1
|
Kamihata K, Nomura A, Okada T, Inamoto S, Nishida K, Katsura R, Kanaya S, Sakai Y. Transabdominal levatorplasty technique in laparoscopic mesh rectopexy for rectal prolapse. Tech Coloproctol 2024; 28:101. [PMID: 39138703 DOI: 10.1007/s10151-024-02975-7] [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: 12/04/2023] [Accepted: 07/12/2024] [Indexed: 08/15/2024]
Abstract
Rectal prolapse is characterized by a full-thickness intussusception of the rectal wall and is associated with a spectrum of coexisting anatomic abnormalities. We developed the transabdominal levatorplasty technique for laparoscopic rectopexy, inspired by Altemeier's procedure. In this method, following posterior mesorectum dissection, we expose the levator ani muscle just behind the anorectal junction. Horizontal sutures, using nonabsorbable material, are applied to close levator diastasis associated with rectal prolapse. The aim of the transabdominal levatorplasty is to (i) reinforce the pelvic floor, (ii) narrow the anorectal hiatus, and (iii) reconstruct the anorectal angle. We report a novel transabdominal levatorplasty technique during laparoscopic rectopexy for rectal prolapse. The laparoscopic mesh rectopexy with levatorplasty technique was performed in eight cases: six underwent unilateral Orr-Loygue procedure, one modified Wells procedure, and one unilateral Orr-Loygue procedure combined with sacrocolpopexy for uterine prolapse. The median follow-up period was 178 (33-368) days, with no observed recurrences. Six out of seven patients with fecal incontinence experienced symptomatic improvement. Although the sample size is small and the follow-up period is short, this technique has the potential to reduce the recurrence rate and improve functional outcomes, as with levatorplasty of Altemeier's procedure. We believe that this technique may have the potential to become an option for rectal prolapse surgery.
Collapse
Affiliation(s)
- K Kamihata
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - A Nomura
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan.
| | - T Okada
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - S Inamoto
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - K Nishida
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - R Katsura
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - S Kanaya
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan
| | - Y Sakai
- Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30, Fudegasakicho, Tennouji-Ku, Osaka, 543-8555, Japan
| |
Collapse
|
2
|
Wang B, Han W, Zhai Y, Shi R. Sigmoido-rectal intussusception anastomosis in the Altemeier procedure for complete rectal prolapse: preliminary results of a new technique. Front Surg 2024; 11:1340500. [PMID: 38375412 PMCID: PMC10875026 DOI: 10.3389/fsurg.2024.1340500] [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: 11/18/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose Our research introduces an innovative surgical approach, combining the Altemeier Procedure with Sigmoido-rectal Intussusception Anastomosis, effectively reducing recurrence, minimizing complications, and improving postoperative anal function in rectal prolapse patients. Materials and methods This retrospective study, conducted at tertiary referral hospitals including Shandong University of Traditional Chinese Medicine's Affiliated Hospital, Linyi People's Hospital, and Pingyi People's Hospital, examined data from patients undergoing conventional Altemeier surgery or Altemeier combined with Sigmoido-rectal Intussusception Anastomosis. Analyzing hospitalization and follow-up data from January 2009 to December 2022, the study focused on prolapse recurrence, complications, and anal function as primary outcome indicators across these three study centers. Results In the study, both groups had an average follow-up of (12.5 ± 2.41) months, and only two traditional group patients experienced mortality. Recurrence rates significantly differed, with 26.47% in the traditional group and 1.54% in the modified group (P < 0.001). The modified group showed no perioperative anastomotic dehiscence, contrasting with a 13.24% occurrence in the conventional group (P = 0.003). Primary complications in the modified group included anastomotic hemorrhage, with rates of 17.65% and 6.15% in the traditional and modified groups, respectively (P = 0.077). At 12 months postoperatively, both groups improved in anal manometry parameters and the Wexner anal incontinence score. Resting pressure was significantly lower in the traditional group (32.50 ± 1.76 mmHg) than the modified group (33.24 ± 2.06 mmHg) (P = 0.027), while the extrusion pressure was higher in the modified group (64.78 ± 1.55 mmHg) than the traditional group (62.85 ± 2.30 mmHg) (P < 0.001). The Wexner anal incontinence score was significantly lower in the modified group (2.69 ± 1.65) than the traditional group (3.69 ± 1.58, P = 0.001). Conclusion This retrospective study affirms that adding Sigmoido-rectal Intussusception Anastomosis to the Altemeier procedure reduces recurrence and complications. While both approaches enhance postoperative anal function in complete rectal prolapse patients, the combined method, particularly with Sigmoido-rectal Intussusception Anastomosis, proves more effective.
Collapse
Affiliation(s)
- Benjun Wang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Weiwei Han
- Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuze Zhai
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Renjie Shi
- Department of Anorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Anorectal Surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, China
| |
Collapse
|
3
|
Abstract
Complete rectal prolapse or rectal procidentia is a debilitating disease that presents with fecal incontinence, constipation, and rectal discharge. Definitive surgical techniques described for this disease include perineal procedures such as mucosectomy and rectosigmoidectomy, and abdominal procedures such as rectopexy with or without mesh and concomitant resection. The debate over these techniques regarding the lowest recurrence and morbidity rates, and the best functional outcomes for constipation or incontinence, has been going on for decades. The heterogeneity of available studies does not allow us to draw firm conclusions. This article aims to review the surgical techniques for complete rectal prolapse based on the current evidence base regarding surgical and functional outcomes.
Collapse
|
4
|
Kwakye G, Maguire LH. Anorectal Physiology Testing for Prolapse-What Tests are Necessary? Clin Colon Rectal Surg 2021; 34:15-21. [PMID: 33536845 PMCID: PMC7843946 DOI: 10.1055/s-0040-1714246] [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 frequently occurs in conjunction with functional and anatomic abnormalities of the bowel and pelvic floor. Prolapse surgery should have as its goal not only to correct the prolapse, but also to improve function to the greatest extent possible. Careful history-taking and physical exam continue to be the surgeon's best tools to put rectal prolapse in its functional context. Physiologic testing augments this and informs surgical decision-making. Defecography can identify concomitant middle compartment prolapse and pelvic floor hernias, potentially targeting patients for urogynecologic consultation or combined repair. Other tests, including manometry, ultrasound, and electrophysiologic testing, may be of utility in select cases. Here, we provide an overview of available testing options and their individual utility in rectal prolapse.
Collapse
Affiliation(s)
- Gifty Kwakye
- Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
5
|
Tsunoda A. Surgical Treatment of Rectal Prolapse in the Laparoscopic Era; A Review of the Literature. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:89-99. [PMID: 32743110 PMCID: PMC7390613 DOI: 10.23922/jarc.2019-035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/26/2020] [Indexed: 02/08/2023]
Abstract
Rectal prolapse is associated with debilitating symptoms including the discomfort of prolapsing tissue, mucus discharge, hemorrhage, and defecation disorders of fecal incontinence, constipation, or both. The aim of treatment is to eliminate the prolapse, correct associated bowel function and prevent new onset of bowel dysfunction. Historically, abdominal procedures have been indicated for young fit patients, whereas perineal approaches have been preferred in older frail patients with significant comorbidity. Recently, the laparoscopic procedures with their advantages of less pain, early recovery, and lower morbidity have emerged as an effective tool for the treatment of rectal prolapse. This article aimed to review the current evidence base for laparoscopic procedures and perineal procedures, and to compare the results of various techniques. As a result, laparoscopic procedures showed a relatively low recurrence rate than the perineal procedures with comparable complication rates. Laparoscopic resection rectopexy and laparoscopic ventral mesh rectopexy had a small advantage in the improvement of constipation or the prevention of new-onset constipation compared with other laparoscopic procedures. However, the optimal surgical repair has not been clearly demonstrated because of the significant heterogeneity of available studies. An individualized approach is recommended for every patient, considering age, comorbidity, and the underlying anatomical and functional disorders.
Collapse
Affiliation(s)
- Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| |
Collapse
|
6
|
Perineal Rectosigmoidectomy Revisited. Int Surg 2020. [DOI: 10.9738/intsurg-d-16-00095.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
The aim of this study was to evaluate the long-term results of perineal rectosigmoidectomy.
Background
Multiple surgical options are available for rectal prolapse perineal rectosigmoidectomy (Altemeier procedure) is the procedure of choice in elderly patients and those with multiple comorbidities.
Methods
Retrospective review was performed of all patients undergoing perineal rectosigmoidectomy from 1998 to 2008.
Results
Of 128 patients, 125 (98%) were women; with mean age 74 years. Mean operating time was 76 minutes. Hemostasis was achieved using ultrasonic scalpel or clamp and tie technique in equal numbers. Ultrasonic scalpel use resulted in shorter operative times (57.9 versus 94.7 minutes, respectively, P < 0.0001,) and estimated blood loss (18.8 versus 73 mL, respectively, P < 0.0001) compared to clamp-tie technique. Recurrence was seen in 23 (18%) patients. Recurrence was more after a handsewn anastomosis compared to a stapled anastomosis. Complications occurred in 3 patients (2%: 1 experienced major bleeding, 1 experienced perineal abscess, and 1 experienced postoperative ileus).
Conclusions
Perineal rectosigmoidectomy is associated with low morbidity and mortality. In addition, the minimal discomfort to patient, short length of stay and improvement in quality of life makes this a suitable operation for the elderly.
Collapse
|
7
|
Alwahid M, Knight SR, Wadhawan H, Campbell KL, Ziyaie D, Koch SMP. Perineal rectosigmoidectomy for rectal prolapse-the preferred procedure for the unfit elderly patient? 10 years experience from a UK tertiary centre. Tech Coloproctol 2019; 23:1065-1072. [PMID: 31720908 PMCID: PMC6872601 DOI: 10.1007/s10151-019-02100-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Rectal prolapse is a disease presentation with a prevalence of about 1%, mainly affecting older women. It usually presents with symptoms of rectal mass, rectal bleeding, fecal incontinence or constipation, with patients frequently feeling socially isolated as a result. Perineal rectosigmoidectomy is associated with lesser morbidity and mortality than the abdominal procedure, but with a much higher recurrence rate. Therefore, this technique is mainly suitable for the frail elderly patient. Specific outcomes in an elderly population have been described in only a few studies. We evaluated the morbidity, mortality, recurrence rate and functional results after this procedure related to age. METHODS All patients who underwent a perineal rectosigmoidectomy over a 10-year period in two tertiary referral centers were included in the study. American Society of Anesthesiology (ASA) grade, pre- and postoperative symptoms, pathology-reported post-fixation specimen length, length of in-patient stay, 30-day morbidity/mortality, and recurrence were measured. RESULTS A total of 45 patients underwent a perineal rectosigmoidectomy. Forty-three (95%) were female, with a median age of 82.0 years (IQR 70.5-86.5), ASA grade III and median follow-up of 20 months (range 8.5-45.5 months). Half of the cohort was over 80 years old. Significant symptomatic relief was achieved, predominantly the resolution of rectal mass (8.9% vs. 60.0% preoperatively), fecal incontinence (15.6% vs. 46.7%) and constipation (4.4% vs. 26.7%). The median length of stay was 6 days, while morbidity occurred in 14 patients (31.1%) and recurrence occurred in 6 patients (13%). There were no deaths within 30 days of the procedure and outcomes were comparable in the < 80 and ≥ 80 age group. CONCLUSIONS Perineal rectosigmoidectomy is safe for older patients with greater comorbidities resulting in good functional results and is associated with low morbidity and mortality.
Collapse
Affiliation(s)
- M Alwahid
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - S R Knight
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - H Wadhawan
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - K L Campbell
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - D Ziyaie
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - S M P Koch
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| |
Collapse
|
8
|
García-Muñoz P, Ramallo-Solís I, Jiménez-Rodríguez R, Reyes-Díaz ML, de la Portilla F. Perineal rectosigmoidectomy (Altemeier's procedure) for the treatment of full-thickness rectal prolapse - a video vignette. Colorectal Dis 2019; 21:1091-1092. [PMID: 31095871 DOI: 10.1111/codi.14711] [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: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Affiliation(s)
- P García-Muñoz
- Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - I Ramallo-Solís
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - R Jiménez-Rodríguez
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - M L Reyes-Díaz
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - F de la Portilla
- Colorectal Unit, Department of Surgery, University Hospital Virgen del Rocío, Seville, Spain
| |
Collapse
|
9
|
Acar N, Ballı G, Khabbazazar D, Cengiz F, Acar T, Dilek ON. Emergency perineal rectosigmoidectomy (Altemeier procedure) for strangulated rectal prolapse - a video vignette. Colorectal Dis 2019; 21:608-609. [PMID: 30887628 DOI: 10.1111/codi.14612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/05/2019] [Indexed: 01/10/2023]
Affiliation(s)
- N Acar
- Department of General Surgery, Basın Sitesi, İzmir Katip Çelebi UniversityAtatürk Training and Research Hospital, İzmir, Turkey
| | - G Ballı
- Department of General Surgery, Basın Sitesi, İzmir Katip Çelebi UniversityAtatürk Training and Research Hospital, İzmir, Turkey
| | - D Khabbazazar
- Department of General Surgery, Basın Sitesi, İzmir Katip Çelebi UniversityAtatürk Training and Research Hospital, İzmir, Turkey
| | - F Cengiz
- Department of General Surgery, Basın Sitesi, İzmir Katip Çelebi UniversityAtatürk Training and Research Hospital, İzmir, Turkey
| | - T Acar
- Department of General Surgery, Basın Sitesi, İzmir Katip Çelebi UniversityAtatürk Training and Research Hospital, İzmir, Turkey
| | - O N Dilek
- Department of General Surgery, Basın Sitesi, İzmir Katip Çelebi UniversityAtatürk Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
10
|
Trompetto M, Tutino R, Realis Luc A, Novelli E, Gallo G, Clerico G. Altemeier's procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients. BMC Surg 2019; 19:1. [PMID: 30606166 PMCID: PMC6318906 DOI: 10.1186/s12893-018-0463-7] [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] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier’s rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. Methods Peri-operative data on 43 consecutive female patients were reviewed. At follow-up any change in pelvic floor function and recurrences were determined. Thirty four patients were assessed at a median interval of 49 (2–135) months, six being deceased for reason not related to the prolapse and three lost to follow-up. Results Post-operative complications at 30 days occurred in 18 patients (38%). Major complication occurred in only one patient that was pneumonia with lung failure. Major complications were not related to the ASA score, BMI or age [average age 76.4]. There was no post-operative mortality at 30 days. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48 months of 40%. There were no statistically significant differences between patients with and without recurrence regarding age (p = 0.188), BMI (p = 0.864), ASA score (p = 0.433), previously repaired prolapse (p = 0.398), previous hysterectomy (p = 0.705), length of resected bowel (p = 0.126), and levatorplasty (p = 0.304). Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p = 0.012). Conclusions Altemeier’s procedure had in our series low complications rate and no mortality. It offered improved evacuation in constipated patients while didn’t improve fecal and urinary continence. Recurrence of prolapse was 40% at four years. Electronic supplementary material The online version of this article (10.1186/s12893-018-0463-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mario Trompetto
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
| | - Roberta Tutino
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy. .,Dept. of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
| | | | - Eugenio Novelli
- Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy
| | - Gaetano Gallo
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy.,Department of General Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Clerico
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
| |
Collapse
|
11
|
Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol 2018; 22:919-931. [PMID: 30554284 DOI: 10.1007/s10151-018-1908-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022]
Abstract
Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and C.
Collapse
Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.,Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Unit of General Surgery, Università della Campania "Luigi Vanvitelli", Naples, Italy.,Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - R Ghiselli
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - A Infantino
- Department of Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - F Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
| |
Collapse
|
12
|
Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol 2018; 22:589-596. [DOI: 10.1007/s10151-018-1830-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
|
13
|
Catanzarite T, Klaristenfeld DD, Tomassi MJ, Zazueta-Damian G, Alperin M. Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse. Dis Colon Rectum 2018; 61:861-867. [PMID: 29528907 PMCID: PMC5992067 DOI: 10.1097/dcr.0000000000001023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pelvic organ prolapse is prevalent among women with rectal prolapse. OBJECTIVE This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair. DESIGN A retrospective cohort. SETTING This study was performed at a single managed-care institution. PATIENTS Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURES Full-thickness rectal prolapse recurrence was compared between 4 groups: abdominal repair without pelvic organ prolapse (AR-POP); abdominal repair with pelvic organ prolapse (AR+POP); perineal repair without pelvic organ prolapse PR-POP; and perineal repair with pelvic organ prolapse (PR+POP). Recurrence-free period and hazard of recurrence were compared using Kaplan-Meier and Cox proportional hazards methods. To identify potential confounding risk factors for rectal prolapse recurrence, the characteristics of subjects with/without recurrence were compared with univariable and multivariable analyses. RESULTS Overall, pelvic organ prolapse was present in 33% of 112 women and was more prevalent among subjects with rectal prolapse recurrence (52.4% vs 28.6%, p = 0.04). Median follow-up was 42.5 months; rectal prolapse recurrence occurred in 18.8% at a median of 9 months. The rate of recurrence and the recurrence-free period differed significantly between groups: AR-POP 3.8%, 95.7 months; AR+POP 13.0%, 86.9 months; PR-POP 34.8%, 42.1 months; PR+POP 57.1%, 23.7 months (p < 0.001). Compared with AR-POP the HR (95% CI) of rectal prolapse recurrence was 3.1 (0.5-18.5) for AR+POP; 14.7 (3.0-72.9) for PR-POP and 31.1 (6.2-154.5) for PR+POP. Compared with AR+POP, PR+POP had a shorter recurrence-free period (p < 0.001) and a higher hazard of recurrence (HR, 10.2; 95% CI, 2.1-49.3). LIMITATIONS The retrospective design was a limitation of this study. CONCLUSIONS Pelvic organ prolapse was associated with a higher rectal prolapse recurrence rate and earlier recurrence in women undergoing perineal, but not abdominal, repairs. Multidisciplinary evaluation can facilitate individualized management of women with rectal prolapse. Abdominal repair should be considered in women with concomitant rectal and pelvic organ prolapse. See Video Abstract at http://links.lww.com/DCR/A513.
Collapse
Affiliation(s)
- Tatiana Catanzarite
- Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, San Diego, California
- Department of Obstetrics and Gynecology, Division of Urogynecology, Kaiser Permanente, San Diego, California
| | | | - Marco J. Tomassi
- Department of General Surgery, Kaiser Permanente, San Diego, California
| | - Gisselle Zazueta-Damian
- Department of Obstetrics and Gynecology, Division of Urogynecology, Kaiser Permanente, San Diego, California
| | - Marianna Alperin
- Department of Reproductive Medicine, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, San Diego, San Diego, California
| |
Collapse
|
14
|
|
15
|
Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD. Perineal resectional procedures for the treatment of complete rectal prolapse: A systematic review of the literature. Int J Surg 2017; 46:146-154. [PMID: 28890414 DOI: 10.1016/j.ijsu.2017.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Several procedures for the treatment of complete rectal prolapse (CRP) exist. These procedures are performed via the abdominal or perineal approach. Perineal procedures for rectal prolapse involve either resection or suspension and fixation of the rectum. The present review aimed to assess the outcomes of the perineal resectional procedures including Altemeier procedure (AP), Delorme procedure (DP), and perineal stapled prolapse resection (PSR) in the treatment of CRP. PATIENTS AND METHODS A systematic search of the current literature for the outcomes of perineal resectional procedures for CRP was conducted. Databases queried included PubMed/MEDLINE, SCOPUS, and Cochrane library. The main outcomes of the review were the rates of recurrence of CRP, improvement in bowel function, and complications. RESULTS Thirty-nine studies involving 2647 (2390 females) patients were included in the review. The mean age of patients was 69.1 years. Recurrence of CRP occurred in 16.6% of patients. The median incidences of recurrence were 11.4% for AP, 14.4% for DP, and 13.9% for PSR. Improvement in fecal incontinence occurred in 61.4% of patients after AP, 69% after DP, and 23.5% after PSR. Complications occurred in 13.2% of patients. The median complication rates after AP, DP and PSR were 11.1%, 8.7%, and 11.7%, respectively. CONCLUSION Perineal resectional procedures were followed by a relatively high incidence of recurrence, yet an acceptably low complication rate. Definitive conclusions on the superiority of any procedure cannot be reached due to the significant heterogeneity of the studies.
Collapse
Affiliation(s)
- Sameh Hany Emile
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Hossam Elfeki
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt; Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Mostafa Shalaby
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt; Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Ahmad Sakr
- Department of General Surgery, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Egypt.
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, United States.
| |
Collapse
|
16
|
Abstract
Full-thickness rectal prolapse is a painful and debilitating condition that often responds well to surgical intervention. The best method of surgical repair is a matter of debate. Historically, perineal approaches have been thought to have inferior outcomes and were therefore reserved for elderly and unfit patients. Despite recent data calling that into question, perineal approaches are still commonly performed and have their role. We present risks and benefits along with a description of perineal approaches for surgical treatment of rectal prolapse.
Collapse
Affiliation(s)
- Louis R Barfield
- Baton Rouge Colon and Rectal Associates, Our Lady of the Lake Physicians Group, Baton Rouge, Louisiana; Department of Surgery, LSUHSC, New Orleans, Louisiana
| |
Collapse
|
17
|
Abstract
BACKGROUND The rates of recurrent prolapse after perineal proctectomy vary widely in the literature, with incidences ranging between 0% and 50%. The Thiersch procedure, first described in 1891 for the treatment of rectal prolapse, involves encircling the anus with a foreign material with the goal of confining the prolapsing rectum above the anus. The Bio-Thiersch procedure uses biological mesh for anal encirclement and can be used as an adjunct to perineal proctectomy for rectal prolapse to reduce recurrence. OBJECTIVE The aim of this study was to evaluate the Bio-Thiersch procedure as an adjunct to perineal proctectomy and its impact on recurrence compared with perineal proctectomy alone. DESIGN A retrospective review of consecutive patients undergoing perineal proctectomy with and without Bio-Thiersch was performed. SETTINGS Procedures took place in the Division of Colon and Rectal Surgery at a tertiary academic teaching hospital. PATIENTS Patients who had undergone perineal proctectomy and those who received perineal proctectomy with Bio-Thiersch were evaluated and compared. INTERVENTIONS All of the patients with rectal prolapse received perineal proctectomy with levatorplasty, and a proportion of those patients had a Bio-Thiersch placed as an adjunct. MAIN OUTCOME MEASURES The incidence of recurrent rectal prolapse after perineal proctectomy alone or perineal proctectomy with Bio-Thiersch was documented. RESULTS Sixty-two patients underwent perineal proctectomy (8 had a previous prolapse procedure), and 25 patients underwent perineal proctectomy with Bio-Thiersch (12 had a previous prolapse procedure). Patients who received perineal proctectomy with Bio-Thiersch had a lower rate of recurrent rectal prolapse (p < 0.05) despite a higher proportion of them having had a previous prolapse procedure (p < 0.01). Perineal proctectomy with Bio-Thiersch had a lower recurrence over time versus perineal proctectomy alone (p < 0.05). LIMITATIONS This study was limited by nature of being a retrospective review. CONCLUSIONS Bio-Thiersch as an adjunct to perineal proctectomy may reduce the risk for recurrent rectal prolapse and can be particularly effective in patients with a history of previous failed prolapse procedures.
Collapse
|
18
|
Abstract
Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexistence of vaginal prolapse, severe constipation, surgical fitness, and whether the patient has had a previous prolapse procedure. Consideration of a multidisciplinary approach is critical in patients with concomitant vaginal prolapse. Surgeons must weigh their familiarity with each approach and should have in their armamentarium both perineal and abdominal approaches. Previous barriers to abdominal procedures, such as age and comorbidities, are waning as minimally invasive approaches have gained acceptance. Laparoscopic ventral rectopexy is one such approach offering relatively low morbidity, low recurrence rates, and good functional improvement. However, proficiency with this procedure may require advanced training. Robotic rectopexy is another burgeoning approach which facilitates suturing in the pelvis. Successful rectal prolapse surgeries improve function and have low recurrence rates, though it is important to note that correcting the prolapse does not assure functional improvement.
Collapse
Affiliation(s)
- Jennifer Hrabe
- Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brooke Gurland
- Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
19
|
Hummel B, Hardt J, Bischofberger S, Hetzer F, Warschkow R, Zadnikar M, Brunner W, Widmann B, Schmied B, Marti L. New kid on the block: perineal stapled prolapse resection (PSP) is it worthwhile in the long-term? Langenbecks Arch Surg 2016; 401:519-29. [DOI: 10.1007/s00423-016-1431-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
|
20
|
|
21
|
Eftaiha S, Nordenstam J. Ventral rectopexy for rectal procidentia. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2015.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
22
|
Delorme's Procedure for Complete Rectal Prolapse: A Study of Recurrence Patterns in the Long Term. Surg Res Pract 2016; 2015:920154. [PMID: 26783557 PMCID: PMC4689976 DOI: 10.1155/2015/920154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction. The objective of this study was to determine the recurrence rate and associated risk factors of full-thickness rectal prolapse in the long term after Delorme's procedure. Patients and Methods. The study involved adult patients with rectal prolapse treated with Delorme's surgery between 2000 and 2012 and followed up prospectively in an outpatient unit. We assessed epidemiological data, Wexner constipation and incontinence score, recurrence patterns, and risk factors. Data were analyzed by univariate and multivariate studies and follow-up was performed according to Kaplan-Meier technique. The primary outcome was recurrence. Results. A total of 42 patients, where 71.4% (n = 30) were women, with a median age of 76 years (IQR 66 to 86), underwent Delorme's surgery. The median follow-up was 85 months (IQR 28 to 132). There was no mortality, and morbidity was 9.5%. Recurrence occurred in five patients (12%) within 14 months after surgery. Actuarial recurrence at five years was 9.9%. According to the univariate analysis, constipation and concomitant pelvic floor repair were the only factors found to be associated with recurrence. Multivariate analysis showed no statistically significant differences among variables studied. Kaplan-Meier estimate revealed that constipation was associated with a higher risk of recurrence (log-rank test, p = 0.006). Conclusions. Delorme's procedure is a safe technique with an actuarial recurrence at five years of 9.9%. The outcomes obtained in this study support the performance of concomitant postanal repair and levatorplasty to reduce recurrences. Also, severe constipation is associated with a higher recurrence rate.
Collapse
|
23
|
Explaining the undulating outcomes of perineal rectosigmoidectomy (Altemeier Procedure) for rectal prolapse over the last century: technique matters! Tech Coloproctol 2014; 18:979-80. [DOI: 10.1007/s10151-014-1179-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
|
24
|
Ram E, Krissi H, Zbar A, Atar E, Joubran S, Rath-Wolfson L. Perineal stapled prolapse resection (PSPR) in elderly patients for external rectal prolapse: early experience. Tech Coloproctol 2014; 18:1003-7. [DOI: 10.1007/s10151-014-1137-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/24/2014] [Indexed: 12/01/2022]
|
25
|
Abstract
Sphincteroplasty (SP) is the operation most frequently performed in patients suffering from moderate-to-severe anal incontinence (AI) who do not respond to conservative treatment. Other costly surgeries, such as artificial bowel sphincter (ABS) and electro-stimulated graciloplasty, have been more or less abandoned due to their high morbidity rate. Minimally invasive procedures are widely used, such as sacral neuromodulation and injection of bulking agents, but both are costly and the latter may cure only mild incontinence. The early outcome of SP is usually good if the sphincters are not markedly denervated, but its effect diminishes over time. SP is more often performed for post-traumatic than for idiopathic AI. It may also be associated to the Altemeier procedure, aimed at reducing the recurrence rate of rectal prolapse, and may be useful when AI is due either to injury to the sphincter, or to a narrowed rectum following the procedure for prolapse and haemorrhoids (PPH) and stapled transanal rectal resection (STARR). The outcome of SP is likely to be improved with biological meshes and post-operative pelvic floor rehabilitation. SP is more effective in males than in multiparous women, whose sphincters are often denervated, and its post-operative morbidity is low. In conclusion, SP, being both low-cost and safe, remains a good option in the treatment of selected patients with AI.
Collapse
|
26
|
Dauser B, Ghaffari S, Salehi B, Loncsar G, Herbst F. Altemeier’s procedure for complete rectal prolapse in elderly and frail patients: should we be afraid of? Eur Surg 2013. [DOI: 10.1007/s10353-013-0236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Perineal stapled prolapse resection for external rectal prolapse: is it worthwhile in the long-term? Tech Coloproctol 2013; 17:537-40. [DOI: 10.1007/s10151-013-1009-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
|
28
|
Masumori K, Maeda K, Hanai T, Sato H, Koide Y, Matsuoka H, Katsuno H, Shiota M. Short-term outcomes of local correction of stoma prolapse with a stapler device. Tech Coloproctol 2013; 17:437-40. [DOI: 10.1007/s10151-012-0959-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 11/27/2012] [Indexed: 11/24/2022]
|
29
|
Abstract
Pelvic floor disorders that affect stool evacuation include structural (for example, rectocele) and functional disorders (for example, dyssynergic defecation (DD)). Meticulous history, digital rectal examination (DRE), and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion, and imaging studies such as anal ultrasound, defecography, and static and dynamic magnetic resonance imaging (MRI) can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and finally surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating DD. Because DD may coexist with conditions such as solitary rectal ulcer syndrome (SRUS) and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic, and transabdominal approach, stapled transanal rectal resection, and robotic colon and rectal resections. However, there is lack of well-controlled randomized studies and the efficacy of these surgical procedures remains to be established.
Collapse
|
30
|
Ris F, Colin JF, Chilcott M, Remue C, Jamart J, Kartheuser A. Altemeier's procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Colorectal Dis 2012; 14:1106-11. [PMID: 22150996 DOI: 10.1111/j.1463-1318.2011.02904.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Altemeier's procedure (perineal rectosigmoidectomy) is the operation of choice for rectal prolapse in the elderly. The aims of this prospective observational study were to evaluate its long-term actuarial recurrence risk and the influence of the length of rectosigmoid resection and associated levatorplasty on recurrence rate and continence. METHOD The perioperative and long-term data for all patients undergoing Altemeier's procedure since 1992 were analysed with regard to mortality, morbidity, continence, anorectal function and recurrence rate. RESULTS Sixty patients [median age 77 years (35-98)] underwent rectosigmoid resection [median length of bowel 14 (6-60) cm] with associated levatorplasty in 21 (35%). Overall mortality and morbidity were 1.6 and 11.6%, respectively. Manometry showed increased anal sphincter basal pressure and maximal squeeze pressure. We observed a decrease in postoperative rectal compliance (P=0.002). Age, gender, prolapse duration before surgery, levatorplasty and length of resection had no statistically significant relationship with recurrence. Continence improved in 62% and was stable over a median follow-up of 48 (1-186) months. Continence was positively related to a short length of bowel resection, but not to decreased rectal compliance. Actuarial recurrence was 14% at 4 years. CONCLUSION The long-term recurrence rate after the Altemeier procedure was low and not linked to resection length or to levatorplasty. Improvement in continence was stable over time.
Collapse
Affiliation(s)
- F Ris
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | | | | |
Collapse
|
31
|
Boccasanta P, Venturi M, Spennacchio M, Fratus G, Despini L, Roviaro G. Trans-obturator colonic suspension during Altemeier's operation for full-thickness rectal prolapse: preliminary results with a new technique. Colorectal Dis 2012; 14:616-22. [PMID: 21801294 DOI: 10.1111/j.1463-1318.2011.02734.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM With the aim of reducing recurrence after perineal surgery for full-thickness rectal prolapse, a new operation consisting of a trans-obturator colonic suspension during Altemeier's operation has been developed. METHOD Eighteen women with full-thickness rectal prolapse were examined clinically, with validated quality of life and continence scores, colonoscopy, anorectal manometry, anal EMG and sacral reflex latency. Ten had a newly diagnosed and eight a recurrent prolapse. The Altemeier operation was combined with a levatorplasty in all cases using two porcine collagen prostheses sutured to the descending colon and passed through the trans-obturator space bilaterally. The operation was completed by a manual or stapled colo-anal anastomosis. Clinical examination, with quality of life and continence scores, anorectal manometry, EMG and sacral reflex latency, was scheduled during follow up, with the recurrence of prolapse as the primary outcome measure. RESULTS There were no recurrences at 30 months. There was no mortality and no complications. All patients experienced significant improvement in quality of life and faecal continence scores (P<0.01). Surgery did not affect anorectal pressures or sacral reflex latencies. CONCLUSION The new technique appears to be relatively easy to perform and is complication free with no recurrence after a short period of follow up. A larger study with appropriate controls and longer follow up is now needed to assess its real effectiveness in reducing the risk of recurrence.
Collapse
Affiliation(s)
- P Boccasanta
- 1st Department of General Surgery, Fondazione I.R.C.C.S Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza, 35 20122 Milan, Italy.
| | | | | | | | | | | |
Collapse
|
32
|
Pescatori M. External Rectal Prolapse. PREVENTION AND TREATMENT OF COMPLICATIONS IN PROCTOLOGICAL SURGERY 2012:183-196. [DOI: 10.1007/978-88-470-2077-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
33
|
Abstract
Transperineal rectosigmoidectomy is a relatively safe operation for the treatment of rectal prolapse; however, it carries a high rate of recurrence. The use of biologic mesh to buttress the repair and support the pelvic floor muscles may decrease the rate of recurrence. The technique for performing an Altemeier procedure with biologic mesh is described.
Collapse
|
34
|
|
35
|
Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I. Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis 2011; 13:561-6. [PMID: 20184638 DOI: 10.1111/j.1463-1318.2010.02242.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Perineal approaches are considered to be the 'gold standard' in treating elderly patients with external rectal prolapse (ERP) because morbidity and mortality with perineal approaches are lower compared with transabdominal approaches. Higher recurrence rates and poorer function are tolerated as a compromise. The aim of the present study was to assess the safety of laparoscopic ventral rectopexy (LVR) in elderly patients, compared with perineal approaches. METHOD The prospectively collected databases from two tertiary referral pelvic floor units were interrogated to identify outcome in patients of 80 years of age and older with full-thickness ERP treated by LVR. The primary end-points were age, American Society of Anesthesiology (ASA) grade, mortality, and major and minor morbidity. Secondary end-points were length of stay (LOS) and recurrence. RESULTS Between January 2002 and December 2008, 80 [median age 84 (80-97) years] patients underwent rectopexy. The mean ± standard deviation ASA grade was 2.44 (± 0.57) (two patients were ASA grade I, 42 patients were ASA grade II, 35 patients were ASA grade III and one patient was ASA grade IV). The median LOS was 3 (range 1-37) days. There was no mortality, and 10 (13%) patients had complications (one major and nine minor). At a median follow-up of 23 (2-82) months, two (3%) patients had developed a recurrent full-thickness prolapse. CONCLUSION LVR is a safe procedure for using to treat full-thickness ERP in elderly patients. Mortality, morbidity and hospital stay are comparable with published rates for perineal procedures, with a 10-fold lower recurrence.
Collapse
Affiliation(s)
- N Wijffels
- Pelvic Floor Centre, Churchill Hospital, Oxford, UK
| | | | | | | | | |
Collapse
|
36
|
Pescatori M. Prolasso esterno del retto. PREVENZIONE E TRATTAMENTO DELLE COMPLICANZE IN CHIRURGIA PROCTOLOGICA 2011:185-199. [DOI: 10.1007/978-88-470-2062-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
37
|
Abstract
PURPOSE Perineal rectosigmoidectomy was the most popular operation performed for rectal prolapse in the first half of the 20th century. However, high recurrence rates relegated it to a back-up role for elderly or other high-risk patients who were not candidates for an abdominal operation. Recent series (combined with levatorplasty = Altemeier procedure) revealed excellent results across a broader spectrum of patients and inspired this ongoing consecutive series of cases. METHODS This is a review of 103 (99 women) consecutive patients (mean age, 68.9 y; range, 20-97 y) who underwent the Altemeier procedure between 2000 and 2009. Patients were placed in the prone jackknife position: 93 patients (90%) with the use of general anesthesia and 10 patients (10%) with the use of spinal anesthesia. The mean follow-up was 43 months (range, 3 mo to 10 y). RESULTS The mean time for the operation was 97.7 minutes (range, 50-180 min) with a mean 7.2 cm of rectum resected (range, 2.5-26.7 cm). The mean blood loss was 66.9 mL (range, 0-350 mL). The mean time to tolerating a diet was 2.3 days (100% within 4 d) and mean postoperative length of hospital stay was 4.2 days (93% within 6 d). There was no mortality, minimal morbidity (14%), and no recurrence. Preoperative constipation (61% of patients) improved in 94% and preoperative fecal incontinence (47% of patients) improved in 85%, whereas 15% developed new onset of seepage or incontinence to flatus. CONCLUSIONS The Altemeier procedure for rectal prolapse provided excellent results across all age groups with minimal morbidity, allowing for short hospital stays and periods of convalescence. To this point, there has been no evidence of recurrence in this group of patients, pending longer periods of follow-up, especially among patients from the younger age groups.
Collapse
|
38
|
Abstract
Despite the innovation of more than 100 surgical procedures for the treatment of complete rectal prolapse, no one procedure is best and applicable to all patients. Traditionally, procedures have been divided into abdominal and perineal approaches. The application of the laparoscopic approach to colon and rectal disease has allowed an additional less invasive method of therapy to treat rectal prolapse successfully. In comparison with conventional approaches, laparoscopy has achieved similar functional results and recurrence rates while reducing postoperative pain and hospital length of stay.
Collapse
Affiliation(s)
- David P O'Brien
- Division of Colon and Rectal Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA.
| |
Collapse
|
39
|
|
40
|
Affiliation(s)
- James S Wu
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Mayfield Heights, Ohio, USA
| |
Collapse
|
41
|
Pescatori M, Zbar AP. Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period*. Colorectal Dis 2009; 11:410-9. [PMID: 18637923 DOI: 10.1111/j.1463-1318.2008.01626.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Many procedures are used to treat internal (IRP) and external rectal prolapse (ERP). We report the outcome of surgery tailored in accordance with an evolving Unit algorithm over a 21-year period. METHOD Two hundred and sixty-eight patients (151 IRP and 117 ERP) are reported. Perineal procedures (Delorme's mucosectomy, Altemeier's perineal rectosigmoidectomy) were used in frail elderly patients with ERP with abdominal sacrorectopexy or the Frykman-Goldberg procedure in fit patients. In IRP, prolapsectomy was most common with anterior hemi-Delorme's procedures for rectocele and levatorplasty for coincident faecal incontinence. Clinical and functional outcome was assessed over a median of 61 months (range 4-184 months). RESULTS Postoperative mortality was 0.4%. For ERP, a perineal procedure was carried out in 75 (61.4%) cases with a 7.2% complication rate, postoperative incontinence in 20 (26.7%), constipation in four (5.3%) and recurrence in 12 (16%). For 42 abdominal procedures, the complication rate was 5% with incontinence in 7.1%, constipation in eight (19%) and recurrence in five (11.9%). A perineal operation was used in 89.4% of patients with IRP with incontinence in 10.6%, persistent constipation in 48 (52.7%) and recurrence in 25 (27.5%). The overall incontinence rate was 11% following abdominal and 24% following perineal procedures (P < 0.05). Recurrence of ERP was significantly higher following a perineal operation (P < 0.05). CONCLUSION Tailored surgery for ERP achieves satisfactory results in terms of recurrence and functional outcome. For patients with IRP, perineal procedures are associated with a high incidence of recurrence and residual evacuatory difficulty.
Collapse
Affiliation(s)
- M Pescatori
- Coloproctology Unit, Ars Medica and Villa Flaminia Hospital, Rome, Italy.
| | | |
Collapse
|
42
|
Abstract
INTRODUCTION Altemeier's procedure is infrequently applied in European countries and because of the small number of patients treated in each center, its long-term reliability is uncertain. METHODS Medical records of 93 patients (median age, 77 years) undergoing perineal rectosigmoidectomy associated with levatorplasty in 72 patients (78 percent) were reviewed; 65 patients (70 percent) suffered from major fecal incontinence. RESULTS There was no postoperative mortality. Eight (8.6 percent) major complications were observed (3 pelvic hematomas, 1 anastomotic dehiscence, 1 sigmoid perforation, 1 pararectal abscess, and 2 late anal strictures), and 13 (14 percent) minor complications. At a mean follow-up of 41 (range, 12-112) months the complete recurrence rate was 18 percent (17 patients); these patients were treated with a repeat Altemeier's procedure (6 patients), Delorme's operation (1 patient), Wells' rectopexy (1 patient), postanal repair (1 patient), anal bulking agents (2 patients), and sacral nerve stimulation (2 patients). Anal manometry significantly improved postoperatively. Incontinence improved postoperatively in 30 cases (28 percent), deteriorated in 2 patients, while 4 patients developed minor incontinence. CONCLUSIONS Perineal rectosigmoidectomy for rectal prolapse is a relatively safe and effective treatment, in particular, for frail, older patients, with a low postoperative morbidity, but the recurrence rate is not negligible and restoration of continence is unpredictable.
Collapse
|
43
|
Hoel AT, Skarstein A, Ovrebo KK. Prolapse of the rectum, long-term results of surgical treatment. Int J Colorectal Dis 2009; 24:201-7. [PMID: 18791726 DOI: 10.1007/s00384-008-0581-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2008] [Indexed: 02/04/2023]
Abstract
AIMS This study evaluates patency and functional results of abdominal and perineal treatment approaches to prolapse of the rectum. METHODS A database search identified patients operated upon for prolapse of the rectum. The operations were abdominal or perineal approaches. The patient's records were reviewed, patients alive were contacted, and a self-report form evaluated functional results. Patients were followed until the prolapse recurred. RESULTS A primary operation for prolapse of the rectum was performed in 56 patients. Median age was 59 years (range 20-87) and 78 (40-91) for abdominal and perineal approaches, respectively (p < 0.001). The average length of the prolapses was 8.7 cm (2-25) and 8.6 cm (2-15) for abdominal or perineal approaches. All prolapses treated with a Thiersch's operation recurred within a few months and all prolapses treated with the Delorme's operation recurred within 5 years, whereas the 5-year patency of the abdominal approach was 93% (p < 0.001). No prolapses recurred after mesh rectopexy and the 5-year patency of resection rectopexy was 86%. The abdominal approaches improved stool evacuation and constipation significantly, and anal leakage improved somewhat (p = 0.065). The median hospital stay was 11 (4-20) and 7 (2-155) days after abdominal and perineal approaches (p = 0.003). Complications occurred in 20% of patients. CONCLUSIONS The patency of abdominal approach to prolapse of the rectum is better than that of perineal repairs. The abdominal approaches also have a favorable effect on constipation and anal insufficiency. Perineal approaches should be reserved for patients with a very short life expectancy.
Collapse
Affiliation(s)
- Anders T Hoel
- Department of Surgery, Haukeland University Hospital, 5021, Bergen, Norway
| | | | | |
Collapse
|
44
|
Affiliation(s)
- Mark A. Marinella
- From the Department of Internal Medicine, Division of Hematology-Oncology, Wright State University School of Medicine, Dayton, OH
| |
Collapse
|
45
|
Traitement du prolapsus rectal récidivé : principes de prise en charge et application à trois cas cliniques. ACTA ACUST UNITED AC 2008; 32:S235-9. [DOI: 10.1016/j.gcb.2008.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
46
|
Boccasanta P, Venturi M, Barbieri S, Roviaro G. Impact of new technologies on the clinical and functional outcome of Altemeier's procedure: a randomized, controlled trial. Dis Colon Rectum 2006; 49:652-60. [PMID: 16575620 DOI: 10.1007/s10350-006-0505-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE A randomized study was performed to assess whether new technologies offer advantages over the conventional technique on the clinical and functional outcome of patients with full-thickness rectal prolapse and fecal incontinence, submitted to Altemeier's procedure with levatorplasty. METHODS Between January 1999 and December 2003, 58 patients (55 females; mean age, 70.9 +/- 11.3 years) with full-thickness rectal prolapse were evaluated with continence score, colonoscopy, anorectal manometry, anal electromyography, and sacral reflex latency; 40 of them were selected and randomly assigned to two groups: 20 patients (Group 1; 19 females, 73.4 +/- 10.4 years) were submitted to a conventional operation with monopolar electrocautery and handsewn anastomosis, and 20 (Group 2; 18 females, 71.5 +/- 12.2 years) using harmonic scalpel and circular stapler. Patients were followed up with clinical examination, anorectal manometry, and anal electromyography, with mean follow-up 29.3 +/- 8.5 and 27.5 +/- 9.2 months in Groups 1 and 2, respectively. RESULTS Operative time, blood loss, and hospital stay were significantly reduced in Group 2 (P < 0.001), whereas no differences were found in pain score, time to return to normal activity, morbidity, and mortality. Complications were two (10 percent) stenosis in Group 1. Fecal continence score significantly improved in both groups (P < 0.01), whereas anorectal manometry and neurophysiologic data were not significantly modified by the operation. Recurrence rates were 15 and 10 percent in Groups 1 and 2, respectively (P= not significant). CONCLUSIONS The clinical and functional long-term results of perineal rectosigmoidectomy with levatorplasty are not influenced by surgical instruments and type of coloanal anastomosis. The clinical relevance of the short-term results in high-risk patients should be specifically investigated.
Collapse
Affiliation(s)
- Paolo Boccasanta
- Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, IRCCS Foundation, 1st Department of General Surgery, University of Milan, Milan, Italy.
| | | | | | | |
Collapse
|
47
|
Abstract
Rectal prolapse or procidentia is a common condition with detrimental effects on continence and social function. One of the most devastating complications for patients suffering from this disorder is fecal incontinence. The psychologic trauma these patients experience can be debilitating. This article provides an overview of rectal procidentia, including a review of the symptomatic presentation, etiology, classification, diagnosis, and treatment.
Collapse
Affiliation(s)
- Elisa A Stein
- Division of Colon and Rectal Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA 19102-1192, USA
| | | |
Collapse
|