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Bungo CP, Kimura C, Adel H, Au Hoy SL, Mishra K, Gurland BH. Identifying Current Barriers in Patient Educational Content Surrounding Rectal Prolapse and Rectocele: Using Animation to Bridge the Gaps. Dis Colon Rectum 2024; 67:1077-1084. [PMID: 38713067 DOI: 10.1097/dcr.0000000000003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Patient-centered educational resources surrounding rectal prolapse and rectocele can be difficult to locate and understand. Findings of video animation as patient-specific material for these conditions can help guide the creation of effective educational tools for patients. OBJECTIVE To identify female patient preferences for learning about rectal prolapse and rectocele and to obtain feedback on an animation developed to aid patient education on these conditions. DESIGN This was a multiple-methods study. Participants received a 20-question survey about educational preferences and a 100-second video animation on rectal prolapse and rectocele. Respondents were invited for a semistructured interview to further express their thoughts regarding health education. SETTING This study was conducted from 2022 to 2023. Surveys were administered via e-mail, and interviews were held virtually. PATIENTS Female patients in the institutional review board-approved Stanford Rectal Prolapse Registry were included. MAIN OUTCOME MEASURES Assess and describe the ability of short video animations to supplement patient education on rectal prolapse and rectocele. RESULTS Forty-six female participants responded and 10 were interviewed. About 97% of participants indicated that the video animation explained the condition clearly and 66% felt comfortable explaining the condition. During feedback, participants recommended showing the animation during the first appointment and creating similar content for surgery preparation. Patient challenges while researching rectal prolapse and rectocele online included difficulty finding content (41.5%), complex language (18.8%), and uncertainty about source reliability (16.9%). LIMITATIONS Small sample size with little socioeconomic diversity and highly educated participants. CONCLUSIONS Patient-centered resources surrounding specific pelvic floor disorder(s) are not always readily accessible online. This study demonstrated the value of a short video animation to enhance patients' understanding of rectal prolapse and rectocele. See Video Abstract . IDENTIFICACIN DE BARRERAS ACTUALES EN EL CONTENIDO EDUCATIVO PARA PACIENTES EN TORNO AL PROLAPSO RECTAL Y RECTOCELE USO DE LA ANIMACIN PARA CERRAR LAS BRECHAS ANTECEDENTES:Los recursos educativos centrados en el paciente sobre el prolapso rectal y el rectocele pueden ser difíciles de localizar y comprender. Los hallazgos de la animación en vídeo como material específico para estos pacientes pueden ayudar a guiar la creación de herramientas educativas efectivas para los pacientes.OBJETIVO:Identificar las preferencias de las pacientes para aprender sobre el prolapso rectal y el rectocele y obtener retroalimentación sobre una animación desarrollada para ayudar a la educación del paciente sobre estas condiciones.DISEÑO:Este fue un estudio de métodos múltiples. Los participantes recibieron una encuesta de 20 preguntas sobre preferencias educativas y un vídeo de animación de 100 segundos sobre el prolapso rectal y el rectocele. Se invitó a los encuestados que respondieron a una entrevista semiestructurada para expresar sus opiniones sobre la educación sanitaria.ESCENARIO:Este estudio se realizó entre 2022 y 2023, las encuestas se administraron por correo electrónico y las entrevistas se realizaron virtualmente.PACIENTES:Se incluyeron pacientes mujeres en el Registro de Prolapso Rectal de Stanford aprobado por el IRB.PRINCIPALES MEDIDAS DE RESULTADO:Evaluar y describir la capacidad de animaciones de video corto para complementar la educación del paciente sobre el prolapso rectal y el rectocele.RESULTADOS:Respondieron 46 mujeres participantes y 10 fueron entrevistadas. Alrededor del 97% de los participantes indicaron que la video-animación explicaba la afección con claridad y el 66% se sentía cómoda explicando dicha afección. En los comentarios de retroalimentación sugirieron mostrar la animación durante la primera cita y crear contenido similar para la preparación de la cirugía. Los desafíos de los pacientes al investigar el prolapso rectal y el rectocele en línea incluyeron dificultad para encontrar contenido (41.5%), lenguaje complejo (18.8%) e incertidumbre sobre la confiabilidad de la fuente (16.9%).LIMITACIONES:Tamaño de muestra pequeño con poca diversidad socioeconómica y participantes con alto nivel educativo.CONCLUSIONES:Los recursos centrados en el paciente sobre trastornos específicos del piso pélvico no siempre son fácilmente accesibles en línea. Este estudio demostró el valor de un vídeo de animación breve para mejorar la comprensión de los pacientes sobre el prolapso rectal y el rectocele. (Traducción-Dr. Jorge Silva Velazco ).
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Affiliation(s)
- Caitlin P Bungo
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Cintia Kimura
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Hassina Adel
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sydni L Au Hoy
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Kavita Mishra
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Brooke H Gurland
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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Janjua M, Kearse L, Watson K, Zeineddin A, Rivera-Valerio M, Nembhard C. Less is more: Outcomes of surgical approaches to rectal prolapse in patients with cirrhosis. Surgery 2024:S0039-6060(24)00396-9. [PMID: 38997864 DOI: 10.1016/j.surg.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/09/2024] [Accepted: 06/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Patients with cirrhosis have increased risk of perioperative complications, and surgical management of concomitant rectal prolapse poses a challenge in these patients. Given the paucity of data informing this, our study aimed to evaluate postoperative outcomes. METHODS The National Surgical Quality Improvement Program database was queried for patients undergoing rectal prolapse repair from 2011 to 2019. Patients were stratified by cirrhosis (Model for End-Stage Liver Disease ≥10) and no cirrhosis. Bivariate and multivariable regression analyses were used to compare comorbidities, repair types, and identify predictors of postoperative outcomes. RESULTS We identified 2,234 patients: 332 patients with cirrhosis (Model for End-Stage Liver Disease 14 [10-34]). Patients with cirrhosis were older (76 ± 12 years vs 69 ± 17, P < .001) with increased comorbidities (eg, heart failure, lung disease), greater mortality (3.6% vs 0.8%, P < .001), and complication rates compared with patients without cirrhosis. Readmission rates and longer hospital stays also were observed in patients with cirrhosis. A total of 52% of NCPs underwent abdominal repair compared with 62% of patients with cirrhosis who received perineal repair; greater complication rates were observed for abdominal repairs in both groups (patients without cirrhosis 11.4%, patients with cirrhosis 25%). Predictors of greater complication rates in patients with cirrhosis included abdominal repair (odds ratio 2.7, 95% confidence interval 1.4-5, P = .002) and presence of ascites (odds ratio 4.6, 95% confidence interval 1.1-20, P = .04). CONCLUSION Overall, abdominal repairs have greater complication rates even when controlling for Model for End-Stage Liver Disease score and presence of ascites. The Delorme procedure had the lowest complication rates. Additional evidence is needed to recommend a preferred surgical approach to rectal prolapse repair in patients with cirrhosis.
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Affiliation(s)
- Mahin Janjua
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - LaDonna Kearse
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Kyra Watson
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Ahmad Zeineddin
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | | | - Christine Nembhard
- Department of Surgery, Howard University College of Medicine, Washington, DC.
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Kulkarni S, Mabis C, Siblini T, Hagglund K, Aslam MF. Midurethral Sling With Concomitant Sacrocolpopexy: Does the Sequence Matter? A Retrospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102461. [PMID: 38636804 DOI: 10.1016/j.jogc.2024.102461] [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: 12/29/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
The objective is to determine if the timing of midurethral sling (MUS) placement has an impact on the recurrence rate of stress urinary incontinence. We conducted a retrospective cohort study of patients who underwent robot sacrocolpopexy (RSC) with MUS placement at a large community hospital. Our data demonstrated that there was no significant difference in stress urinary incontinence recurrence when the MUS was placed before or after the RSC (15% vs. 11%, P = 0.41, respectively). We concluded that physician preference may dictate surgical approach to sequence of retropubic MUS placement at the time of RSC.
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Affiliation(s)
- Sanjana Kulkarni
- Department of Obstetrics and Gynaecology, Ascension St. John Hospital Detroit, Detroit, MI, USA.
| | - Colton Mabis
- Department of Obstetrics and Gynaecology, Ascension St. John Hospital Detroit, Detroit, MI, USA
| | - Tamara Siblini
- Department of Obstetrics and Gynaecology, Ascension St. John Hospital Detroit, Detroit, MI, USA
| | - Karen Hagglund
- Department of Obstetrics and Gynaecology, Ascension St. John Hospital Detroit, Detroit, MI, USA
| | - Muhammad Faisal Aslam
- Department of Obstetrics and Gynaecology, Ascension St. John Hospital Detroit, Detroit, MI, USA
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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
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Rao SSC, Ahuja NK, Bharucha AE, Brenner DM, Chey WD, Deutsch JK, Kunkel DC, Moshiree B, Neshatian L, Reveille RM, Sayuk GS, Shapiro JM, Shah ED, Staller K, Wexner SD, Baker JR. Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations. Clin Gastroenterol Hepatol 2023; 21:2727-2739.e1. [PMID: 37302444 PMCID: PMC10542660 DOI: 10.1016/j.cgh.2023.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND & AIMS Anorectal manometry (ARM) is a comprehensive diagnostic tool for evaluating patients with constipation, fecal incontinence, or anorectal pain; however, it is not widely utilized for reasons that remain unclear. The aim of this roundtable discussion was to critically examine the current clinical practices of ARM and biofeedback therapy by physicians and surgeons in both academic and community settings. METHODS Leaders in medical and surgical gastroenterology and physical therapy with interest in anorectal disorders were surveyed regarding practice patterns and utilization of these technologies. Subsequently, a roundtable was held to discuss survey results, explore current diagnostic and therapeutic challenges with these technologies, review the literature, and generate consensus-based recommendations. RESULTS ARM identifies key pathophysiological abnormalities such as dyssynergic defecation, anal sphincter weakness, or rectal sensory dysfunction, and is a critical component of biofeedback therapy, an evidence-based treatment for patients with dyssynergic defecation and fecal incontinence. Additionally, ARM has the potential to enhance health-related quality of life and reduce healthcare costs. However, it has significant barriers that include a lack of education and training of healthcare providers regarding the utility and availability of ARM and biofeedback procedures, as well as challenges with condition-specific testing protocols and interpretation. Additional barriers include understanding when to perform, where to refer, and how to use these technologies, and confusion over billing practices. CONCLUSIONS Overcoming these challenges with appropriate education, training, collaborative research, and evidence-based guidelines for ARM testing and biofeedback therapy could significantly enhance patient care of anorectal disorders.
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Affiliation(s)
- Satish S C Rao
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
| | - Nitin K Ahuja
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Darren M Brenner
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - William D Chey
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - David C Kunkel
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Baharak Moshiree
- Division of Gastroenterology and Hepatology, Atrium Health, Wake Forest Medical University, Charlotte, North Carolina
| | - Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California
| | - Robert M Reveille
- Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, Veterans Affairs Medical Center, St. Louis, Missouri
| | | | - Eric D Shah
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida
| | - Jason R Baker
- Department of Gastroenterology and Hepatology, Atrium Health, University of North Carolina, Charlotte, North Carolina
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Perrakis A, Meyer F, Scheidbach H. Complete rectal prolapse presenting with colorectal cancer. Innov Surg Sci 2023; 8:119-122. [PMID: 38058771 PMCID: PMC10696935 DOI: 10.1515/iss-2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/27/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Rectal prolapse is defined as prolapse of all layers of rectal wallout of the anal sphincter. The aim was to (i) describe the extremely rare combination of a rectal prolapse with colon cancer in an older female patient, (ii) comment on management-specific aspects and (iii) derive some generalizing recommendations by means of a scientific case report and based on the case-specific experiences related to the clinical management and current references from the medical literature. Case presentation A 69-year old female patient with cancer of the sigmoid colon at a manifest rectal prolapse was diagnosed. Literature search (using the data bank of "PubMed") resulted in only six patients (the majority of them were females) with the coincidence of rectal prolapse and rectal or colon cancer have been reported so far. Conclusions A patient with a manifest rectal prolapse needs always to undergo colonoscopy and - in case of an ulcer - histological investigation of representative biopsies.
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Affiliation(s)
- Aristoteles Perrakis
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Hubert Scheidbach
- Department of General and Abdominal Surgery, St. Theresien Krankenhaus, Nürnberg, Germany
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7
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Sciberras P, Calleja R, Bugeja R, Montebello G, Camilleri-Brennan J. Pelvic Vascular Malformations and Recurrent Rectal Prolapse in a Patient With Maffucci Syndrome: A Diagnostic and Therapeutic Challenge. Cureus 2023; 15:e39095. [PMID: 37332422 PMCID: PMC10270431 DOI: 10.7759/cureus.39095] [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: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Maffucci syndrome is an extremely rare congenital condition characterized by the development of multiple enchondromas and haemangiomas, primarily on the extremities, and an association with various tumors. Colonic and pelvic floor function has never been explored in patients with Maffucci syndrome. We report a case illustrating the challenges in managing colonic and pelvic floor dysfunction in a female patient secondary to vascular malformations as part of Maffucci syndrome.
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Affiliation(s)
- Peter Sciberras
- Surgery, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | | | - Rebecca Bugeja
- Surgery, Northern Care Alliance NHS Foundation Trust, Salford, GBR
| | | | - John Camilleri-Brennan
- Surgery, NHS Forth Valley, Stirling, GBR
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, GBR
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8
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Penton AA, Jochum SB, Eberhardt JM. Unusual presentation of colon cancer as rectal prolapse in middle-aged male. Clin Case Rep 2023; 11:e6908. [PMID: 36873063 PMCID: PMC9979960 DOI: 10.1002/ccr3.6908] [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: 11/15/2022] [Accepted: 01/10/2023] [Indexed: 03/06/2023] Open
Abstract
Rectal prolapse is typically a benign idiopathic condition. Rarely, rectal prolapse can be due to or associated with colorectal carcinoma. Here we present a middle-aged gentleman with no previous medical or surgical history, who presented with rectal prolapse secondary to sigmoid adenocarcinoma.
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Affiliation(s)
- Ashley A. Penton
- Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
| | - Sarah B. Jochum
- Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
| | - Joshua M. Eberhardt
- Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
- Division of Colon and Rectal Surgery, Department of SurgeryLoyola University Medical CenterMaywoodIllinoisUSA
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9
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Chung JS, Ju JK, Kwak HD. Comparison of abdominal and perineal approach for recurrent rectal prolapse. Ann Surg Treat Res 2023; 104:150-155. [PMID: 36910558 PMCID: PMC9998957 DOI: 10.4174/astr.2023.104.3.150] [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: 11/04/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose Rectal prolapse is a benign disease in which the rectum protrudes below the anus. Although many studies have been reported on the treatment of primary rectal prolapse for many years, there is a lack of treatment or clinical research results on recurrent rectal prolapse. This study aimed to evaluate the outcomes of surgical approaches for recurrent rectal prolapse. Methods We studied patients who underwent surgical treatment for recurrent rectal prolapse disease from March 2016 to February 2021. We analyzed the previous operation methods in patients with recurrent rectal prolapse, as well as the operation time, complication rate, hospital stay, and re-recurrence rates in the perineal and abdominal approach groups. Results Out of a total of 239 patients, 41 patients who underwent surgery for recurrent rectal prolapse were retrospectively enrolled. Recurrent rectal prolapses were surgically treated either by the perineal approach (n = 25, 61.0%) or by the abdominal approach (n = 16, 39.0%). The operation times were significantly longer in the abdominal approach than in the perineal approach (98.44 minutes vs. 58.00 minutes, P = 0.001). Hospital stay was significantly longer in the abdominal approach than in the perineal approach (9.19 days vs. 6.00 days, P = 0.012). Re-recurrence rate after repeat repair was not significantly different between the 2 groups (P = 0.777). Conclusion Although the perineal approach shortened the operation time and hospital stay, there were no significant differences between the 2 groups in postoperative complications and re-recurrence rate. Both approaches can be good surgical options for the treatment of recurrent rectal prolapse.
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Affiliation(s)
- Jun Seong Chung
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.,Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.,Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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RECTAL PROLAPSE IN THE SULAWESI CRESTED BLACK MACAQUE ( MACACA NIGRA): MORBIDITY, MORTALITY, AND RISK FACTORS. J Zoo Wildl Med 2023; 53:722-732. [PMID: 36640074 DOI: 10.1638/2021-0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 01/09/2023] Open
Abstract
Empirical data suggest that rectal prolapse (RP) is common in captive Sulawesi crested black macaques (Macaca nigra) in Europe, resulting in the euthanasia of animals that experience repeat occurrences. However, the prevalence, etiology, and risk factors of RP remain unidentified. The aims of this retrospective study were to assess the morbidity and mortality of RP, to provide an overview of management practices, and to identify risk factors for RP in this species. A questionnaire was sent to all European Ex situ Programme institutions that housed M. nigra between 01 January 2014 and 31 December 2020. Zoological Information Management System medical records and the studbook were used to obtain additional information. The questionnaire had a response rate of 65%, accounting for 204 animals. Of these animals, 25 (12.3%) suffered from at least one RP event during the study period and recurrence was noted in 72%. The majority of prolapses reverted naturally, but 28% of afflicted animals were euthanized for this ailment. Institutions with M. nigra with high frequencies of diarrhea (P= 0.035), those that provided diets of ≥90% vegetables and high-fiber pellet (P < 0.001), and those with more male than female M. nigra (P < 0.001) had increased odds of RP. Institutions that provided fruits daily (P < 0.002) had reduced odds of having RP cases. Although correlation of RP with diet was identified, confounding cannot be excluded, and a detailed dietary analysis needs to take place before altering feeding practices. Acute stressors and detection of protozoa in fecal samples were common findings before an RP event. Demographic analysis indicated that aged females, young males, and subordinate individuals were most affected by this condition. Where tested during an RP intervention, animals had low serum levels of vitamin D. Pedigree analysis hinted at genetic predisposition in this species and requires further investigation.
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Rajasingh CM, Gurland BH. Management of Full Thickness Rectal Prolapse. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Aslam A, Loh K, Yeh ZYT. Perineal resection for incarcerated rectal prolapse. ANZ J Surg 2022; 93:1075-1076. [PMID: 36251444 DOI: 10.1111/ans.18108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Anoosha Aslam
- Department of Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Kim Loh
- Department of Surgery, Blacktown Hospital, Sydney, New South Wales, Australia
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Evaluation and Management of Rectal Prolapse Among Geriatric Patients. Adv Emerg Nurs J 2022; 44:297-301. [DOI: 10.1097/tme.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Smedberg J, Graf W, Pekkari K, Hjern F. Comparison of four surgical approaches for rectal prolapse: multicentre randomized clinical trial. BJS Open 2022; 6:6511762. [PMID: 35045155 PMCID: PMC8769527 DOI: 10.1093/bjsopen/zrab140] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Several different procedures have been described for surgical treatment of rectal prolapse and consensus on the optimal approach has not been reached. The Swedish Rectal Prolapse Trial was performed with the aim to compare the outcomes after the most common surgical approaches to rectal prolapse. METHOD A multicentre randomized trial was conducted from 2000 to 2009. Patients were randomized between a perineal or an abdominal approach for correction of rectal prolapse (randomization A) if eligible for any procedures. Patients considered unsuitable for random allocation were only included in randomizations B or C. Patients in randomization B (perineal group) were randomized to Delorme's or Altemeier's procedures and those in randomization C (abdominal group) to suture rectopexy or resection rectopexy. Primary outcomes were bowel function and quality of life, measured using Wexner incontinence score and RAND-36, and secondary outcomes were complications and recurrence at 3 years. RESULTS During the study period, 134 patients were randomized: 18 in randomization A group, 80 in randomization B group and 54 in randomization C group; of these, 122 patients underwent surgery. Mean follow-up was 2.6 years. Improvements in Wexner and RAND-36 scores were seen but with no significant difference between the groups. Health change scores were significantly improved from baseline up to 1 year after surgery (P < 0.001). At 3 years, recurrence rates were two of seven patients for abdominal versus five of eight patients for perineal approach (P = 0.315), 18 of 31 patients (58 per cent) for Delorme's versus 15 of 30 patients (50 per cent) for Altemeier's (P = 0.611) and four of 19 patients (21 per cent) for suture rectopexy versus two of 21 patients (10 per cent) for resection rectopexy (P = 0.398). There were no significant differences regarding postoperative complications. CONCLUSION For all procedures, significant improvements from baseline in health change scores were noted after surgery. Recurrence rates were higher than previously reported. Registration number: NCT04893642 (http://www.clinicaltrials.gov).
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Affiliation(s)
- J Smedberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - W Graf
- Department of Surgical Sciences, Section of Surgery, Akademiska Sjukhuset, Uppsala, Sweden
| | - K Pekkari
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - F Hjern
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Baltazar JPA, Lopez MPJ, Onglao MAS. Neorectum prolapse after rectal cancer surgery corrected with perineal stapled prolapse resection. BMJ Case Rep 2022; 15:e246356. [PMID: 34983809 PMCID: PMC8728451 DOI: 10.1136/bcr-2021-246356] [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] [Accepted: 12/10/2021] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old woman developed neorectal prolapse after laparoscopic low anterior resection, total mesorectal excision with partial intersphincteric resection and handsewn coloanal anastomosis for rectal cancer. She presented with a 3 cm full thickness reducible prolapse, with associated anal pain and bleeding. A perineal stapled prolapse resection was performed to address the rectal prolapse, with satisfactory results.
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Affiliation(s)
- Joanna Pauline A Baltazar
- Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Marc Paul J Lopez
- Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Mark Augustine S Onglao
- Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
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Hu B, Zou Q, Xian Z, Su D, Liu C, Lu L, Luo M, Chen Z, Cai K, Gao H, Peng H, Cao W, Ren D. OUP accepted manuscript. Gastroenterol Rep (Oxf) 2022; 10:goac007. [PMID: 35198217 PMCID: PMC8859360 DOI: 10.1093/gastro/goac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background External rectal prolapse is a relatively rare disease, in which male patients account for a minority. The selection of abdominal repair or perineal repair for male patients has rarely been investigated. Methods Fifty-one male patients receiving abdominal repair (laparoscopic ventral rectopexy) or perineal repair (Delorme or Altemeier procedures) at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between March 2013 and September 2019 were retrospectively analysed. We compared the recurrence, complication rate, post-operative defecation disorder, length of stay, and quality of life between the abdominal and perineal groups. Results Of the 51 patients, 45 had a complete follow-up, with a median of 48.5 months (range, 22.8–101.8 months). A total of 35 patients were under age 40 years. The complication rate associated with abdominal repair was less than that associated with perineal repair (0% vs 20.7%, P = 0.031) and the recurrence rate was also lower (9.5% vs 41.7%, P = 0.018). Multivariate analysis showed that perineal repair (odds ratio, 9.827; 95% confidence interval, 1.296–74.50; P = 0.027) might be a risk factor for recurrence. Moreover, only perineal repair significantly improved post-operative constipation status (preoperative vs post-operative, 72.4% vs 25.0%, P = 0.001). There was no reported mortality in either of the groups. No patient's sexual function was affected by the surgery. Conclusions Both surgical approaches were safe in men. Compared with perineal repair, the complication rate and recurrence rate for abdominal repair were lower. However, perineal repair was better able to correct constipation.
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Affiliation(s)
- Bang Hu
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Qi Zou
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zhenyu Xian
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Dan Su
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Chao Liu
- Department of Digestive Center, PanYu Central Hospital, Guangzhou, Guangdong, P. R. China
| | - Li Lu
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Minyi Luo
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zixu Chen
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Keyu Cai
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Han Gao
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Hui Peng
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wuteng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Donglin Ren
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Corresponding author. Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, Guangdong 510655, P. R. China. Tel: +86-020-38254005;
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Chase C, Griffith S, Doyle A. The utility of the Altemeier procedure in strangulated rectal procidentia secondary to rectal cancer. A case report. Int J Surg Case Rep 2022; 90:106741. [PMID: 34995896 PMCID: PMC8741483 DOI: 10.1016/j.ijscr.2021.106741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/26/2021] [Accepted: 12/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Altemeier rectosigmoidectomy has been cited in the literature as a suitable approach for incarcerated rectal prolapse when a large segment of bowel is involved. However, the literature is devoid of cases that employed the technique as an oncological procedure for rectal carcinoma. For this reason, this case report heralds a new perspective on an old technique. Case presentation We describe the case of a male in his 6th decade who presented with stage four rectal cancer. Computed tomography imaging showed a rectal mass at the rectosigmoid junction with pelvic lymphadenopathy and a solitary hepatic lesion in segment two of the liver. While admitted to the hospital a 16 cm segment of bowel containing the mass prolapsed and became incarcerated, eventually becoming necrotic. A modification of the Altemeier procedure was performed along with a diverting ileostomy and hepatic wedge resection of the solitary metastases. Histological assessment of the surgical specimens confirmed that adequate resection margins were obtained with one of twenty-one lymph nodes positive for malignancy. He is currently being followed up in the outpatient oncology clinic and has commenced adjuvant chemotherapy. Clinical discussion Synchronous excision of rectal carcinoma with hepatic metastasectomy is a feasible surgery even in the emergency setting and can offer improved patient survival. Conclusion The combination of both an abdominal and perineal approach was suitable for this patient given his improved quality of life and negative pathological margins. Rectal prolapse can be the first presentation of rectal cancer. Strangulated rectal procidentia should be addressed by the perineal route. Altemeier procedure can be utilized for oncological resection of rectal cancer. Low volume liver resection is feasible without adjustment of central venous pressure.
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Affiliation(s)
| | - Sahle Griffith
- Caribbean Colon Cancer Initiative, St Michael, Barbados; Department of Surgery, Queen Elizabeth Hospital, St Michael, Barbados.
| | - Alex Doyle
- Caribbean Colon Cancer Initiative, St Michael, Barbados
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Kyriakos Saad M, Saikaly E. Table Sugar as a Bridge from Emergency to Elective Perineal Proctosigmoidectomy for Incarcerated Rectal Prolapse. DUBAI MEDICAL JOURNAL 2021. [DOI: 10.1159/000520605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Incarcerated rectal prolapse is a rare pathology and is considered an emergency, using table sugar can shift the emergency surgery to an elective one. If left untreated, rectal prolapse may present as an emergency, be it incarceration or strangulation. In an emergency presentation for incarcerated rectal prolapse every attempt should be taken to reduce the prolapsed rectum, if not successful, emergency surgery is indicated, with perineal approach being the first choice in elderly with multiple comorbidities.
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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.
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20
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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.
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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
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21
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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.
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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
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Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, Abongwa H, De Simone B, Gallo G, Rossi G, Abu-Zidan F, Agnoletti V, de'Angelis G, de'Angelis N, Ansaloni L, Baiocchi GL, Carcoforo P, Ceresoli M, Chichom-Mefire A, Di Saverio S, Gaiani F, Giuffrida M, Hecker A, Inaba K, Kelly M, Kirkpatrick A, Kluger Y, Leppäniemi A, Litvin A, Ordoñez C, Pattonieri V, Peitzman A, Pikoulis M, Sakakushev B, Sartelli M, Shelat V, Tan E, Testini M, Velmahos G, Wani I, Weber D, Biffl W, Coccolini F, Catena F. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16:48. [PMID: 34530908 PMCID: PMC8447593 DOI: 10.1186/s13017-021-00384-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Hariscine Abongwa
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Belinda De Simone
- Department of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, Poissy, France
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Rossi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- Department of Emergency and general Surgery, Pavia University Hospital, Pavia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Alain Chichom-Mefire
- Faculty of Health Sciences, Department of Surgery, University of Buea, Buea, Cameroon
| | - Salomone Di Saverio
- General surgery 1st unit, Department of General Surgery, University of Insubria, Varese, Italy
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Mario Giuffrida
- Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Carlos Ordoñez
- Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | | | - Andrew Peitzman
- University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Manos Pikoulis
- 3rd Department of Surgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
| | | | - Vishal Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Edward Tan
- Department of Surgery, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo" Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
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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, [...]
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25
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Soare C, Lasithiotakis K, Dearden H, Singh S, McNaught C. The Surgical Management of Rectal Prolapse. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02058-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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26
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Anatomo-functional outcomes of the laparoscopic Frykman-Goldberg procedure for rectal prolapse in a tertiary referral centre. Updates Surg 2021; 73:1819-1828. [PMID: 34138448 DOI: 10.1007/s13304-021-01114-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
Rectal prolapse is a common disorder that represents a burden for patients due to the associated symptoms that may include both incontinence and constipation. Currently, a huge variation in techniques exist. The aim of this study was to evaluate the anatomo-functional results of the laparoscopic Frykman-Goldberg procedure (LFGP) for the treatment of both internal (IRP) and complete rectal prolapse (CRP). Between July 2004 and October 2019, 45 patients with IRP and CRP underwent a LFGP. The Cleveland Clinic Constipation Score (CCCS), Obstructed Defecation Syndrome Score (ODSS) and Vaizey Score (VS) were assessed preoperatively, 3 months before the procedure, 12 months after the procedures and at the final follow-up visit. The patients' mean age was 51.4 ± 17.9 (15-93) years, and the mean follow-up was 9.24 ± 4.57 (1.6-16.3) years. The VS, CCCS and ODSS significantly improved (p = 0.008; p < 0.001; p < 0.001) from median preoperative values of 3, 20 and 18 to 2, 6 and 5, respectively. Furthermore, the improvements in scores during follow-up remained constant and significant over time when considering the two groups separately (time effect for ODSS p < 0.001, for VS p = 0.026, for CCCS p < 0.001) and when the patients were divided by age (< 40, 41-60 and > 60; p < 0.001). The overall complication rate was 8.9% (4/45), and no intraoperative complications or anastomotic leakage occurred. Conversion to the open approach was not necessary in any case. The overall success rate was 97.7%, and only one recurrence in the IRP group occurred after 14 months. LRGP can be considered a safe, effective and long-lasting procedure in young patients with IRP or CRP, a history of ODS and a redundant sigmoid colon.
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Abstract
BACKGROUND Rectal prolapse has a diverse symptom profile that affects patients of all ages. OBJECTIVE We sought to identify bothersome symptoms and clinical presentation that motivated patients who have rectal prolapse to seek care, characterize differences in symptom severity with age, and determine factors associated with bothersome symptoms. DESIGN This study is a retrospective analysis of a prospectively maintained registry. SETTINGS This study was conducted at a tertiary referral academic center. PATIENTS Included were 129 consecutive women with full-thickness rectal prolapse. MAIN OUTCOME MEASURES The main outcomes measured were primary bothersome symptoms, 5-item Cleveland Clinic/Wexner Fecal Incontinence questionnaire, and the 5-item Obstructed Defecation Syndrome questionnaire. Patients were categorized by age <65 vs age ≥65 years. RESULTS Cleveland Clinic/Wexner Fecal Incontinence score >9 was more common in older patients (87% vs 60%, p = 0.002). Obstructed Defecation Syndrome score >8 was more common in younger patients (57% vs 28%, p < 0.001). Older patients were more likely than younger patients to report bothersome symptoms of pain (38% vs 19%, p = 0.021) and bleeding (12% vs 2%, p = 0.046). Mucus discharge was reported by most patients (older, 72% vs younger, 66%, p = 0.54) but was bothersome for only 18%, regardless of age. Older patients had more severe prolapse expression than younger patients (at rest, 33% vs 11%; during activity, 26% vs 19%; only with defecation, 40% vs 64%, p = 0.006). Older patients were more likely to seek care within 6 months of prolapse onset (29% vs 11%, p = 0.056). On multivariable regression, increasing age, narcotic use, and nonprotracting prolapse at rest were associated with reporting pain as a primary concern. LIMITATIONS This was a single-center study with a small sample size. CONCLUSIONS Rectal prolapse-related bothersome symptoms and health care utilization differ by age. Although rectal pain is often not commonly associated with prolapse, it bothers many women and motivates older women to undergo evaluation. Patient-reported functional questionnaires may not reflect patients' primary concerns regarding specific symptoms and could benefit from supplementation with questionnaires to elicit individualized symptom priorities. See Video Abstract at http://links.lww.com/DCR/B492. PROLAPSO DE RECTO INFLUENCIA DE LA EDAD EN DIFERENCIAS VINCULADAS CON LA PRESENTACIÓN CLÍNICA Y LOS SÍNTOMAS MAS DESAGRADABLES: El prolapso de recto tiene una gran variedad de síntomas que afectan a pacientes con edades diferentes.Identificar los síntomas mas molestos y la presentación clínica que motivaron a los pacientes con un prolapso de recto a consultar por atención médica, caracterizar las diferencias de gravedad de los síntomas con relación a la edad y determinar los factores asociados con los síntomas mas molestos.Análisis retrospectivo de un registro prospectivo.Centro académico de referencia terciaria.Consecutivamente 129 mujeres que presentaban un prolapso rectal completo.Síntomas y molestias primarias, cuestionario de incontinencia fecal de la Cleveland Clinic / Wexner de 5 ítems, cuestionario de síndrome de defecación obstruida de 5 ítems. Los pacientes fueron categorizados en < 65 años versus ≥ 65 años.El puntaje de incontinencia fecal de la Cleveland Clinic / Wexner > 9 fue más común en pacientes mayores (87% vs 60%, p = 0.002). La puntuación del síndrome de defecación obstructiva > 8 fue más común en pacientes más jóvenes (57% vs 28%, p <0,001). Los pacientes mayores fueron más propensos que los pacientes jóvenes a informar síntomas y molestias de dolor (38% vs 19%, p = 0.021) y sangrado (12% vs 2%, p = 0.046). La mayoría de los pacientes informaron secresión de moco (mayores, 72% frente a más jóvenes, 66%, p = 0,54), pero sólo el 18% tuvo molestias, independientemente de la edad. Los pacientes mayores tenían una exteriorización de prolapso más grave que los pacientes jóvenes (en reposo, 33% frente a 11%; durante la actividad, 26% frente a 19%; solo con defecación, 40% frente a 64%, p = 0,006). Los pacientes mayores tenían más probabilidades de buscar atención médica dentro de los 6 meses posteriores al inicio del prolapso (29% frente a 11%, p = 0.056). Tras la regresión multivariable, el aumento de la edad, el uso de narcóticos y el prolapso no prolongado en reposo se asociaron con la notificación de dolor como queja principal.Centro único; tamaño de muestra pequeño.Los síntomas y molestias relacionadas con el prolapso rectal y la solicitud de atención médica difieren según la edad. Aunque el dolor rectal a menudo no se asocia comúnmente con el prolapso, incomoda a muchas pacientes y motiva a las mujeres mayores a someterse a un examen médico. Los cuestionarios funcionales con las respuestas de las pacientes pueden no reflejar las preocupaciones principales de éstos con respecto a los síntomas específicos y podrían requerir cuestionarios complementarios para así obtener prioridades individualizadas con relación a los síntomas identificados. Consulte Video Resumen en http://links.lww.com/DCR/B492. (Traducción-Dr. Xavier Delgadillo).
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Yamamoto T, Hyakudomi R, Takai K, Taniura T, Uchida Y, Ishitobi K, Hirahara N, Tajima Y. Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report. World J Clin Cases 2021; 9:847-853. [PMID: 33585631 PMCID: PMC7852635 DOI: 10.12998/wjcc.v9.i4.847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.
CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse.
CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.
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Affiliation(s)
- Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Takahito Taniura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Boccasanta P, Venturi M, Agradi S, Calabrò G, Bordoni L, Missaglia C, Favetta U, Vergani C. Is it possible to reduce recurrences after Altemeier's procedure for complete rectal prolapse? Twenty-year experience in 130 consecutive patients. Langenbecks Arch Surg 2021; 406:1591-1598. [PMID: 33538872 DOI: 10.1007/s00423-021-02091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In the attempt to understand the reasons for and to find a solution to the high recurrence rate after perineal surgery for complete rectal prolapse, we retrospectively analysed the long-term results of Altemeier's procedure alone, or associated with Trans-Obturator Colonic Suspension (TOCS) in a large series of patients with a median interval of 84 months (range 6-258). METHODS Medical records of 110 patients undergoing Altemeier with levatorplasty (group 1) and 20 patients submitted to the same procedure associated with TOCS (group 2) for newly diagnosed complete rectal prolapse were reviewed. All patients had been recruited after preoperative clinical examination, SF-36 quality of life, continence score and colonoscopy. RESULTS Mortality was nil. The overall complication and the recurrence rates were 12.3%, and 15.0% (P= 0.769) and 24.6% and 5.0% (P=0.067) in group 1 and 2, respectively. Twelve patients of group 1 with a recurrence were submitted to a redo-Altemeier, 8 to a redo-Altemeier associated with TOCS, and 6 associated with an anterior coloplasty with a mesh. The only patient of group 2 with a recurrence was submitted to a Hartmann's operation. Preoperative vs postoperative mean (SD) continence score was 15.8 (3.1) and 15.6 (3.3) versus 4.1 (1.8) and 3.9 (1.9) in group 1 and 2, respectively (P < 0.001). All parameters of SF-36 improved after surgery (P<0.01) and no differences between the 2 groups were found CONCLUSIONS: Long-term results confirmed the safety and effectiveness of Altemeier's procedure for the treatment of complete rectal prolapse, with the limit of a non-negligible incidence of anastomotic complications and recurrences. The combination of Altemeier with TOCS showed a positive trend to a reduction of the recurrence rate, not worsening morbidity and outcomes.
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Affiliation(s)
- Paolo Boccasanta
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Marco Venturi
- Day Week Surgery Departmental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F Sforza 35, Milan, 20122, Italy. marvent-@virgilio.it.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy. marvent-@virgilio.it
| | - Sergio Agradi
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Giuseppe Calabrò
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Luca Bordoni
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Claudio Missaglia
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Umberto Favetta
- Coloproctology & Pelvic Surgical Unit, Humanitas Gavazzeni Castelli, via G Mazzini 11, Bergamo, 24128, Italy
| | - Contardo Vergani
- Day Week Surgery Departmental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F Sforza 35, Milan, 20122, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122, Milan, Italy
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Funahashi K, Kurihara A, Miura Y, Ushigome M, Kaneko T, Kagami S, Yoshino Y, Koda T, Nagashima Y, Yoshida K, Sakai Y. What is the recommended procedure for recurrent rectal prolapse? A retrospective cohort study in a single Japanese institution. Surg Today 2021; 51:954-961. [PMID: 33420822 PMCID: PMC8141484 DOI: 10.1007/s00595-020-02190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
Purpose The choice of surgical procedure for rectal prolapse (RP) is challenging because of the high recurrence and morbidity rates. We aimed to clarify whether laparoscopic suture rectopexy (lap-rectopexy) is suitable for Japanese patients with recurrent RP. Methods We retrospectively evaluated 77 recurrent RP patients who had been treated on average 1.5 times between June 2008 and April 2016. Forty-one patients underwent lap-rectopexy and 36 underwent perineal procedures. We compared surgical outcomes and recurrence rate following surgery between the two groups. The multivariable logistic regression analysis was performed to determine risk factors of recurrent RP. Results In patients’ characteristics, significant differences were observed in the type of anesthesia (p < 0.01) and length of recurrent RP (p = 0.030). The mean operative time was significantly longer in the lap-rectopexy group (p < 0.001). Blood loss, length of hospitalization, and postoperative complications were similar. The recurrence rate was significantly lower in the lap-rectopexy group (17.1% vs. 38.9%, p = 0.032). Multivariate analysis showed that only the laparoscopic approach was significantly associated with a low recurrence following surgery (odds ratio 0.273, 95% CI − 2.568 to − 0.032). Conclusion Lap-rectopexy is recommended for recurrent RP because its low recurrence rate and safety profile are similar to those of perineal procedures.
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Affiliation(s)
- Kimihiko Funahashi
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Akiharu Kurihara
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Yasuyuki Miura
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Mitsunori Ushigome
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Tomoaki Kaneko
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Satoru Kagami
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Yu Yoshino
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Takamaru Koda
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Yasuo Nagashima
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Kimihiko Yoshida
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
| | - Yu Sakai
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan
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Wang L, Li CX, Tian Y, Ye JW, Li F, Tong WD. Abdominal ventral rectopexy with colectomy for obstructed defecation syndrome: An alternative option for selected patients. World J Clin Cases 2020; 8:5976-5987. [PMID: 33344596 PMCID: PMC7723726 DOI: 10.12998/wjcc.v8.i23.5976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/26/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal ventral rectopexy (AVR) with colectomy is controversial in the treatment of obstructed defecation syndrome (ODS). Literature data on this technique for ODS are very limited.
AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.
METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department. Patient demographics, perioperative surgical results, and postoperative follow-up outcomes were collected and analyzed. Long-term follow-up was evaluated with standardized questionnaires. The severity of symptoms was assessed by the objective Wexner Constipation Score (WCS) and ODS Score. The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score. Functional outcome was compared pre- and post-operatively for each patient. The primary outcomes were determined by the improvement in symptoms and quality of life. Secondary outcome measures were operating time, postoperative length of stay, morbidity and mortality, improvement of pelvic floor structure, and patient satisfaction.
RESULTS Four patients underwent robotic-assisted surgery, and two patients underwent a laparoscopic-assisted procedure. The mean operating time for the robotic approach was 243 min (range 160–300 min), and the mean operating time for the laparoscopic approach was 230 min (range 220-240 min). The mean postoperative length of stay was 8.2 d (range 6-12 d). There was no conversion to open procedure and no postoperative mortality. No urinary retention, wound infection, prolonged ileus, pelvic infection and anastomosis leakage occurred. Six patients were followed up for 36 mo. The WCS, ODS, and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively (P < 0.05). The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery. There was no recurrence or novel constipation after surgery. None of the patients used laxative medication.
CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS. However, comprehensive preoperative evaluation and careful patient selection are essential.
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Affiliation(s)
- Li Wang
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Chun-Xue Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yue Tian
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Jing-Wang Ye
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Fan Li
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Wei-Dong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
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Wang L, Li CX, Tian Y, Ye JW, Li F, Tong WD. Abdominal ventral rectopexy with colectomy for obstructed defecation syndrome: An alternative option for selected patients. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Milsom JW, Trencheva K, Gadalla F, Abramovitz S, Garrett KA. Rectal Prolapse Repair with Abdominal Fixation Under Sedation and Local or Epidural Anesthesia: Prospective Pilot Study in 10 Elderly Subjects. J Laparoendosc Adv Surg Tech A 2020; 31:911-916. [PMID: 33090077 DOI: 10.1089/lap.2019.0804] [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: 11/12/2022] Open
Abstract
Background: Rectal prolapse (RP) is primarily a disease of the elderly, where treatment may be associated with significant postoperative morbidity including that related to anesthesia. Objective: The aim of this study was to evaluate the safety and feasibility of a novel abdominal approach to RP repair under sedation and local anesthesia and to assess short- and long-term clinical outcomes in elderly patients (>70 years). Design Settings: This is a prospective pilot study with 10 patients using a novel RP repair. The anesthesia type was local or epidural with sedation. Follow-up was done at 30 days, 12, and 24 months. Patients: Patients were men and women >70 years of age with RP. Main Outcome Measures: (1) Feasibility: successful completion of RP repair using the novel abdominal approach with laparoscopic assistance. (2) Safety: safety was measured by the incidence of the intraoperative complications (bowel perforation, organ injury, and bleeding requiring blood transfusion). (3) Sedation and local anesthesia feasibility: surgery was safely completed without patient intubation. Results: Ten female patients >70 years of age underwent RP repair using the novel abdominal approach. General anesthesia was not required in any of the 10 patients. Two patients recurred within 6 months. One of the patients with recurrence of RP subsequently underwent laparoscopic rectopexy, and the other was minimal and required no further treatment. One mortality occurred at 3 months unrelated to the procedure. No other anesthetic or surgical intraoperative and postoperative complications were observed. Limitations: This is a single-institution pilot study. Conclusions: Abdominal RP repair under sedation and regional anesthesia appears feasible and safe in elderly patients and may, in the future, provide an effective alternative to current treatment options for RP, avoiding general anesthesia. ClinicalTrial.gov registration number: NCT01980043.
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Affiliation(s)
- Jeffrey W Milsom
- Section of Colorectal Surgery, Department of Surgery, and Weill Cornell Medicine/NewYork-Presbyterian, New York, New York, USA
| | - Koianka Trencheva
- Section of Colorectal Surgery, Department of Surgery, and Weill Cornell Medicine/NewYork-Presbyterian, New York, New York, USA
| | - Farida Gadalla
- Department of Anesthesiology, Weill Cornell Medicine/NewYork-Presbyterian, New York, New York, USA
| | - Sharon Abramovitz
- Department of Anesthesiology, Weill Cornell Medicine/NewYork-Presbyterian, New York, New York, USA
| | - Kelly A Garrett
- Section of Colorectal Surgery, Department of Surgery, and Weill Cornell Medicine/NewYork-Presbyterian, New York, New York, USA
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Xie Y, Fan Y, Yang C, Wan R, Cheng X, Yang X, Hu Y, Deng C. Efficacy and safety of Buzhong Yiqi decoction combined with surgery for rectal prolapse: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22732. [PMID: 33031344 PMCID: PMC7544326 DOI: 10.1097/md.0000000000022732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is extremely easy for rectal prolapse to relapse with surgery alone. Clinical practice indicates that Buzhong Yiqi decoction combined with surgery has certain therapeutic advantages, while there is a lack of evidence-based medicine support. This study aimed to systematically investigate the efficacy and safety of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse. METHODS The English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure [CNKI], Wanfang, China Science and Technology Journal Database [VIP], China Biology Medicine disc) were searched by computer. In addition, Baidu Scholar and Google Scholar were searched manually. A randomized controlled clinical study of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse was performed from the establishment of databases to September 2020. Two investigators independently conducted data extraction and assessed the literature quality of the included studies. The Revman5.3 software was used for meta-analysis of the included literature. RESULTS The efficacy and safety of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse were evaluated in terms of efficiency, symptom score, recurrence rate, adverse reaction rate, and so on. CONCLUSIONS Thisstudy provides reliable evidence-based support for the clinical application of Buzhong Yiqi decoction combined with surgery in the treatment of rectal prolapse. OSF REGISTRATION NUMBER DOI: 10.17605/OSF.IO/K3PJX.
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Affiliation(s)
- Yanpeng Xie
- Chengdu Anorectal Hospital, Chengdu, Sichuan Province
| | - Yihua Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion
| | - Chen Yang
- Tianjin University of Traditional Chinese Medicine
| | - Renhong Wan
- Tianjin University of Traditional Chinese Medicine
| | - Xiaoen Cheng
- School of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu
| | | | - Yuanzhang Hu
- School of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu
| | - Changyou Deng
- Longwang Town Central Hospital, Guangyuan, Sichuan Province, China
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El-Dhuwaib Y, Pandyan A, Knowles CH. Epidemiological trends in surgery for rectal prolapse in England 2001-2012: an adult hospital population-based study. Colorectal Dis 2020; 22:1359-1366. [PMID: 32346972 DOI: 10.1111/codi.15094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/02/2020] [Indexed: 02/08/2023]
Abstract
AIM To analyse trends in admission and surgery for rectal prolapse in adults in England between 2001 and 2012 as well as prolapse reoperation rates. METHOD Analysis of data derived from a comparative longitudinal population-based cohort study using Hospital Episode Statistics (HES). RESULTS During the study period, a total of 25 238 adults, of median age 73 [interquartile range (IQR: 58-83] years, underwent a total of 29 379 operations for rectal prolapse (mean: 2662 per annum). The female to male ratio of this group of patients was 7:1. Median length of hospital stay was 3 (IQR: 1-7) days with an overall in-hospital mortality rate of 0.9%. Total number of admissions (4950 in 2001/2002 vs 8927 in 2011/2012) and of patients undergoing prolapse surgery (2230 in 2001/2002 vs 2808 in 2011/2012) significantly increased over the study period (P < 0.001 for trends). The overall increase in prolapse surgery (of 33% overall and of 44% for elective procedures) was dwarfed by an increase in popularity of laparoscopic surgery (of 15-fold). Overall prolapse reoperation rate was 12.7%. The lowest recurrence rate was observed for elective open resection (9.1%) but this had the highest mortality (1.9%). Laparoscopic and perineal fixations were also associated with low reoperation rates (< 11%) and the lowest mortality rates, of 0.3%, when these procedures were elective. These data refute a trend towards subspecialization (by surgeon or hospital) during the study period. CONCLUSION Admissions for rectal prolapse increased in England between 2001 and 2012, together with increases in rectal prolapse surgery. Surgical decision making has changed over this period and may be reflected in outcome.
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Affiliation(s)
- Y El-Dhuwaib
- East Sussex Healthcare NHS Trust, East Sussex, UK.,FMHS, Keele University, Stoke-on-Trent, UK
| | - A Pandyan
- FMHS, Keele University, Stoke-on-Trent, UK
| | - C H Knowles
- Blizard Institute, Barts and London SMD, Queen Mary University of London, London, UK
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Loh KC, Umanskiy K. Ventral Rectopexy. Clin Colon Rectal Surg 2020; 34:62-68. [PMID: 33536851 DOI: 10.1055/s-0040-1714288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rectal prolapse is a debilitating condition that often results in impaired quality of life. Posterior compartment defects including rectal prolapse and rectal intussusception are often associated with middle and anterior compartment prolapse and require a multicompartment approach to treatment. In recent years, ventral rectopexy, with or without sacrocolpopexy for combined middle compartment prolapse, has emerged as a safe and effective method of treatment for rectal prolapse. In this article, we aim to review the etiology of rectal prolapse and intussusception, describe the indications and workup for surgery, discuss technical aspects of ventral rectopexy alone and in combination with sacrocolpopexy, review potential surgical complications, and describe the reported outcomes of the surgery.
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Affiliation(s)
- Kenneth C Loh
- Department of General Surgery, Kaiser Permanente, San Francisco, California
| | - Konstantin Umanskiy
- Department of Surgery, Section of Colon and Rectal Surgery, The University of Chicago, Chicago, Illinois
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Rectal prolapse surgery in males and females: An ACS NSQIP-based comparative analysis of over 12,000 patients. Am J Surg 2020; 220:697-705. [DOI: 10.1016/j.amjsurg.2020.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/10/2020] [Indexed: 12/11/2022]
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Speed JM, Zhang CA, Gurland B, Enemchukwu E. Trends in the Diagnosis and Management of Combined Rectal and Vaginal Pelvic Organ Prolapse. Urology 2020; 150:188-193. [PMID: 32439552 DOI: 10.1016/j.urology.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the rates of surgical repair of comorbid rectal prolapse (RP) and pelvic organ prolapse (POP) over time in a large population-based cohort. MATERIALS AND METHODS We queried Optum, a national administrative claims database, from 2003 to 2017. We evaluated female patients age 18 or older with a diagnosis of POP and/or RP. Sociodemographic characteristics, comorbidities, and rates of procedures were collected. RESULTS We identified 481,051 women diagnosed with RP and/or POP. Only 2.0% of women in the cohort had comorbid POP and RP. While 29.9% of women with RP had dual prolapse, only 2.1% of women with POP had both diagnoses. Overall, 25.8% of women had one or more surgical repairs. Surgical repairs were done in 26.0% of women with POP, 15.0% of women with RP, and 48.2% of women with comorbid POP/RP, though only 19.8% of patients with dual diagnoses had both RP and POP repairs. Over the study period, the rate of multidisciplinary surgical repairs increased by 2.7-fold. CONCLUSION The prevalence of comorbid RP and POP among women in our cohort is low (2.0%). Rates of multidisciplinary surgery have increased possibly due to the increased use of imaging, laparoscopic surgery, and awareness of the shared pathophysiology of the disease.
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Affiliation(s)
- Jacqueline M Speed
- Department of Urology, Stanford University Medical Center, Stanford, CA.
| | - Chiyuan Amy Zhang
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Brooke Gurland
- Department of General Surgery, Division of Colorectal Surgery, Stanford University Medical Center, Stanford, CA
| | - Ekene Enemchukwu
- Department of Urology, Stanford University Medical Center, Stanford, CA
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Enterocele Presenting as Anterior Rectal Prolapse: Resolution with Vaginal Repair. Case Rep Obstet Gynecol 2020; 2020:1796365. [PMID: 31976100 PMCID: PMC6961605 DOI: 10.1155/2020/1796365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/02/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
An enterocele is a pelvic hernia formed from the separation of endopelvic fascia, associated with the posterior or anterior vaginal fornix, and most commonly located in the posterior superior vaginal segment. Rectal prolapse is a debilitating condition in which the mucosa of the rectum protrudes circumferentially from the anus. Surgical repair is the recommended treatment for rectal prolapse, and though there are many different surgical options, there is no consensus on which approach is best. We present a case of anterior rectal prolapse due to enterocele which was treated by correction of enterocele with a vaginal approach and propose some clinical features and diagnostic techniques that may distinguish this entity from traditional rectal prolapse.
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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.
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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.
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Hashida H, Sato M, Kumata Y, Mizumoto M, Kondo M, Kobayashi H, Yamamoto T, Terajima H, Kaihara S. Usefulness of laparoscopic posterior rectopexy for complete rectal prolapse: A cohort study. Int J Surg 2019; 72:109-114. [PMID: 31704417 DOI: 10.1016/j.ijsu.2019.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/24/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transabdominal rectopexy for complete rectal prolapse reportedly yields more definitive results than transperineal surgery. Recently, minimally invasive laparoscopic rectopexy has become a popular treatment option for patients with rectal prolapse. Herein, we describe our surgical procedure for correction of rectal prolapse. We further aimed to perform a comparative assessment between perioperative outcomes achieved with open and laparoscopic applications of this technique. MATERIALS AND METHODS In this cohort study, 65 patients underwent posterior rectopexy (laparoscopic, 50; open, 15) between April 2008 and December 2015. The basic procedure consisted of posterior rectopexy using mesh fixation (modified Wells' method). We assessed and compared perioperative outcomes (duration of surgery and hospitalization, complication rates, blood-loss, degree of fecal incontinence) of laparoscopic and open rectopexy. Furthermore, pre- and post-operative urinary incontinence was measured (using pad test, questionnaire) and compared to determine the effects of the procedure on pelvic organ function. A p-value <0.05 indicated statistical significance. RESULTS The mean operative time of the laparoscopic and open procedures was 127 and 83.6 min, respectively. The amount of blood-loss was negligible and 77 (range, 18-200) g with the laparoscopic and open approaches, respectively. The mean duration of hospitalization was 4.2 and 7.2 days for the former and latter procedures, respectively (p < 0.05). Rectal prolapse and fecal incontinence (evaluated using Wexner's score) diminished in all patients. Urinary incontinence also decreased postoperatively. There were no recurrences of rectal prolapse. CONCLUSION Laparoscopic rectopexy can be safely performed in older patients to achieve early postoperative ambulation and significantly shorten the hospital-stay. It may therefore be considered an effective treatment for complete rectal prolapse and urinary dysfunction.
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Affiliation(s)
- Hiroki Hashida
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Masato Sato
- Department of Pediatric Surgery, Kitano Hospital, Osaka, Japan
| | - Yukiko Kumata
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Motoko Mizumoto
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroyuki Kobayashi
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takehito Yamamoto
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Ng SC, Lior T. Unusual presentation of rectal prolapse. ANZ J Surg 2019; 90:621-622. [PMID: 31081277 DOI: 10.1111/ans.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Suat Chin Ng
- Colorectal Unit, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Tali Lior
- Colorectal Unit, Ballarat Base Hospital, Ballarat, Victoria, Australia
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Clinical Outcome and Surgical Technique of Laparoscopic Posterior Rectopexy Using the Mesh With Anti-adhesion Coating. Surg Laparosc Endosc Percutan Tech 2019; 29:e41-e44. [PMID: 30855403 DOI: 10.1097/sle.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We herein present an innovative technique of laparoscopic posterior mesh rectopexy (LPMR) for full-thickness rectal prolapse and report the clinical outcomes in our institution. Ten consecutive patients who were treated with our latest LPMR technique using mesh with an anti-adhesion coating from June 2014 to May 2017 were retrospectively analyzed. All patients were women with a mean age of 63.6 years (range, 39 to 82 y). The median operative time and blood loss volume were 197.5 minutes (range, 156 to 285 min) and 0 mL (range, 0 to 152 mL), respectively. No perioperative complications occurred, including surgical site infection, pneumonia, urinary dysfunction, and intestinal obstruction. The median follow-up duration was 768 days (range, 396 to 1150 d). During the follow-up, the cumulative incidence of full-thickness rectal prolapse and any mesh-related complications was 0. It may be possible to eliminate retroperitoneal closure using a mesh with an anti-adhesion coating. Our LPMR technique appears safe and acceptable.
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Daniel VT, Davids JS, Sturrock PR, Maykel JA, Phatak UR, Alavi K. Getting to the bottom of treatment of rectal prolapse in the elderly: Analysis of the National Surgical Quality Improvement Program (NSQIP). Am J Surg 2019; 218:288-292. [PMID: 30803700 DOI: 10.1016/j.amjsurg.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/30/2019] [Accepted: 02/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many approaches to treat rectal prolapse exists, yet little is known regarding their safety in the elderly. METHOD NSQIP (2008-2014) was queried to identify patients ≥ 70 years who underwent open rectopexy (OR), laparoscopic rectopexy (LR) and perineal rectosigmoidectomy (PR). Patients were selected using NSQIP's estimated probability of morbidity of ≥50th percentile. Outcomes were 30-day mortality and a composite: mortality, septic shock and organ space abscess and fascial dehiscence. RESULTS Overall, 1361 patients underwent OR(18%), LR(15%) and PR(67%) with no difference in outcomes among 3 approaches. After adjustment of other factors, the composite was associated with PR [OR 2.5, CI 1.1, 5.7] and not with older age [OR 1.3, (CI) 0.7, 2.4]. From 2008 to 2014, LR increased from 11% to 19%; and PR decreased from 75% to 72%. CONCLUSIONS All 3 surgical approaches carry low morbidity among the sick, elderly. PR remains the predominant approach nationally. A paradigm shift accepting the safety of abdominal approaches is needed. There should also be less focus on age in the decision-making process of surgical treatment.
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Affiliation(s)
- Vijaya T Daniel
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Jennifer S Davids
- Division of Colorectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Paul R Sturrock
- Division of Colorectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Justin A Maykel
- Division of Colorectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Uma R Phatak
- Division of Colorectal Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Karim Alavi
- Division of Colorectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
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Trompetto M, Tutino R, Realis Luc A, Novelli E, Gallo G, Clerico G. Altemeier's procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients. BMC Surg 2019; 19:1. [PMID: 30606166 PMCID: PMC6318906 DOI: 10.1186/s12893-018-0463-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier’s rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. Methods Peri-operative data on 43 consecutive female patients were reviewed. At follow-up any change in pelvic floor function and recurrences were determined. Thirty four patients were assessed at a median interval of 49 (2–135) months, six being deceased for reason not related to the prolapse and three lost to follow-up. Results Post-operative complications at 30 days occurred in 18 patients (38%). Major complication occurred in only one patient that was pneumonia with lung failure. Major complications were not related to the ASA score, BMI or age [average age 76.4]. There was no post-operative mortality at 30 days. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48 months of 40%. There were no statistically significant differences between patients with and without recurrence regarding age (p = 0.188), BMI (p = 0.864), ASA score (p = 0.433), previously repaired prolapse (p = 0.398), previous hysterectomy (p = 0.705), length of resected bowel (p = 0.126), and levatorplasty (p = 0.304). Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p = 0.012). Conclusions Altemeier’s procedure had in our series low complications rate and no mortality. It offered improved evacuation in constipated patients while didn’t improve fecal and urinary continence. Recurrence of prolapse was 40% at four years. Electronic supplementary material The online version of this article (10.1186/s12893-018-0463-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mario Trompetto
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
| | - Roberta Tutino
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy. .,Dept. of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
| | | | - Eugenio Novelli
- Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy
| | - Gaetano Gallo
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy.,Department of General Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Clerico
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
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Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol 2018; 22:919-931. [PMID: 30554284 DOI: 10.1007/s10151-018-1908-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/09/2018] [Indexed: 12/15/2022]
Abstract
Rectal prolapse, rectal procidentia, "complete" prolapse or "third-degree" prolapse is the full-thickness prolapse of the rectal wall through the anal canal and has a significant impact on quality of life. The incidence of rectal prolapse has been estimated to be approximately 2.5 per 100,000 inhabitants with a clear predominance among elderly women. The aim of this consensus statement was to provide evidence-based data to allow an individualized and appropriate management and treatment of complete rectal prolapse. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL and EMBASE. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Gastroenterology's Chronic Constipation Task Force. Five evidence levels were defined. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.,Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Pellino
- Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Unit of General Surgery, Università della Campania "Luigi Vanvitelli", Naples, Italy.,Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain
| | - R Ghiselli
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - A Infantino
- Department of Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - F Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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Nguyen XH, Pham PK, Steinhagen RM, Pham GA, Le NH, Nguyen NA. Case series: Incarcerated massive rectal prolapse successfully treated with Altemeier's procedure. Int J Surg Case Rep 2018; 51:309-312. [PMID: 30360238 PMCID: PMC6170932 DOI: 10.1016/j.ijscr.2018.08.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
We review in the literature, and find out there are very few incarceration rectal prolapse. There is not clear indication of management for these cases. Our two cases, both were operated by Altemeier’s procedure, but creating the colostomy is performed only in one case. When do we need to create diverting colostomy? It depends on patient condition, anastomosis condition and surgeon’s skill. These two different cases give us the chance to show we should manage this uncommon condition individually.
Introduction Incarceration and necrosis of rectal prolapse is rare but when it occurs it requires urgent management. Perineal rectosigmoidectomy (Altemeier’s procedure) may be a reasonable approach for the treatment of this condition. In some cases, a diverting stoma may be necessary. Methods We report two cases of incarcerated massive rectal prolapse, one of which also manifested tissue necrosis, that were successfully treated with perineal rectosigmoidectomy. In one case a diverting colostomy was required. Both patients recovered uneventfully. Results A literature review was performed to determine the optimal management of incarcerated and necrotic rectal prolapse, and to determine the indication for fecal diversion. Conclusion Perineal rectosigmoidectomy (Altemeier’s procedure) can be utilized in emergency circumstances and, in our experience, the procedure was both safe and effective. The need for fecal diversion depends on the condition of the patient and the experience and judgement of the surgeon.
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Affiliation(s)
- Xuan Hung Nguyen
- Viet Duc University Hospital, 40 Trang Thi, Hoan Kiem, Hanoi, Viet Nam.
| | - Phuc Khanh Pham
- Viet Duc University Hospital, 40 Trang Thi, Hoan Kiem, Hanoi, Viet Nam.
| | - Randolph M Steinhagen
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States.
| | - Gia Anh Pham
- Viet Duc University Hospital, 40 Trang Thi, Hoan Kiem, Hanoi, Viet Nam.
| | - Nhat Huy Le
- Viet Duc University Hospital, 40 Trang Thi, Hoan Kiem, Hanoi, Viet Nam.
| | - Ngoc Anh Nguyen
- Viet Duc University Hospital, 40 Trang Thi, Hoan Kiem, Hanoi, Viet Nam.
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Abstract
PURPOSE Rectal prolapse is a common condition, with conflicting opinions on optimal surgical management. Existing literature is predominantly composed of case series, with a dearth of evidence demonstrating current, real-world practice. This study investigated recent national trends in management of rectal prolapse in the Republic of Ireland (ROI). METHODS This population analysis used a national database to identify patients admitted in the ROI primarily for the management of rectal prolapse, as defined by the International Classification of Diseases, 10th Revision (ICD-10). Demographics, procedures, comorbidities, and outcomes were obtained for patients admitted from 2005 to 2015 inclusive. RESULTS There were 2648 admissions with a primary diagnosis of rectal prolapse; 39.3% underwent surgical correction. The majority were treated with either a perineal resection (47.2%) or an abdominal rectopexy ± resection (45.1%). The population-adjusted rate of operative intervention increased over the study period, from 25 to 42 per million (p < 0.001), with no change in the mean age of patients over time (p = 0.229). The application of a laparoscopic approach increased over time (p = 0.001). Patients undergoing an abdominal rectopexy were younger than those undergoing a perineal procedure (64.1 ± 17.3 versus 75.2 ± 15.5 years, p < 0.001) despite having a similar Charlson Comorbidity Index (p = 0.097). The mortality rate for elective repair was 0.2%. CONCLUSIONS Despite the popularization of ventral mesh rectopexy over the study period, perineal resection Delorme's procedure remains the most common procedure employed for the correction of rectal prolapse in the ROI, with specific approach determined by age.
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Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Iyomasa S. Laparoscopic low anterior resection for rectal cancer with rectal prolapse: a case report. J Med Case Rep 2018; 12:28. [PMID: 29402298 PMCID: PMC5799977 DOI: 10.1186/s13256-017-1555-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rectal cancer with rectal prolapse is rare, described by only a few case reports. Recently, laparoscopic surgery has become standard procedure for either rectal cancer or rectal prolapse. However, the use of laparoscopic low anterior resection for rectal cancer with rectal prolapse has not been reported. CASE PRESENTATION A 63-year-old Japanese woman suffered from rectal prolapse, with a mass and rectal bleeding for 2 years. An examination revealed complete rectal prolapse and the presence of a soft tumor, 7 cm in diameter; the distance from the anal verge to the tumor was 5 cm. Colonoscopy demonstrated a large villous tumor in the lower rectum, which was diagnosed as adenocarcinoma on biopsy. We performed laparoscopic low anterior resection using the prolapsing technique without rectopexy. The distal surgical margin was more than 1.5 cm from the tumor. There were no major perioperative complications. Twelve months after surgery, our patient is doing well with no evidence of recurrence of either the rectal prolapse or the cancer, and she has not suffered from either fecal incontinence or constipation. CONCLUSIONS Laparoscopic low anterior resection without rectopexy can be an appropriate surgical procedure for rectal cancer with rectal prolapse. The prolapsing technique is useful in selected patients.
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Affiliation(s)
- Ryusei Yamamoto
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hideo Matsubara
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hirokazu Kaneko
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Shinsuke Iyomasa
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
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Davies D, Bailey J. Diagnosis and Management of Anorectal Disorders in the Primary Care Setting. Prim Care 2017; 44:709-720. [PMID: 29132530 DOI: 10.1016/j.pop.2017.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anorectal disorders are very common among a wide population of patients. Because patients may be embarrassed about the anatomic location of their symptoms, they may present to care late in the course of their illness. Care should be taken to validate patient concerns and normalize fears. This article discusses the diagnoses and management of common anorectal disorders among patients presenting to a primary care physician.
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Affiliation(s)
- Danielle Davies
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA; Department of Family Medicine, Family Medicine Residency of Idaho, 777 North Raymond Street, Boise, ID 83702, USA.
| | - Justin Bailey
- Department of Family Medicine, Family Medicine Residency of Idaho, 777 North Raymond Street, Boise, ID 83702, USA; Department of Family Medicine, University of Washington School of Medicine, 331 North East Thornton Place, Seattle, WA 98125, USA
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