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Attaallah W, Akmercan A, Feratoglu H. The role of rectal redundancy in the pathophysiology of rectal prolapse: a pilot study. Ann Surg Treat Res 2022; 102:289-293. [PMID: 35611091 PMCID: PMC9111960 DOI: 10.4174/astr.2022.102.5.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/04/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Rectal prolapse is hypothesized to be caused due to weakness of the pelvic floor which is related to childbearing. However, half of the female patients with rectal prolapse were reported to be nulliparous and this hypothesis doesn't explain the prolapse in males. The aim of this study is to evaluate the role of rectal redundancy in rectal prolapse pathophysiology. Methods This study was conducted prospectively. Fourteen patients who underwent rectopexy were included in the study group. A total of 17 patients who underwent laparotomy for another reason and who have no symptoms regarding rectal prolapse were included in the control group. In order to measure the redundancy of the rectum, we have calculated the ratio of length of intraperitoneal rectum (R) to length of distance between promontorium and peritoneal reflection (PRx). The primary outcome of this study was to evaluate whether the R/PRx ratio is higher in patients with rectal prolapse compared to the control group. Results Comparing the anatomic features showed that the length of sigmoid colon and length of PRx were not significantly different between the two groups. However, the length of intraperitoneal rectum was significantly higher in the prolapse group. Furthermore, the median R/PRx ratio in the prolapse group was significantly higher than in the control group. Conclusion This study showed that intraperitoneal rectum in patients with rectal prolapse is significantly more redundant than in the normal population. This could be considered reasonable evidence for the role of rectal redundancy on rectal prolapse pathophysiology.
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Affiliation(s)
- Wafi Attaallah
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Akmercan
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Hale Feratoglu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Kraiem I, Kellil T, Chaouch MA, Korbi I, Zouari K. Strangled rectal prolapse in young adults: A case report. Ann Med Surg (Lond) 2020; 55:33-35. [PMID: 32454968 PMCID: PMC7235615 DOI: 10.1016/j.amsu.2020.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background Rectal prolapse (RP) is an uncommon perineal disease. It is defined as a complete protrusion or intussusception of the rectum through the anus. Strangulation of the RP is rare. This complication presents requires an emergent surgery. This case presentation aims to report the therapeutic management and results of this condition. Observation A 29-year-old men, who consulted for a sudden, painful, irreducible rectal prolapse. At the anus, there was an irreducible, edematous, without signs of ischemia or necrosis rectal prolapse measuring 25*10 cm wide. The laboratory data showed a high white blood cell count and elevated C-reactive protein. After a failure of external manual reduction under general anesthesia, the patient underwent emergent surgery. The procedure consisted of a rectosigmoidectomy with coloanal anastomosis using a perineal approach according to the Altemeier technique associated to a diverting ileostomy. The postoperative follow-up was uneventful. The patient was discharged at post-operative day five. Conclusion Strangulated RP is a rare complication. Altemeier procedure remains the intervention of choice in this situation. An uncommon perineal disease. Therapeutic surgical management and issues. Socio-psychological impact of this disease.
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Affiliation(s)
- Iyed Kraiem
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Tarek Kellil
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Ibtissem Korbi
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Khadija Zouari
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
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Abstract
Introduction Rectal prolapse is the complete protrusion of the rectum through the anal canal, incarceration rarely complicates rectal prolapse. Even more rarely, it becomes strangulated and gangrenous, necessitating emergency surgery. Case presentation We present the first reported case of strangulated acute rectal prolapse as the first manifestation of rectal prolapse. The patient was a 26-year-old man who presented with a 20×6 cm semi-spherical mass extra-anally. Rectosigmoidectomy with sacral rectopexy was performed, resecting 20 cm of the incarcerated rectum and sigmoid colon. The postoperative course was uneventful with a good final result after colostomy closure and continuity restoration. Conclusion The successful treatment of this patient illustrates the value of surgery in this difficult and unusual case scenario of rectal incarceration.
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Affiliation(s)
- Imad El Moussaoui
- Surgeon, Department of General Surgery, Etterbeek-Ixelles Hospital, Belgium
| | - Augustin Limbga
- Surgeon, Department of General Surgery, Etterbeek-Ixelles Hospital, Belgium
| | - Manke Dika
- Surgeon, Department of General Surgery, Etterbeek-Ixelles Hospital, Belgium
| | - Abdelilah Mehdi
- Surgeon, Department of General Surgery, Etterbeek-Ixelles Hospital, Belgium
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Sazhin VP, Khubezov DA, Ogorel'tsev AY, Puchkov DK, Rodimov SV. [Rectal prolapse with ileum and sigmoid colon eventration]. Khirurgiia (Mosk) 2017:94-96. [PMID: 28374719 DOI: 10.17116/hirurgia2017394-96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- V P Sazhin
- Department of obstetrics and additional professional education, Pavlov Russian State Medical University, Ryazan, Russia
| | - D A Khubezov
- Department of obstetrics and additional professional education, Pavlov Russian State Medical University, Ryazan, Russia
| | - A Yu Ogorel'tsev
- Department of obstetrics and additional professional education, Pavlov Russian State Medical University, Ryazan, Russia
| | - D K Puchkov
- Department of obstetrics and additional professional education, Pavlov Russian State Medical University, Ryazan, Russia
| | - S V Rodimov
- Department of obstetrics and additional professional education, Pavlov Russian State Medical University, Ryazan, Russia
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Emile SH, Elbanna H, Youssef M, Thabet W, Omar W, Elshobaky A, Abd El-Hamed TM, Farid M. Laparoscopic ventral mesh rectopexy vs Delorme's operation in management of complete rectal prolapse: a prospective randomized study. Colorectal Dis 2017; 19:50-57. [PMID: 27225971 DOI: 10.1111/codi.13399] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/11/2016] [Indexed: 02/08/2023]
Abstract
AIM Various surgical operations have been devised for the treatment of rectal prolapse, yet no ideal procedure has been described. The present study aims to compare the clinical and functional outcome of laparoscopic ventral mesh rectopexy (LVMR) and Delorme's operation for complete rectal prolapse. METHOD Fifty patients with complete rectal prolapse were enrolled in this study. Patients were randomly selected to undergo either LVMR or Delorme's procedure after clinical, manometric and radiological evaluation. Patient characteristics, operative data, postoperative complications, recurrence of rectal prolapse and continence state were evaluated. Patients were followed for a mean duration of 18 months. RESULTS Thirty-one (62%) patients were women and 19 (38%) patients were men with a mean age of 39.7 ± 6.9 years. Patients were allocated into two equal groups: LVMR group and Delorme's group. Thirty-three (66%) complained of faecal incontinence preoperatively. Patients were followed for 18 months. There was no major postoperative complication or treatment death. Improvement in continence was reported in 80.9% of patients (83.3% in group 1 vs 71.4% in group 2). Recurrent prolapse was observed in 16% of patients in group 2 and 8% in group 1 (P = 0.66). The operation time was significantly greater in group 1 and the length of stay greater in group 2. There was no difference in the fall of constipation score between the groups. CONCLUSION There was no statistically significant difference in the incidence of recurrence of complete rectal prolapse or postoperative improvement of symptoms between the two groups. Hospital stay was longer after Delorme's procedure but the operation time was shorter. Neither procedure proved definite superiority regarding the clinical and functional outcome at 18 months of follow-up.
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Affiliation(s)
- S H Emile
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - H Elbanna
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - M Youssef
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - W Thabet
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - W Omar
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - A Elshobaky
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - T M Abd El-Hamed
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
| | - M Farid
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Dakahlia Providence, Egypt
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Al-Ameen WM, Privitera A, Al-Ayed A, Sabr K. Laparoscopic-Assisted Altemeier's Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:827-829. [PMID: 27811832 PMCID: PMC5098925 DOI: 10.12659/ajcr.900243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Female, 39 Final Diagnosis: Recurrent strangulated rectal prolapse Symptoms: Chronic constipation • painful rectal mass • irreducible rectal prolapse Medication: — Clinical Procedure: Operation Specialty: Surgery
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Affiliation(s)
- Wael M Al-Ameen
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Antonio Privitera
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amal Al-Ayed
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Khalid Sabr
- Department of General Surgery, Colorectal Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Abstract
Minimally invasive surgery is slowly taking over as the preferred operative approach for colorectal diseases. However, many of the procedures remain technically difficult. This article will give an overview of the state of minimally invasive surgery and the many advances that have been made over the last two decades. Specifically, we discuss the introduction of the robotic platform and some of its benefits and limitations. We also describe some newer techniques related to robotics.
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Affiliation(s)
- Matthew Whealon
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Vinci
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, Orange, California
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Rahman AA, Robinson AM, Brookes SJH, Eri R, Nurgali K. Rectal prolapse in Winnie mice with spontaneous chronic colitis: changes in intrinsic and extrinsic innervation of the rectum. Cell Tissue Res 2016; 366:285-299. [DOI: 10.1007/s00441-016-2465-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/29/2016] [Indexed: 12/19/2022]
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Chandra A, Kumar S, Maurya AP, Gupta V, Gupta V, Rahul. Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population. World J Gastrointest Surg 2016; 8:321-325. [PMID: 27152139 PMCID: PMC4840172 DOI: 10.4240/wjgs.v8.i4.321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/06/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse (CRP) in North Indian patients with inherent bulky and redundant colon.
METHODS: The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively.
RESULTS: Fifteen patients (9 female) with a median age of 50 years (range, 15-68) were included in the study. The median operative time was 200 min (range, 180-350 min) and the median post-operative stay was 4 d (range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo (range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17 (range, 5-24) to 6 (range, 0-23) (P < 0.001) and the fecal incontinence severity index score from 24 (range, 0-53) to 2 (range, 0-53) (P = 0.007). No de novo constipation or fecal incontinence was recorded during the follow-up. On personal conversation, all patients expressed satisfaction with the outcome of their treatment.
CONCLUSION: Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.
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Steele SR, Varma MG, Prichard D, Bharucha AE, Vogler SA, Erdogan A, Rao SS, Lowry AC, Lange EO, Hall GM, Bleier JI, Senagore AJ, Maykel J, Chan SY, Paquette IM, Audett MC, Bastawrous A, Umamaheswaran P, Fleshman JW, Caton G, O’Brien BS, Nelson JM, Steiner A, Garely A, Noor N, Desrosiers L, Kelley R, Jacobson NS. The evolution of evaluation and management of urinary or fecal incontinence and pelvic organ prolapse. Curr Probl Surg 2015; 52:92-136. [DOI: 10.1067/j.cpsurg.2015.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/29/2015] [Indexed: 12/23/2022]
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Dyrberg DL, Nordentoft T, Rosenstock S. Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients: A prospective follow-up study. Scand J Surg 2015; 104:227-32. [PMID: 25567855 DOI: 10.1177/1457496914565418] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 11/19/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The aim of this study is to examine the clinical and functional outcome of laparoscopic posterior rectopexy in a consecutive series of adult patients with full-thickness rectal prolapse. MATERIAL AND METHODS Preoperative data on demography, life-style practices, medication, comorbidity, and previous surgery for rectal prolapse were ascertained from patient charts. Information on operative procedure, and pre- and postoperative complications were recorded. Short- and long-term follow-up were done after a median of 60 days and 2 years after surgery. RESULTS Between 1 February 2009 to 1 June 2012, 81 laparoscopic posterior rectopexies were done. Male-to-female ratio was 4:77, median age 73 [57-80.5] years and median ASA Grade 2. Conversion to open surgery was done in 6.2%, the median operating time was 82 min [66 - 102] and median length of hospital stay was 2 days [2-5.7]. Minor and major complications were seen in 5.3% and 14.8%, respectively. The 30-day mortality rate was 1.2%. Constipation or incontinence improved or disappeared in 65.2% and 74.4%, respectively. The cumulated recurrence rate was 11.1% after a median observation time of 2 years. CONCLUSION Laparoscopic posterior rectopexy is a safe and well-tolerated procedure in older patients and can be done with acceptable complications and recurrence rates and short hospital stays. Laparoscopic posterior rectopexy seems to improve bowel function in many patients.
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Affiliation(s)
- D L Dyrberg
- Department of Gastroenterology, Surgical Unit, Hvidovre University Hospital, Hvidovre, Denmark
| | - T Nordentoft
- Department of Gastroenterology, Surgical Unit, Herlev University Hospital, Herlev, Denmark
| | - S Rosenstock
- Department of Gastroenterology, Surgical Unit, Hvidovre University Hospital, Hvidovre, Denmark
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12
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Ammar SA, Kottb MBM. A novel percutaneous technique for treating complete rectal prolapse in adults. Surg Innov 2014; 22:240-4. [PMID: 25143439 DOI: 10.1177/1553350614546005] [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: 11/17/2022]
Abstract
PURPOSE To evaluate a new technique for treating complete rectal prolapse in adults that combines injection sclerotherapy with anal encirclement. METHODS From 2008 to 2012, 20 patients were treated using combined perirectal injection sclerotherapy with anal encirclement. The primary outcome was recurrent full-thickness/mucosal rectal prolapse. RESULTS The mean age of the patients was 39 years. The mean operating time was 17 minutes. Patients had short hospital stays (range = 2-4 days) and rapid recovery with no serious postoperative complications. After a mean follow-up of 22 months, recurrence occurred in 9 patients, and was complete in 6 cases and mucosal in 3 patients. Recurrent mucosal prolapse was treated with a mucosectomy, while recurrent complete rectal prolapse was treated with an open rectopexy with mesh. CONCLUSION The combination of perirectal sclerotherapy and anal encirclement for treating complete rectal prolapse in adults is a simple and safe procedure with reasonable outcome. These findings call for confirmatory trials in larger series.
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Laparoscopy for pelvic floor disorders. Best Pract Res Clin Gastroenterol 2014; 28:69-80. [PMID: 24485256 DOI: 10.1016/j.bpg.2013.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/21/2013] [Accepted: 11/23/2013] [Indexed: 02/07/2023]
Abstract
Surgical treatment of pelvic floor disorders has significantly evolved during the last decade, with increasing understanding of anatomy, pathophysiology and the minimally-invasive 'revolution' of laparoscopic surgery. Laparoscopic pelvic floor repair requires a thorough knowledge of pelvic floor anatomy and its supportive components before repair of defective anatomy is possible. Several surgical procedures have been introduced and applied to treat rectal prolapse syndromes. Transabdominal procedures include a variety of rectopexies with the use of sutures or prosthesis and with or without resection of redundant sigmoid colon. Unfortunately there is lack of one generally accepted standard treatment technique. This article will focus on recent advances in the management of pelvic floor disorders affecting defecation, with a brief overview of contemporary concepts in pelvic floor anatomy and different laparoscopic treatment options.
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14
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Vunda A, Alcoba G, Gervaix A. ''Rectal intussusception'': avoid the confusion. J Emerg Med 2013; 45:259-260. [PMID: 23561313 DOI: 10.1016/j.jemermed.2012.09.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/05/2012] [Accepted: 09/18/2012] [Indexed: 06/02/2023]
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15
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Abstract
The applicability of laparoscopy to many complex intraabdominal colorectal procedures continues to expand, and has been shown to be feasible and safe in experienced hands. Data are available on the elderly, rectal prolapse, diverticulitis, Hartman's takedown, small bowel obstruction, Crohn's disease, and ulcerative colitis. Clinically relevant advantages have been clearly demonstrated in selected patient populations. Laparoscopic surgery for benign colorectal disease should be considered in patients suitable for this approach to an abdominal operation.
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Affiliation(s)
- Y Panis
- Service de Chirurgie Digestive, Hôpital Lariboisière - Paris.
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