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Landolfi V, Brusciano L, Gambardella C, Tolone S, Del Genio G, Grossi U, Gualtieri G, Lucido FS, Docimo L. Long-Term Outcomes of Sectorial Longitudinal Augmented Prolapsectomy for Asymmetric Muco-hemorrhoidal Prolapse: An Observational Study of 433 Consecutive Patients. Surg Innov 2021; 29:27-34. [PMID: 33830810 DOI: 10.1177/15533506211007292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Hemorrhoidal disease (HD) is a widespread condition severely influencing patients' quality of life. Recently, the large diffusion of stapled hemorrhoidopexy has revealed a new unexpected pathological entity: the asymmetric mucosal prolapse. We aimed to assess the outcomes of the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse, in terms of HD symptoms, prolapse recurrence, and rectal stenosis. METHODS Patients affected by III-IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP of 1 or 2 hemorrhoidal columns (SLAP1 or SLAP2) were retrospectively assessed. The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery. Mean outcome was evaluation of medium-long-term outcomes as the occurrence of recurrence and anal or rectal stenosis. Secondary outcome was the evaluation of postoperative bleeding, reoperation rate, length of hospitalization, fecal urgency, and time to return to work. RESULTS We enrolled 433 patients (277 SLAP1 and 156 SLAP2). Hemorrhoidal symptoms recurrence was reported in 9 patients undergone SLAP1 and 4 patients undergone SLAP2, while prolapse recurrence occurred, respectively, in 4 and 2 patients. No major intraoperative complications occurred. An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2. Fecal incontinence occurred in 8 and 4 cases of patients treated with SLAP1 and SLAP2. CONCLUSIONS The combination of a simple hemorrhoidectomy to a mucosal rectal prolapsectomy should be part of every coloproctologist background. Promising and satisfying results can be achieved using SLAP for HD associated with asymmetric prolapse.
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Affiliation(s)
- Vincenzo Landolfi
- Division of General Surgery, "Agostino Landolfi Hospital" of Solofra, Avellino, Italy
| | - Luigi Brusciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Gambardella
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Tolone
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianmattia Del Genio
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ugo Grossi
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgia Gualtieri
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Saverio Lucido
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ludovico Docimo
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
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Brusciano L, Tolone S, Limongelli P, Del Genio G, Messina F, Martellucci J, Lanza Volpe M, Longo A, Docimo L. Anatomical and Functional Features of the Internal Rectal Prolapse With Outlet Obstruction Determined With 3D Endorectal Ultrasonography and High-Resolution Anorectal Manometry: An Observational Case-Control Study. Am J Gastroenterol 2018; 113:1247-1250. [PMID: 29915399 DOI: 10.1038/s41395-018-0141-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate correlation between rectal wall thickness (RWT) and anorectal pressures, in obstructed defecation syndrome (ODS) patients caused by internal rectal prolapse. METHODS ODS patients and healthy volunteers (HVs) underwent 3D endorectal ultrasound (3D-EUS) and high-resolution anorectal manometry (HRAM); RWT, total rectal wall volume (TRWV), pushing endorectal pressure (PEP), recto-anal gradient were determined RESULTS: We enrolled 35 ODS patients and 25 HVs. Patients showed markedly decreased TRWV, PEP, and recto-anal gradient. Linear correlation was found between markedly reduced TRWV and markedly hypotonic PEP. CONCLUSIONS HRAM and 3D-EUS could be performed in ODS assessment, to better understand rectal function.
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Affiliation(s)
- Luigi Brusciano
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Salvatore Tolone
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Paolo Limongelli
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Gianmattia Del Genio
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Federico Messina
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Jacopo Martellucci
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Mariachiara Lanza Volpe
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Antonio Longo
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
| | - Ludovico Docimo
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, General, Mininvasive and Obesity Surgery Unit, Master of Coloproctology, Master of Pelvic Floor Rehabilitation, University of Campania "Luigi Vanvitelli", Naples, Italy. General, Emergency and Mini-invasive Surgery, Careggi University Hospital, Largo Brambilla 3, Florence, Italy. St. Elizabeth Hospital, Wien, Austria. These authors contributed equally: Luigi Brusciano and Salvatore Tolone
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