division, Daehang Hospital, Seoul
| | - Doo-Seok Lee
- Department of Surgery, Colorectal Division, Daehang Hospital, Seoul
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Fan K, Cao AM, Barto W, De Lacavalerie P. Perineal stapled prolapse resection for external rectal prolapse: a systematic review and meta-analysis. Colorectal Dis 2020; 22:1850-1861. [PMID: 32865320 DOI: 10.1111/codi.15338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/18/2020] [Indexed: 12/29/2022]
Abstract
AIM Rectal prolapse is an uncommon but debilitating pelvic floor disorder that significantly decreases the quality of life of affected patients. Perineal stapled prolapse resection is a relatively new perineal approach that offers an promising alternative technique in the surgical management of rectal prolapse. It appears to be a simple, reproducible and efficient method. However, long-term outcomes are limited. The aims of this review are to assess the safety and effectiveness of perineal stapled prolapse resection in the management of rectal prolapse. METHOD A systematic review of all articles describing this approach was searched using MEDLINE, Embase, PubMed, Cochrane, Scopus, Web of Science and China National Knowledge Infrastructure. Included in this review were all randomized and nonrandomized prospective and retrospective studies reporting patients (aged 16 years and older) with complete rectal prolapse who underwent perineal stapled prolapse resection for the surgical treatment of the rectal prolapse. RESULTS A total of 408 patients across 20 articles were included. There were 58 cases of recurrence out of 368 patients over a median length of follow-up of 18 months (interquartile range 12-34 months). The total weighted overall recurrence was 12%. There were 51 cases of postoperative complications in 350 cases, bleeding being the most common complication. CONCLUSION The recurrence rate is comparable to those of the well-established Altemeier and Delorme procedures. However, given the heterogeneity of studies and variations in lengths of follow-up, further randomized prospective studies are needed to adequately compare this technique against other procedures for complete rectal prolapse.
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Affiliation(s)
- K Fan
- Colorectal Surgery department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - A M Cao
- Colorectal Surgery department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - W Barto
- Colorectal Surgery department, Nepean Hospital, Kingswood, New South Wales, Australia
| | - P De Lacavalerie
- Department of Surgery, Nepean Private Hospital, Kingswood, New South Wales, Australia.,University of Sydney Nepean Clinical School, Kingswood, New South Wales, Australia
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26
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Laitakari KE, Mäkelä-Kaikkonen JK, Kairaluoma M, Junttila A, Kössi J, Ohtonen P, Rautio TT. Redo ventral rectopexy: is it worthwhile? Tech Coloproctol 2020; 25:299-307. [PMID: 33151385 PMCID: PMC7932956 DOI: 10.1007/s10151-020-02369-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). METHODS This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life. RESULTS A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation. CONCLUSIONS Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.
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Affiliation(s)
- K E Laitakari
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland.
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland.
| | - J K Mäkelä-Kaikkonen
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
| | - M Kairaluoma
- Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - A Junttila
- Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - J Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - P Ohtonen
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
| | - T T Rautio
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
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Di Leo A, Andreuccetti J. What happens to the biological prosthesis implanted during laparoscopic ventral mesh rectopexy? - a video vignette. Colorectal Dis 2020; 22:1754-1756. [PMID: 32585062 DOI: 10.1111/codi.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 02/08/2023]
Affiliation(s)
- A Di Leo
- Unit of General and Minimally-invasive Surgery, San Camillo Hospital, Trento, Italy
| | - J Andreuccetti
- Unit of General and Minimally-invasive Surgery, San Camillo Hospital, Trento, Italy
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Funktionelle Langzeitdaten nach laparoskopischer posteriorer Nahtrektopexie versus ventraler Netzrektopexie beim externen Rektumvollwandprolaps. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Loh KC, Umanskiy K. Ventral Rectopexy. Clin Colon Rectal Surg 2020; 34:62-68. [PMID: 33536851 DOI: 10.1055/s-0040-1714288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rectal prolapse is a debilitating condition that often results in impaired quality of life. Posterior compartment defects including rectal prolapse and rectal intussusception are often associated with middle and anterior compartment prolapse and require a multicompartment approach to treatment. In recent years, ventral rectopexy, with or without sacrocolpopexy for combined middle compartment prolapse, has emerged as a safe and effective method of treatment for rectal prolapse. In this article, we aim to review the etiology of rectal prolapse and intussusception, describe the indications and workup for surgery, discuss technical aspects of ventral rectopexy alone and in combination with sacrocolpopexy, review potential surgical complications, and describe the reported outcomes of the surgery.
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Affiliation(s)
- Kenneth C Loh
- Department of General Surgery, Kaiser Permanente, San Francisco, California
| | - Konstantin Umanskiy
- Department of Surgery, Section of Colon and Rectal Surgery, The University of Chicago, Chicago, Illinois
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Rectal prolapse surgery in males and females: An ACS NSQIP-based comparative analysis of over 12,000 patients. Am J Surg 2020; 220:697-705. [DOI: 10.1016/j.amjsurg.2020.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/10/2020] [Indexed: 12/11/2022]
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Wallace SL, Syan R, Enemchukwu EA, Mishra K, Sokol ER, Gurland B. Surgical approach, complications, and reoperation rates of combined rectal and pelvic organ prolapse surgery. Int Urogynecol J 2020; 31:2101-2108. [DOI: 10.1007/s00192-020-04394-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
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Laparoscopic Pelvic Organ Prolapse Suspension (Pops) Versus Laparoscopic Ventral Mesh Rectopexy for Treatment of Rectal Prolapse: Prospective Cohort Study. World J Surg 2020; 44:3158-3166. [PMID: 32424455 DOI: 10.1007/s00268-020-05585-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to compare ventral mesh rectopexy (VMR) and pelvic organ prolapse suspension surgery (POPS) in management of patients presenting with rectal prolapse. METHODS Our study was a prospective cohort trial in which 120 female patients with complete rectal prolapse were included, 60 patients had had VMR and the other 60 had had POPS as a surgical management for complete rectal prolapse. Results had been compared 6 months postoperatively regarding operative time, postoperative pain, hospital stay, complications of surgery including recurrence of the rectal prolapse, the efficacy of each operation in treatment of rectal prolapse and associated symptoms. RESULTS The patients were assessed 6 months postoperatively. There was no significant statistical difference regarding hospital stay and postoperative pain. Operative time was significantly shorter in POPS in comparison with VMR (P value < 0.05). VMR showed slight improvement regarding constipation and continence scores; however, this was statistically significant. VMR showed less complications compared to POPS. Complications with rectopexy happened only with 4 patients compared to 24 patients in POPS groups, 2 cases of recurrence in rectopexy group compared to 6 cases of recurrence in POPS. CONCLUSION POPS is comparable to VMR in management of rectal prolapse and in improving the ODS symptoms. Thus, POPS can be used as easier, faster option to treat rectal prolapse in selected patients.
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Role of Endoanal Ultrasonography in Grading Anal Sphincter Integrity in Rectal Prolapse and in Predicting Improvement in the Continence State After Surgical Treatment. Surg Laparosc Endosc Percutan Tech 2019; 30:62-68. [DOI: 10.1097/sle.0000000000000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Hidaka J, Elfeki H, Duelund-Jakobsen J, Laurberg S, Lundby L. Functional Outcome after Laparoscopic Posterior Sutured Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse: Six-year Follow-up of a Double-blind, Randomized Single-center Study. EClinicalMedicine 2019; 16:18-22. [PMID: 31832616 PMCID: PMC6890942 DOI: 10.1016/j.eclinm.2019.08.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been implemented to reduce postoperative bowel symptoms. The preoperative-to-postoperative change in a double-blinded, randomized study comparing it to laparoscopic posterior sutured rectopexy (LPSR) found no significant difference between the two procedures after one year. The aim of this study was to investigate the long-term functional outcomes. METHODS From November 2006-January 2014, 75 patients were randomized to LVMR (n = 37) or LPSR (n = 38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS, CCIS) were mailed to all the patients included in the RCT. Prolapse recurrences and mesh complications were recorded. FINDING Sixty-nine patients were available for long-term follow-up. Questionnaires were completed by 64 patients (94.4%). The median follow-up was 6.1 years. The total PAC-QoL was significantly lower in the LVMR group 0.26 (0.14-0.83) compared to the LPSR group 0.93(0.32-1.61)(P = 0.008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0.21-0.87) compared to the LPSR group 1.0 (0.5-1.5)(P = 0.031). Except for CCIS, the ODS and the CCCS significantly favored the LVMR group at six years (P = 0.011 & 0.017). Only three(8.82%) patients in the LVMR group developed recurrence compared to seven(23.33%) in the LPSR group (P = 0.111). INTERPRETATION The long-term functional outcome after LVMR is superior to that after LPSR. Larger multicenter studies are warranted. FUNDING None.
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Affiliation(s)
- Jin Hidaka
- Department of Surgery, Aarhus University Hospital, Denmark
- Corresponding author at: Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Hossam Elfeki
- Department of Surgery, Aarhus University Hospital, Denmark
- Department of surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Denmark
| | - Lilli Lundby
- Department of Surgery, Aarhus University Hospital, Denmark
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35
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Emile SH. How should we manage complete rectal prolapse in men? Colorectal Dis 2019; 21:1218-1219. [PMID: 31260604 DOI: 10.1111/codi.14745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 02/08/2023]
Affiliation(s)
- S H Emile
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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