1
|
Kusunoki C, Uemura M, Osaki M, Nagae A, Tokuyama S, Kawai K, Takahashi Y, Miyake M, Miyazaki M, Ikeda M, Kato T. Reduced port laparoscopic rectopexy for full-thickness rectal prolapse. BMC Surg 2024; 24:246. [PMID: 39227841 PMCID: PMC11370075 DOI: 10.1186/s12893-024-02545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Laparoscopic rectopexy is an established treatment option for full-thickness rectal prolapse. Recently, reduced port surgery (RPS) has emerged as a novel concept, offering reduced postoperative pain and improved cosmetic outcomes compared with conventional multiport surgery (MPS). This study aimed to evaluate the feasibility and safety of RPS for full-thickness rectal prolapse. METHODS From October 2012 to December 2018, 37 patients (MPS: 10 cases, RPS: 27 cases) underwent laparoscopic rectopexy for full-thickness rectal prolapse. Laparoscopic posterior mesh rectopexy (Wells procedure) is the standard technique for full-thickness rectal prolapse at our hospital. RPS was performed using a multi-channel access device, with an additional 12-mm right-hand port. Short-term outcomes were retrospectively compared between MPS and RPS. RESULTS No significant differences were observed between MPS and RPS in the median operative time, the median blood loss volume, the postoperative complication rates, and median hospital stay duration after surgery. CONCLUSION Reduced port laparoscopic posterior mesh rectopexy may serve as an effective therapeutic option for full-thickness rectal prolapse. However, to establish the superiority of RPS over MPS, a prospective, randomized, controlled trial is warranted.
Collapse
Affiliation(s)
- Chikako Kusunoki
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan
| | - Mamoru Uemura
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan.
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan.
| | - Mao Osaki
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan
| | - Ayumi Nagae
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita City, Osaka, 565-0871, Japan
| | - Shinji Tokuyama
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Kenji Kawai
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Yusuke Takahashi
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Masakazu Miyake
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Department of Surgery, Rinku General Medical Center, 2-23 Rinku Ourai Kita, Izumisanoshi, Osaka, 598-8577, Japan
| | - Michihiko Miyazaki
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| | - Masataka Ikeda
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
- Division of Lower Gastrointestinal Surgery, Hyogo College of Medicine, 1-1 Mukogawacho Nishinomiya, Hyogo, 663-8501, Japan
| | - Takeshi Kato
- Department of Surgery, NHO Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku, Osaka City, Osaka, 540-0006, Japan
| |
Collapse
|
2
|
Toffaha A, Al-Dhaheri M, Ahmed A, Abunada M, Parvaiz A, Kurer M. Altemeier's procedure after laparoscopic rectopexy in refractory Crohn's proctitis-A video vignette. Colorectal Dis 2024; 26:1634-1635. [PMID: 38812079 DOI: 10.1111/codi.17043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Ali Toffaha
- Colorectal Surgery Unit, General Surgery Department, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Mahmood Al-Dhaheri
- Colorectal Surgery Unit, General Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | - Ayman Ahmed
- Colorectal Surgery Unit, General Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abunada
- Colorectal Surgery Unit, General Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | - Amjad Parvaiz
- Colorectal Surgery Unit, General Surgery Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health Sciences, University of Portsmouth, Portsmouth, UK
- Department of Colorectal Surgery, Poole Hospital NHS Trust, Poole, UK
| | - Mohamed Kurer
- Colorectal Surgery Unit, General Surgery Department, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Kumari M, MadhuBabu M, Vaidya H, Mital K, Pandya B. Outcomes of Laparoscopic Suture Rectopexy Versus Laparoscopic Mesh Rectopexy: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e61631. [PMID: 38966481 PMCID: PMC11223666 DOI: 10.7759/cureus.61631] [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] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
The contemporary literature provides conflicting evidence regarding the precedence of laparoscopic mesh rectopexy over laparoscopic suture rectopexy for full-thickness rectal prolapse. This study aimed to compare the clinical outcomes of mesh and suture rectopexy to improve the surgical management of complete rectal prolapse. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to extract studies based on mesh versus suture rectopexy and published from 2001 to 2023. The articles of interest were obtained from PubMed Central, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journal Storage (JSTOR), Web of Science, Embase, Scopus, and the Cochrane Library. The primary outcomes included rectal prolapse recurrence, constipation improvement, and operative time. The secondary endpoints included the Cleveland Clinic Constipation Score, Cleveland Clinic Incontinence Score, intraoperative bleeding, hospital stay duration, mortality, overall postoperative complications, and surgical site infection. A statistically significant low recurrence of rectal prolapse (odds ratio: 0.41, 95% confidence interval (CI) 0.21-0.80; p=0.009) and longer mean operative duration (mean difference: 27.05, 95% CI 18.86-35.24; p<0.00001) were observed in patients with mesh rectopexy versus suture rectopexy. Both study groups, however, had no significant differences in constipation improvement and all secondary endpoints (all p>0.05). The laparoscopic mesh rectopexy was associated with a low postoperative rectal prolapse recurrence and a longer operative duration compared to laparoscopic suture rectopexy. Prospective randomized controlled trials should further evaluate mesh and suture rectopexy approaches for postoperative outcomes to inform the surgical management of complete rectal prolapse.
Collapse
Affiliation(s)
- Meena Kumari
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Harsh Vaidya
- Department of Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | - Kushal Mital
- Department of Coloproctology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND
| | - Bharati Pandya
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, IND
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Tutino R, Pata F. Editorial: Pelvic floor disorders: a multidisciplinary issue. Front Surg 2024; 11:1400636. [PMID: 38586240 PMCID: PMC10995366 DOI: 10.3389/fsurg.2024.1400636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Roberta Tutino
- Department of General and Emergency Surgery, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| |
Collapse
|
7
|
Williams B, Gupta A, Koller SD, Starr TJ, Star MJH, Shaw DD, Hakim AH, Leinicke J, Visenio M, Perrone KH, Torgerson ZH, Person AD, Ternent CA, Chen KA, Kapadia MR, Keller DS, Elnagar J, Okonkwo A, Gagliano RA, Clark CE, Arcomano N, Abcarian AM, Beaty JS. Emergency Colon and Rectal Surgery, What Every Surgeon Needs to Know. Curr Probl Surg 2024; 61:101427. [PMID: 38161059 DOI: 10.1016/j.cpsurg.2023.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Brian Williams
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Abhinav Gupta
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Sarah D Koller
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Tanya Jt Starr
- Health Corporation of America, Midwest Division, Kansas City, KS
| | | | - Darcy D Shaw
- Health Corporation of America, Midwest Division, Kansas City, KS
| | - Ali H Hakim
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Jennifer Leinicke
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Michael Visenio
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Kenneth H Perrone
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | | | - Austin D Person
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Charles A Ternent
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Kevin A Chen
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Muneera R Kapadia
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Deborah S Keller
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA; Marks Colorectal Surgical Associates, Wynnewood, PA
| | - Jaafar Elnagar
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA
| | | | | | | | - Nicolas Arcomano
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Ariane M Abcarian
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL; Cook County Health, Chicago, IL
| | | |
Collapse
|
8
|
Zigiotto D, Sturiale A, Naldini G. Robotic Rectosigmoidopexy for Recurrent External Prolapse After Altemeier Procedure. Dis Colon Rectum 2023; 66:e1264. [PMID: 37646675 DOI: 10.1097/dcr.0000000000002932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Daniele Zigiotto
- Department of General Surgery, San Bonifacio Hospital, ULSS 9 Scaligera, Verona, Italy
| | - Alessandro Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Via Paradisa, Pisa, Italy
| | - Gabriele Naldini
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Via Paradisa, Pisa, Italy
| |
Collapse
|
9
|
Oruc M, Erol T. Current diagnostic tools and treatment modalities for rectal prolapse. World J Clin Cases 2023; 11:3680-3693. [PMID: 37383136 PMCID: PMC10294152 DOI: 10.12998/wjcc.v11.i16.3680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
Collapse
Affiliation(s)
- Mustafa Oruc
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Timucin Erol
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
| |
Collapse
|
10
|
Gosavi R, Narasimhan V, Arachchi A, Jaya J, Teoh W, Chouhan H. The Altemeier procedure: A step by step video vignette for trainees. Colorectal Dis 2023; 25:501. [PMID: 36100291 DOI: 10.1111/codi.16335] [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: 01/03/2022] [Revised: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Rathin Gosavi
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Asiri Arachchi
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Joseph Jaya
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - William Teoh
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Hanumant Chouhan
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Fagan G, Bathgate A, Dalzell A, Collinson R, Lin A. Outcomes for men undergoing rectal prolapse surgery - a systematic review. Colorectal Dis 2023. [PMID: 36847704 DOI: 10.1111/codi.16534] [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: 05/29/2022] [Revised: 01/26/2023] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
AIM Rectal prolapse is considered rare in men but the prevalence can be high in certain populations. It is unclear which surgical approach offers lower recurrence rates and better functional outcomes in men. The aim of this work was to determine the recurrence rates, complications and functional outcomes after prolapse surgery in men. METHOD The MEDLINE, EMBASE and Scopus databases were systematically searched to identify studies on outcomes following surgical management of full-thickness rectal prolapse in men (over 18 years of age) published between 1951 and September 2022. Outcomes of interest included recurrence rate after surgery, bowel function, urinary function, sexual function and postoperative complications. RESULTS Twenty-eight studies involving 1751 men were included. Two papers focused exclusively on men. Twelve studies employed a mixture of abdominal approaches, ten employed perineal approaches and six compared both. The recurrence rate varied across studies, ranging from 0% to 34%. Sexual and urinary function were poorly reported, but the incidence of dysfunction appears low. CONCLUSION The outcomes of rectal prolapse surgery in men are poorly studied with small sample sizes and variable outcomes reported. There is insufficient evidence to recommend a specific repair approach based on the recurrence rate and functional outcomes. Further studies are required to identify the optimal surgical approach for rectal prolapse in men.
Collapse
Affiliation(s)
- Georgina Fagan
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Andrea Bathgate
- Department of Surgery and Anaesthesia, University of Otago Wellington, Wellington Hospital, New Zealand
| | - Alex Dalzell
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Rowan Collinson
- Department of General Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Anthony Lin
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago Wellington, Wellington Hospital, New Zealand
| |
Collapse
|
12
|
Jurić O, Lisica Šikić N, Žufić V, Matak L, Karlo R, Mihanović J. Rectal prolapse as the initial presentation of rectal cancer-A case report. Front Surg 2023; 10:1176726. [PMID: 37114157 PMCID: PMC10126431 DOI: 10.3389/fsurg.2023.1176726] [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: 02/28/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023] Open
Abstract
Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with traces of blood and mucus and had experienced fatigue after hiking. After the initial evaluation, it became clear that prolapse bares a large rectal tumor as a leading point. The prolapse was reduced under general anesthesia, along with a tumor biopsy. Further workup confirmed locally advanced adenocarcinoma of the rectum, which was treated with neoadjuvant chemoradiation followed by curative surgery in another hospital after repatriation. Rectal prolapse affects people of all ages, but it is more common in older adults, particularly women. Treatment options vary depending on the severity of the prolapse and can range from conservative measures to surgical interventions. This case report highlights the importance of early recognition and appropriate management of rectal prolapse in the emergency setting and the possibility of an underlying malignancy.
Collapse
Affiliation(s)
- Oliver Jurić
- Department of Surgery, Zadar General Hospital, Zadar, Croatia
- Department of Health Studies, University of Zadar, Zadar, Croatia
| | - Nataša Lisica Šikić
- Department of Health Studies, University of Zadar, Zadar, Croatia
- Department of Pathology, Forensic Medicine and Cytology, Zadar General Hospital, Zadar, Croatia
| | - Vanja Žufić
- Department of Surgery, Zadar General Hospital, Zadar, Croatia
- Department of Health Studies, University of Zadar, Zadar, Croatia
| | - Luka Matak
- Department of Health Studies, University of Zadar, Zadar, Croatia
- Department of Obstetrics and Gynecology, General Hospital Zadar, Zadar, Croatia
| | - Robert Karlo
- Department of Surgery, Zadar General Hospital, Zadar, Croatia
- Department of Health Studies, University of Zadar, Zadar, Croatia
| | - Jakov Mihanović
- Department of Surgery, Zadar General Hospital, Zadar, Croatia
- Department of Health Studies, University of Zadar, Zadar, Croatia
- Correspondence: Jakov Mihanović
| |
Collapse
|
13
|
A case report of largest rectal prolapse in the literature successfully treated with Altemeier's procedure. Ann Med Surg (Lond) 2022; 80:104231. [PMID: 36045867 PMCID: PMC9422288 DOI: 10.1016/j.amsu.2022.104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background The rectal prolapse is defined as the concentric protrusion of full or partial thickness of the rectum or rectosigmoid via the anus. This is an increasing clinical concern that is usually found in old female patients. Cases presentation A 39-year-old male patient was referred due to an un-reduceable rectal projection from a week ago. The primary endeavor for reduction of the projection under sedation and after local mannitol treatment at the operation room was unsuccessful, so surgical resection and reduction were planned for the patient. Conclusion Management of rectal prolapse has always been one of the challenges of colorectal surgery. For patients with incarcerated prolapse manual reduction under sedation is used. If the reduction is unsuccessful, surgical procedures are used. The rectal prolapse is defined as the concentric protrusion of full or partial thickness of the rectum or rectosigmoid via the anus. Management of rectal prolapse has always been one of the challenges of colorectal surgery. Giant rectal prolapse defined as segment of rectosigmoid larger than 10 cm in length.
Collapse
|
14
|
Yamanaka S, Enomoto T, Moue S, Owada Y, Ohara Y, Oda T. Mesh erosion into the rectum after laparoscopic posterior rectopexy: A case report. Int J Surg Case Rep 2022; 95:107136. [PMID: 35576752 PMCID: PMC9118509 DOI: 10.1016/j.ijscr.2022.107136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Rectal prolapse typically presents in elderly women with protruding full-thickness rectum from the anus. Rectopexy using mesh is known to be a highly curative treatment for rectal prolapse, however, this procedure carries the risk of severe complication as mesh erosion. Presentation of case A 78-year-old woman who had undergone laparoscopic posterior rectopexy 4 years earlier visited the outpatient clinic with a complaint of bloody stool. A colonoscopy and computed tomography revealed that part of the mesh had migrated into the rectal lumen at 8 cm from the anal verge. Based on the above findings, a diagnosis of mesh erosion into the rectum was made. Complete removal of the mesh and tacker with rectal resection was performed. Before rectopexy, the patient had severe fecal incontinence, and her anal sphincter function was decreased, therefore, Permanent colostomy was indicated instead of anastomosis. In the resected specimen, the mesh was folded and placed in the mesenteric fat of the posterior wall of the rectum, with the corner of the edge of the mesh protruding into the inside lumen. Discussion Mesh erosion typically occurs when using mesh made of synthetic mesh and non-absorbable threads; it might induce chronic irritation and friction due to mesh shrinkage. Conclusion To prevent mesh erosion, it is important to pay attention to the mesh materials used and ensure secure fixation. Mesh erosion into rectum after Laparoscopic posterior rectopexy was reported. Complete removal of the mesh and tacker with rectal resection was needed. Colostomy was made because of existence of severe fecal incontinence, preoperatively. Paying attention to the Shrinkage and secure fixation of synthetic mesh.
Collapse
Affiliation(s)
- Shun Yamanaka
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan
| | - Tsuyoshi Enomoto
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Shoko Moue
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Yohei Owada
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Yusuke Ohara
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Tatsuya Oda
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| |
Collapse
|
15
|
Du Y, Zhu J, Li H, Fu Z, He Z. Value of Defecography in the Diagnostic and Therapeutic Management of the Modified Wells Procedure for Rectal Prolapse. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2219330. [PMID: 35480080 PMCID: PMC9013572 DOI: 10.1155/2022/2219330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
The main aim of this study was to explore the role of defecography in the preoperative diagnosis and postoperative evaluation of rectal prolapse surgery (modified Wells procedure). We collected and summarized the X-ray performance and then analyzed the results of 107 patients with defecatory dysfunction who underwent defecography from January 2020 to March 2021. Furthermore, the preoperative and 6-month postoperative defecography results and clinical symptoms of 25 patients who underwent rectal prolapse surgery (modified Wells procedure) were compared. Results showed that among the 107 patients with defecation dysfunction, women had worse defecography results than men (P < 0.01). A total of 25 patients successfully completed the surgery without complications such as infection and intestinal fistula and there was no recurrence at 12 months of follow-up. Compared with the preoperative results, anorectal angle during defecation, the depth of rectocele, and perineal descent were significantly improved after the surgery (P < 0.01). Moreover, the patient's feeling of obstructed defecation and incomplete defecation was significantly relieved compared to that before the procedure (P < 0.01). In conclusion, defecography can be used to diagnose rectal prolapse preoperatively and evaluate the surgical effect combined with clinical symptoms postoperatively, which provides a clinical reference.
Collapse
Affiliation(s)
- Yangbin Du
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jinxin Zhu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hailun Li
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Zhiqiang Fu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Zhenyu He
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| |
Collapse
|
16
|
Pellino G, Fuschillo G, Simillis C, Selvaggi L, Signoriello G, Vinci D, Kontovounisios C, Selvaggi F, Sciaudone G. OUP accepted manuscript. BJS Open 2022; 6:6564775. [PMID: 35390136 PMCID: PMC8989040 DOI: 10.1093/bjsopen/zrac018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background External rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP. Methods This was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle–Ottawa Scale and Cochrane tool. Results Fifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, and several outcomes from RCTs were not consistent with those observed in non-RCTs. Conclusion The overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic.
Collapse
Affiliation(s)
- Gianluca Pellino
- Correspondence to: Gianluca Pellino, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy (e-mail: ; ; @GianlucaPellino)
| | - Giacomo Fuschillo
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Costantinos Simillis
- Cambridge Colorectal Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lucio Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giuseppe Signoriello
- Section of Statistic, Department of Experimental Medicine, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Danilo Vinci
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Christos Kontovounisios
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francesco Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Guido Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| |
Collapse
|
17
|
Alkatrani H, Basrah MM. Perineal Rectosigmoidal Resection for Complete Rectal Prolapse. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Rectal prolapse (RP) (rectal Providencia) is a disorder manifest by full-thickness intussusceptions of the rectal wall that protrudes externally through the anus.
AIM: A retrospective study was done to evaluate the outcome of rectosigmoidal resection for complete rectal prolapse (CRP) in our hospital from 2008 to 2020.
METHODS: This study analyzes the data of post-operative outcomes for 25 patients with CRP treated by perineal rectosigmoidal resection; eight patients were male and 17 were female.
RESULTS: A total of 25 patients enrolled with the median age of 50 years. There was an improvement in the general condition of patients regarding constipation, bleeding per rectum, incontinence, and perineal discomfort. There were no mortality, no major complication, and a low recurrence rate.
CONCLUSION: Altemier’s procedure for CRP improves patients’ general condition regarding constipation and incontinence, no mortality, low complication rate, and negligible rate of recurrence.
Collapse
|
18
|
Mitchell CM, Salyards GW, Theriault BR, Langan GP, Luchins KR. Evaluation of Pain and Distress and Therapeutic Interventions for Rectal Prolapse in Mice to Reduce Early Study Removal. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2021; 60:692-699. [PMID: 34749842 DOI: 10.30802/aalas-jaalas-21-000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rectal prolapse (RP) is a common clinical condition in mice, that does not have a recognized or documented standard of care. At our institution, an average of 240 mice develop RP each year. Our practice has been to recommend euthanasia upon identifying a RP based on its appearance as a painful or distressful condition. This study aimed to assess treatment options that would maintain the RP mucosa and allow mice to reach their study endpoint, and to evaluate the perception of this condition as a painful or distressful event. This study used 120 mice with spontaneous RP, concurrently assigned to ongoing research protocols. Mice were randomly assigned to 1 of 3 treatment groups: petroleum jelly, lidocaine jelly, or no treatment. Fecal samples were collected for pathogen testing, and all mice received an initial base score, followed by weekly blind scores. Upon euthanasia, RP tissue was collected for histopathology. Of the 120 mice identified with RP, 47 mice were breeders; 28% successfully produced 22 additional litters after developing RP. Seventy-three were nonbreeders, with 92% reaching their research study endpoint. No statistically significant differences were detected between the 3 treatment groups based on gross mucosal health, pain and distress, or histopathology. In this study, none of the mice in any group were euthanized based on the RP endpoint scoring criteria. These findings demonstrate that treatment is unnecessary for RP, and mice with RP did not show signs of pain or distress. In adherence to the 3Rs, this study supports animal number reduction and clinical refinement, allowing mice with RPs to reach their intended research study endpoints or produce additional litters.
Collapse
Affiliation(s)
- Cara M Mitchell
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
| | - Gregory W Salyards
- Division of Veterinary Resources Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Betty R Theriault
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
| | - George P Langan
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kerith R Luchins
- Animal Resources Center and Department of Surgery, University of Chicago, Chicago, Illinois
| |
Collapse
|
19
|
Tuncer A, Akbulut S, Ogut Z, Sahin TT. Management of irreducible giant rectal prolapse: A case report and literature review. Int J Surg Case Rep 2021; 88:106485. [PMID: 34678595 PMCID: PMC8536514 DOI: 10.1016/j.ijscr.2021.106485] [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] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Rectal prolapse is defined as herniation of mucosa or full-thickness of the rectal wall through the anal canal. It has a negative impact on the quality of life and therefore, it should be treated as soon as diagnosis is confirmed. Definitive treatment is surgical and it depends on the clinical characteristics of the patients. We aimed to present the one of the largest rectal prolapse case in the literature. CASE PRESENTATION A 32- years- old male patient with a history of severe constipation was admitted to our institution with a giant rectal prolapse. The prolapsed segment was incarcerated, and a semi-emergent procedure was performed though a mid-line laparotomy. The sigmoid colon was redundant and therefore sigmoid colon and the upper two thirds of rectum were resected and end to end anastomosis was performed. The patient was discharged postoperative day 7 without any complication. CLINICAL DISCUSSION Rectal prolapse has a negative impact on quality of life and should be operated as soon as the diagnosis is reached. The surgical strategy depends on the compliance of the patient as well as the experience of the surgical team. CONCLUSION Clinicians should know that chronic constipation together with other factors may result in rectal prolapse which may become disproportionately large in size.
Collapse
Affiliation(s)
- Adem Tuncer
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
| | - Zeki Ogut
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| |
Collapse
|
20
|
Faugeroux V, Ahmed O, Trésallet C. Altemeier procedure for surgical treatment of full thickness external rectal prolapse (with video). J Visc Surg 2021; 158:530-531. [PMID: 34556450 DOI: 10.1016/j.jviscsurg.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- V Faugeroux
- Service de chirurgie digestive, bariatrique et endocrinienne, Université Sorbonne Paris Nord, Groupe hospitalier Avicenne, Assistance Publique des Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93000 Bobigny, France
| | - O Ahmed
- Service de chirurgie digestive, bariatrique et endocrinienne, Université Sorbonne Paris Nord, Groupe hospitalier Avicenne, Assistance Publique des Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93000 Bobigny, France
| | - C Trésallet
- Service de chirurgie digestive, bariatrique et endocrinienne, Université Sorbonne Paris Nord, Groupe hospitalier Avicenne, Assistance Publique des Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93000 Bobigny, France.
| |
Collapse
|
21
|
Albeladi AM, Odeh A, AlAli AH, Alkhars AM, Boumarah K, Al Ghadeer HA, Alsaied SA, Omrani A, Ahmed K. Incarcerated Rectal Procidentia: A Case Report and Review. Cureus 2021; 13:e17135. [PMID: 34532173 PMCID: PMC8435057 DOI: 10.7759/cureus.17135] [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] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Rectal procidentia is an uncommon perineal disease that is rare in males. There is no specific medical role in treatment of rectal procidentia and surgical intervention is the treatment of choice. Various surgical approaches have been performed, but there is no consensus on which procedure is most effective in terms of patient condition, recurrence rate, bowel function, and risk. This case presentation of a healthy male patient with experience of uncomplicated reducible rectal prolapse and a history of chronic constipation. Presented with complicated rectal prolapse in the presence of incarcerated rectal prolapse after a failed trial with conservative maneuvers, he ended up with abdominal approach sigmoidectomy and posterior mesh rectopexy.
Collapse
Affiliation(s)
| | - Ahmad Odeh
- General Surgery, Prince Saud Bin Jalawy Hospital, Al Ahsa, SAU
| | - Aminah H AlAli
- General Surgery, Prince Saud Bin Jalawy Hospital, Al Ahsa, SAU
| | | | - Kawther Boumarah
- Medicine, King Faisal Univesity, College of Medicine, Dammam, SAU
| | | | - Sara A Alsaied
- General and Colorectal Surgery, Prince Saud Bin Jalawy Hospital, Al Mubarraz, SAU
| | - Ammar Omrani
- Laparoscopic Surgery, Prince Saud Bin Jalawy Hospital, Al Mubarraz, SAU
| | - Khadir Ahmed
- General and Colorectal Surgery, Prince Saud Bin Jalawy Hospital, Al Ahsa, SAU
| |
Collapse
|
22
|
An Age-Old Problem: The Surgical Treatment of Complete Rectal Prolapse. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dear Editor, [...]
Collapse
|
23
|
Tamosiunas A, Klimsauskiene V, Dailidenas S, Eismontas V, Janušonis T, Samalavicius NE, Dulskas A. Laparoscopic posterior sutured rectopexy for full-thickness rectal prolapse in a male patient - a video vignette. Colorectal Dis 2021; 23:2206-2207. [PMID: 33993610 DOI: 10.1111/codi.15734] [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: 02/24/2021] [Revised: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Albinas Tamosiunas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
| | | | - Sarunas Dailidenas
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
| | | | - Tomas Janušonis
- Department of Anaesthesiology and Intensive Care, Klaipeda University Hospital, Klaipeda, Lithuania.,Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius, Lithuania
| | - Narimantas E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Institute of Clinical Medicine Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Health Research and Innovation Science Centre, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | - Audrius Dulskas
- Institute of Clinical Medicine Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| |
Collapse
|
24
|
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
|
25
|
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.
Collapse
|
26
|
A step-by-step approach to endorectal proctopexy (ERPP): how we do it. Tech Coloproctol 2021; 25:879-886. [PMID: 34046758 DOI: 10.1007/s10151-021-02467-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
There are many surgical treatments aimed at correcting internal mucosal prolapse and rectocele associated with obstructed defecation syndrome (ODS). Perineal procedures can be considered as first options in young men in whom an abdominal approach poses risks of sexual dysfunction and in selected women with isolated posterior compartment prolapse who failed conservative treatment. About 20 years ago, we described endorectal proctopexy (ERPP) also known as internal Delorme procedure. The aim of the present study was to describe, with attention to technical details and the aid of a video, the different steps of ERPP for the treatment of ODS. A retrospective analysis of our last 100 cases confirms our initial good results. Complications included suture line dehiscence with consequent stricture in four patients (4%). Bleeding occurred in four (4%) patients and was conservatively treated. Transient anal continence impairment consisting of urgency and soiling occurred in 12 (12%) and 6 (6%) patients, respectively. At 6-month follow-up the Cleveland Clinic Constipation Score and ODS score improved from a median preoperative value of 18.9 and 18.5 to 5 and 5, respectively (p < 0.0001). The mean follow-up was 36.05 ± 13.3 (range 12-58) months and anatomical recurrence rate was 6 (%). Due to its excellent safety profile and the ability to tailor the procedure to different disease presentations, we think that ERPP should be part of the basic armamentarium of all colorectal surgeons operating on the pelvic floor.
Collapse
|
27
|
Surgical treatment of total rectal prolapse using Delorme's procedure (with video). J Visc Surg 2021; 158:274-275. [PMID: 33992575 DOI: 10.1016/j.jviscsurg.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Clinical applications of pelvic floor imaging: opinion statement endorsed by the society of abdominal radiology (SAR), American Urological Association (AUA), and American Urogynecologic Society (AUGS). Abdom Radiol (NY) 2021; 46:1451-1464. [PMID: 33772614 DOI: 10.1007/s00261-021-03017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Pelvic floor dysfunction is prevalent, with multifactorial causes and variable clinical presentations. Accurate diagnosis and assessment of the involved structures commonly requires a multidisciplinary approach. Imaging is often complementary to clinical assessment, and the most commonly used modalities for pelvic floor imaging include fluoroscopic defecography, magnetic resonance defecography, and pelvic floor ultrasound. This collaboration opinion paper was developed by representatives from multiple specialties involved in care of patients with pelvic floor dysfunction (radiologists, urogynecologists, urologists, and colorectal surgeons). Here, we discuss the utility of imaging techniques in various clinical scenarios, highlighting the perspectives of referring physicians. The final draft was endorsed by the Society of Abdominal Radiology (SAR), American Urogynecologic Society (AUGS), and the American Urological Association (AUA).
Collapse
|
29
|
Transanal Endoscopic Microsurgery: An Alternative Perineal Approach to Treat Rectal Prolapse: A Video Vignette. Surg Laparosc Endosc Percutan Tech 2021; 31:277-280. [PMID: 33605679 DOI: 10.1097/sle.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Laparoscopic ventral rectopexy is the most favored surgical treatment for rectal prolapse. Perineal approaches are recommended for frail patients and those with major comorbidities, and in young men to avoid genitourinary disorders. There are very few descriptions in the literature of transanal endoscopic surgery to treat complete rectal prolapse. The aim of this article is to describe our experience with this technique. PATIENTS AND METHODS Patients undergoing transanal endoscopic surgery for rectal prolapse repair between 2010 and 2019 were recruited for the study. Preoperative, surgical, and postoperative variables were recorded. Surgical technique, 30-day morbidity and follow-up are described. RESULTS Five patients have been included. The postoperative period was uneventful and all patients were discharged in 48 hours without complications. All showed improved symptoms at 1-year control, and none presented recurrence in a mean follow-up period of 6 years. CONCLUSIONS The transanal endoscopic procedure allows improved endoscopic vision, and the reconstruction is performed transpelvically by fixing the anastomosis suture to the pelvic wall to prevent recurrence. Therefore, we think it is a valid alternative to other perineal procedures in patients in whom abdominal surgery is contraindicated.
Collapse
|
30
|
De Silva HM, Hewagama S, Strugnell N. Enterococcus faecalis infective endocarditis arising from chronic rectal prolapse in the setting of spinal cord injury. BMJ Case Rep 2021; 14:14/2/e240356. [PMID: 33558386 PMCID: PMC7872921 DOI: 10.1136/bcr-2020-240356] [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: 11/04/2022] Open
Abstract
A 45-year-old man had recurrent presentations with pleuritic chest pain and shortness of breath. Four months prior, he had developed cauda equina syndrome from a spinal epidural abscess in the setting of intravenous drug use, complicated by lasting neurological deficits and a rectal prolapse. On his final presentation, blood cultures taken in the absence of antibiotics grew Enterococcus faecalis from multiple sets. A transoesophageal echocardiogram confirmed tricuspid valve endocarditis. He recovered well post-targeted long-term antibiotics. Endoscopy confirmed a chronic rectal prolapse with multiple ulcers and was hypothesised as the source of bacteraemia. He subsequently underwent perineal rectosigmoidectomy. This uncommon sequela of rectal prolapse highlights several issues, including the management of neurogenic bowel dysfunction following spinal cord injury and the importance of early prolapse recognition and management. Finally, appropriate collection of blood cultures and correct use of echocardiography are critical steps in investigating infective endocarditis.
Collapse
Affiliation(s)
| | - Saliya Hewagama
- Department of General Medicine, The Northern Hospital, Epping, Victoria, Australia
| | - Neil Strugnell
- Department of General Surgery, The Northern Hospital, Epping, Victoria, Australia
| |
Collapse
|
31
|
Abstract
Hemorrhoids are one of the most common diseases of the anorectal region. Previously, treatment for hemorrhoids included conservative treatment, outpatient treatment, and surgical treatment. The development of flexible reversible endoscopes has provided precise controllability and imaging, enabling further improvement and development of various endoscopic techniques to treat hemorrhoids. This article discusses several of these endoscopic techniques: rubber band ligation, sclerotherapy, and electrocoagulation. The development, efficacy, and advantages of these treatments are summarized and evaluated. It is expected that going forward, endoscopic technology will be further applied in clinical practice and may become the first-line method for the treatment of hemorrhoids.
Collapse
|
32
|
Allaeys T, Beunis A, Ruppert M, Van den Broeck S, Hubens G, Komen N. Mesh erosion after robotic ventral mesh rectopexy, a minimally invasive solution - a video vignette. Colorectal Dis 2020; 22:2357. [PMID: 32931660 DOI: 10.1111/codi.15359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/08/2023]
Affiliation(s)
- T Allaeys
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - A Beunis
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - M Ruppert
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - S Van den Broeck
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - G Hubens
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| | - N Komen
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
| |
Collapse
|
33
|
Gallo G, Cuccurullo D, Stratta E, Realis Luc A, Clerico G, Trompetto M. Altemeier procedure for complete rectal prolapse - a video vignette. Colorectal Dis 2020; 22:1807-1808. [PMID: 32644282 DOI: 10.1111/codi.15250] [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: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 02/08/2023]
Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - D Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera dei Colli, Napoli, Italy
| | - E Stratta
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.,Department of Surgery, University of Genoa, Genoa, Italy
| | - A Realis Luc
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| |
Collapse
|
34
|
Lee SH. Changing Trend of Rectal Prolapse Surgery in the Era of the Minimally Invasive Surgery. JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:135-136. [PMID: 35601374 PMCID: PMC8980143 DOI: 10.7602/jmis.2019.22.4.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 11/23/2022]
Abstract
With the life span of the general population increased, rectal prolapse in elderly patients became a major concern in terms of the decision of the treatment modalities and quality of life of patients. Most elderly patients with rectal prolapse in the past received a perineal approach with the fear of general anesthetic complications rather than the abdominal approach. However, improvement in perioperative care in anesthesiology and minimally invasive surgery, the trend of surgical management of rectal prolapse is rapidly changing. Minimally invasive surgery including the laparoscopic and robotic surgeries showed comparable short-term outcomes even in elderly patients. Recently published guidelines also recommended a laparoscopic abdominal approach for the management of rectal prolapse.
Collapse
Affiliation(s)
- Suk-Hwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
35
|
Yuda Handaya A, Fauzi AR, Werdana VAP, Andrew J. Anal encirclement using polypropylene mesh for high grade complete full-thickness rectal prolapse: A case report. Int J Surg Case Rep 2019; 66:80-84. [PMID: 31812642 PMCID: PMC6906718 DOI: 10.1016/j.ijscr.2019.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Rectal prolapse is defined as protrusion of the rectal wall outside the anus caused by pelvic floor abnormalities. Operative repair is the only definitive treatment. Until now, there is no ideal surgical technique that can be used for all patients. PRESENTATION OF CASE Here we report two cases of full-thickness rectal prolapse in elderly patients with high-risk comorbidities. A seventy and seventy-eight-year-old female patients presented with complaints of anal lumps. Their past medical history was significant for arrhythmia, hypertensive heart disease, and pneumonia. The patients then underwent surgical repair with mesh cerclage. The patients were hospitalized for three days after surgery. On days 3, 7, 14, and 6 months after surgery the patients did not complain of any recurrence nor complications. DISCUSSION We did a modified anal encirclement surgical repair technique in managing these elderly patients with full-thickness rectal prolapse and high-risk comorbidities using mesh to prevent recurrence. CONCLUSIONS Anal encirclement technique using mesh can be considered as an alternative procedure for the treatment of full-thickness rectal prolapse in elderly patients with high-risk comorbidities because this procedure is simple, safe, causes fewer postoperative complications, and also can prevent recurrence.
Collapse
Affiliation(s)
- Adeodatus Yuda Handaya
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Aditya Rifqi Fauzi
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Victor Agastya Pramudya Werdana
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Joshua Andrew
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| |
Collapse
|
36
|
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
|
37
|
Trappey AF, Galganski L, Saadai P, Stephenson J, Stark R, Farmer DL, Langer JC, Hirose S. Surgical management of pediatric rectal prolapse: A survey of the American Pediatric Surgical Association (APSA). J Pediatr Surg 2019; 54:2149-2154. [PMID: 30987759 DOI: 10.1016/j.jpedsurg.2019.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/19/2019] [Accepted: 02/17/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many management options exist for the treatment of refractory rectal prolapse (RP) in children. Our goal was to characterize current practice patterns among active members of APSA. METHODS A 23-item questionnaire assessed the management of full-thickness RP for healthy children who have failed medical management. The survey was approved by our IRB and by the APSA Outcomes committee. RESULTS 236 surgeons participated. The respondents were geographically dispersed (44 states, 5 provinces). 32% of respondents had twenty or more years of clinical experience. 71% evaluated 1-5 RP patients in the last 2 years, while 5% evaluated >10. 71% performed 0-1 procedure (operation or local therapy [LT]) for RP over 2 years. 59% would treat a 2-year-old patient differently than a 6-year-old with the same presentation, and were more likely to offer up-front surgery to a 6-year-old (26% vs 15%, p = 0.04), less likely to continue medical management indefinitely (2% vs 7%, p=0.01), and more likely to perform resection with rectopexy (30% vs. 15%, p=0.01). 71% perform LT as an initial intervention: injection sclerotherapy (59%), anal encirclement (8%), and sclerotherapy + anal encirclement (5%). 70% consider LT a failure after 1-3 attempts. If LT fails, surgical management consists of transabdominal rectopexy (46%), perineal proctectomy or proctosigmoidectomy (22%), transabdominal sigmoidectomy + rectopexy (22%), and posterior sagittal rectopexy (9%). CONCLUSIONS There is wide variability in the surgical management of pediatric rectal prolapse. This suggests a need for development of processes to identify best practices and optimize outcomes for this condition.
Collapse
Affiliation(s)
- Alfred Francois Trappey
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, David Grant Medical Center, Travis AFB, CA, 2425 Stockton Blvd., Sacramento, CA 25817.
| | - Laura Galganski
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Payam Saadai
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Jacob Stephenson
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, David Grant Medical Center, Travis AFB, CA, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Rebecca Stark
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Diana L Farmer
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Jacob C Langer
- Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| | - Shinjiro Hirose
- University of California at Davis Medical Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd., Sacramento, CA 25817
| |
Collapse
|
38
|
Gallo G, Trompetto M. Complete rectal prolapse: still a lot of work to do. Tech Coloproctol 2019; 23:287-288. [PMID: 30937642 DOI: 10.1007/s10151-019-01961-8] [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: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 12/11/2022]
Affiliation(s)
- G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.,Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
| |
Collapse
|
39
|
Porwal A. TRRPCS: a new promising technique in the treatment of rectal prolapse - a video vignette. Colorectal Dis 2019; 21:493. [PMID: 30702797 DOI: 10.1111/codi.14575] [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: 12/03/2018] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
- A Porwal
- Healing Hands Clinic, Pune, India
| |
Collapse
|