1
|
Emile SH, Khan SM, Garoufalia Z, Silva-Alvarenga E, Gefen R, Horesh N, Freund MR, Wexner SD. A network meta-analysis of surgical treatments of complete rectal prolapse. Tech Coloproctol 2023; 27:787-797. [PMID: 37150800 DOI: 10.1007/s10151-023-02813-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI). METHODS A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI. RESULTS Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47 months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant. CONCLUSIONS Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.
Collapse
Affiliation(s)
- S H Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - S M Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Z Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - E Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - R Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - N Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - M R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA.
| |
Collapse
|
2
|
Sseruwagi TM, Lewis CR. Rectal prolapse associated with intussusception and malignancy. J Surg Case Rep 2023; 2023:rjad363. [PMID: 37332665 PMCID: PMC10271216 DOI: 10.1093/jscr/rjad363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023] Open
Abstract
Rectal prolapse associated with intussusception is when the intestine slides into the adjacent part causing a protrusion through the anus. It is also referred to as recto-anal intussusception or trans-anal protrusion of intussusception. Pre-operative diagnosis of the associated intussusception is usually hard to make. We present a case of a patient who presented with a rectal prolapse. Surgical exploration also noted an intussusception and rectal malignancy. We demonstrate the importance of surgical management in patients with rectal prolapse to avoid progression of a malignancy or intussusception.
Collapse
Affiliation(s)
| | - Catherine R Lewis
- Correspondence address. East Tennessee State University, Department of Surgery, Johnson City, TN, USA. Tel: 1-678-427-9329; Fax: 1-855-275-8432; E-mail:
| |
Collapse
|
3
|
Tuncer A, Akbulut S, Ogut Z, Sahin TT. Management of irreducible giant rectal prolapse: A case report and literature review. Int J Surg Case Rep 2021; 88:106485. [PMID: 34678595 PMCID: PMC8536514 DOI: 10.1016/j.ijscr.2021.106485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Rectal prolapse is defined as herniation of mucosa or full-thickness of the rectal wall through the anal canal. It has a negative impact on the quality of life and therefore, it should be treated as soon as diagnosis is confirmed. Definitive treatment is surgical and it depends on the clinical characteristics of the patients. We aimed to present the one of the largest rectal prolapse case in the literature. CASE PRESENTATION A 32- years- old male patient with a history of severe constipation was admitted to our institution with a giant rectal prolapse. The prolapsed segment was incarcerated, and a semi-emergent procedure was performed though a mid-line laparotomy. The sigmoid colon was redundant and therefore sigmoid colon and the upper two thirds of rectum were resected and end to end anastomosis was performed. The patient was discharged postoperative day 7 without any complication. CLINICAL DISCUSSION Rectal prolapse has a negative impact on quality of life and should be operated as soon as the diagnosis is reached. The surgical strategy depends on the compliance of the patient as well as the experience of the surgical team. CONCLUSION Clinicians should know that chronic constipation together with other factors may result in rectal prolapse which may become disproportionately large in size.
Collapse
Affiliation(s)
- Adem Tuncer
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
| | - Zeki Ogut
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Tevfik Tolga Sahin
- Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| |
Collapse
|
4
|
Albeladi AM, Odeh A, AlAli AH, Alkhars AM, Boumarah K, Al Ghadeer HA, Alsaied SA, Omrani A, Ahmed K. Incarcerated Rectal Procidentia: A Case Report and Review. Cureus 2021; 13:e17135. [PMID: 34532173 PMCID: PMC8435057 DOI: 10.7759/cureus.17135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Rectal procidentia is an uncommon perineal disease that is rare in males. There is no specific medical role in treatment of rectal procidentia and surgical intervention is the treatment of choice. Various surgical approaches have been performed, but there is no consensus on which procedure is most effective in terms of patient condition, recurrence rate, bowel function, and risk. This case presentation of a healthy male patient with experience of uncomplicated reducible rectal prolapse and a history of chronic constipation. Presented with complicated rectal prolapse in the presence of incarcerated rectal prolapse after a failed trial with conservative maneuvers, he ended up with abdominal approach sigmoidectomy and posterior mesh rectopexy.
Collapse
Affiliation(s)
| | - Ahmad Odeh
- General Surgery, Prince Saud Bin Jalawy Hospital, Al Ahsa, SAU
| | - Aminah H AlAli
- General Surgery, Prince Saud Bin Jalawy Hospital, Al Ahsa, SAU
| | | | - Kawther Boumarah
- Medicine, King Faisal Univesity, College of Medicine, Dammam, SAU
| | | | - Sara A Alsaied
- General and Colorectal Surgery, Prince Saud Bin Jalawy Hospital, Al Mubarraz, SAU
| | - Ammar Omrani
- Laparoscopic Surgery, Prince Saud Bin Jalawy Hospital, Al Mubarraz, SAU
| | - Khadir Ahmed
- General and Colorectal Surgery, Prince Saud Bin Jalawy Hospital, Al Ahsa, SAU
| |
Collapse
|
5
|
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
|
6
|
Ciesielski P, Szczotko M, Kołodziejczak M. Surgical Treatment of Full-Thickness Rectal Prolapse (FTRP): a Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02439-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Tomochika S, Suzuki N, Yoshida S, Fujii T, Tokumitsu Y, Shindo Y, Iida M, Takeda S, Hazama S, Nagano H. Laparoscopic Sutureless Rectopexy Using a Fixation Device for Complete Rectal Prolapse. Surg Laparosc Endosc Percutan Tech 2021; 31:608-612. [PMID: 34618787 PMCID: PMC8500361 DOI: 10.1097/sle.0000000000000960] [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: 11/09/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete rectal prolapse (CRP) commonly affects the daily life of older people and has no established operative treatment approach. We describe our simple method of laparoscopic, sutureless rectopexy, involving rectal mobilization (along with its peritoneum bilaterally) and fixation to the sacral promontory using a fixation device. We also present an analysis of short-term outcomes in patients treated using this procedure. MATERIALS AND METHODS We retrospectively evaluated 62 patients with CRP, who underwent a laparoscopic rectopexy via tack fixation, between 2004 and 2017. The peritoneum was widely attached near the site of peritoneal reflection, as in rectal cancer surgery. The hypogastric nerve was carefully detached from the front of the sacrum. Keeping the nerve intact, we lifted and mobilized the dissected rectum cranially towards the promontory, and the rectal peritoneum was affixed to the sacrum by applying 2 to 3 fixed tacks bilaterally, using a fixation device. RESULTS The median age of the study group was 80 (10 to 91) years. All procedures were successful without serious intraoperative complications; only 1 patient required conversion to open surgery. Median values for operative duration, intraoperative blood loss, and postoperative period of hospitalization were 177 (125 to 441) minutes, 5 (0 to 275) mL, and 7 (3 to 17) days, respectively. Only 6 (9.7%) patients experienced recurrence during the follow-up period. CONCLUSION Laparoscopic tacking rectopexy performed using a fixation device for repairing CRP is a simple, safe, and sutureless procedure with no severe complications or mortality.
Collapse
Affiliation(s)
- Shinobu Tomochika
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| | - Nobuaki Suzuki
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| | - Shin Yoshida
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| | - Toshiyuki Fujii
- Shunan Memorial Hospital, Shunan, Yamaguchi Prefecture, Japan
| | - Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| | - Michihisa Iida
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| | - Shoichi Hazama
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
- Department of Translational Research and Developmental Therapeutics against Cancer, Yamaguchi University Faculty of Medicine, Ube
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Yuda Handaya A, Fauzi AR, Werdana VAP, Andrew J. Anal encirclement using polypropylene mesh for high grade complete full-thickness rectal prolapse: A case report. Int J Surg Case Rep 2019; 66:80-84. [PMID: 31812642 PMCID: PMC6906718 DOI: 10.1016/j.ijscr.2019.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Rectal prolapse is defined as protrusion of the rectal wall outside the anus caused by pelvic floor abnormalities. Operative repair is the only definitive treatment. Until now, there is no ideal surgical technique that can be used for all patients. PRESENTATION OF CASE Here we report two cases of full-thickness rectal prolapse in elderly patients with high-risk comorbidities. A seventy and seventy-eight-year-old female patients presented with complaints of anal lumps. Their past medical history was significant for arrhythmia, hypertensive heart disease, and pneumonia. The patients then underwent surgical repair with mesh cerclage. The patients were hospitalized for three days after surgery. On days 3, 7, 14, and 6 months after surgery the patients did not complain of any recurrence nor complications. DISCUSSION We did a modified anal encirclement surgical repair technique in managing these elderly patients with full-thickness rectal prolapse and high-risk comorbidities using mesh to prevent recurrence. CONCLUSIONS Anal encirclement technique using mesh can be considered as an alternative procedure for the treatment of full-thickness rectal prolapse in elderly patients with high-risk comorbidities because this procedure is simple, safe, causes fewer postoperative complications, and also can prevent recurrence.
Collapse
Affiliation(s)
- Adeodatus Yuda Handaya
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Aditya Rifqi Fauzi
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Victor Agastya Pramudya Werdana
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| | - Joshua Andrew
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Porwal A. TRRPCS: a new promising technique in the treatment of rectal prolapse - a video vignette. Colorectal Dis 2019; 21:493. [PMID: 30702797 DOI: 10.1111/codi.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
- A Porwal
- Healing Hands Clinic, Pune, India
| |
Collapse
|
12
|
Saraswati Y, Sedman P, Sedman R, Wibisono AP, Nente C, Simatupang MS, Singleton I, Pizzi R. Perineal repair of a full-thickness rectal prolapse in a wild Sumatran orangutan (Pongo abelii). J Med Primatol 2018; 48:65-67. [PMID: 30307044 DOI: 10.1111/jmp.12379] [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: 03/26/2018] [Revised: 05/27/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
A Delorme's procedure perineal surgical repair was performed in a wild adult male Sumatran orangutan (Pongo abelii) with a chronic persistent rectal prolapse that had been unsuccessfully treated by 6 previous surgeries. The rectal prolapse did not recur, and the orangutan was successfully released to the wild, 6 weeks later.
Collapse
Affiliation(s)
| | - Peter Sedman
- Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.,University of Hull, Hull, UK.,Wildlife Surgery International, Roslin, UK
| | - Rebecca Sedman
- Wildlife Surgery International, Roslin, UK.,University of Liverpool School of Veterinary Science, Neston, UK
| | | | | | | | - Ian Singleton
- Sumatran Orangutan Conservation Programme, Medan, Indonesia
| | - Romain Pizzi
- Wildlife Surgery International, Roslin, UK.,Royal Zoological Society of Scotland, Edinburgh, UK.,School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, UK
| |
Collapse
|
13
|
Simon R, Hollister K, Stanley JD, Lorenzo-Rivero S. J-Pouch Prolapse as a Late Complication of Restorative Proctocolectomy. Am Surg 2018. [DOI: 10.1177/000313481808400915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Remil Simon
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - Keith Hollister
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - J. Daniel Stanley
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - Shauna Lorenzo-Rivero
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| |
Collapse
|
14
|
Fowler GE, Baker DM, Lee MJ, Brown SR. A systematic review of online resources to support patient decision-making for full-thickness rectal prolapse surgery. Tech Coloproctol 2017; 21:853-862. [PMID: 29101494 PMCID: PMC5701040 DOI: 10.1007/s10151-017-1708-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022]
Abstract
Background The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery. Methods This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch–Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0). Results Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch–Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2–85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1–5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1–8). Conclusions Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.
Collapse
Affiliation(s)
- G E Fowler
- The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - D M Baker
- The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.,Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - M J Lee
- The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.,Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - S R Brown
- Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| |
Collapse
|
15
|
Abstract
Minimally invasive surgery is slowly taking over as the preferred operative approach for colorectal diseases. However, many of the procedures remain technically difficult. This article will give an overview of the state of minimally invasive surgery and the many advances that have been made over the last two decades. Specifically, we discuss the introduction of the robotic platform and some of its benefits and limitations. We also describe some newer techniques related to robotics.
Collapse
Affiliation(s)
- Matthew Whealon
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Vinci
- Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, Orange, California
| |
Collapse
|
16
|
Khromov Y, Sakran N, Becker A, Hershko D. Perineal approach in strangulated rectal prolapse: early surgical intervention. ANZ J Surg 2015; 87:E212-E213. [PMID: 25988375 DOI: 10.1111/ans.13105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Yakov Khromov
- Department of Surgery A, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nasser Sakran
- Department of Surgery A, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alexander Becker
- Department of Surgery A, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dan Hershko
- Department of Surgery A, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
17
|
Ammar SA, Kottb MBM. A novel percutaneous technique for treating complete rectal prolapse in adults. Surg Innov 2014; 22:240-4. [PMID: 25143439 DOI: 10.1177/1553350614546005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate a new technique for treating complete rectal prolapse in adults that combines injection sclerotherapy with anal encirclement. METHODS From 2008 to 2012, 20 patients were treated using combined perirectal injection sclerotherapy with anal encirclement. The primary outcome was recurrent full-thickness/mucosal rectal prolapse. RESULTS The mean age of the patients was 39 years. The mean operating time was 17 minutes. Patients had short hospital stays (range = 2-4 days) and rapid recovery with no serious postoperative complications. After a mean follow-up of 22 months, recurrence occurred in 9 patients, and was complete in 6 cases and mucosal in 3 patients. Recurrent mucosal prolapse was treated with a mucosectomy, while recurrent complete rectal prolapse was treated with an open rectopexy with mesh. CONCLUSION The combination of perirectal sclerotherapy and anal encirclement for treating complete rectal prolapse in adults is a simple and safe procedure with reasonable outcome. These findings call for confirmatory trials in larger series.
Collapse
|
18
|
Naalla R, Prabhu R, Shenoy R, Hendriks IGJ. Thiersch wiring as a temporary procedure in a haemodynamically unstable patient with an incarcerated rectal procidentia. BMJ Case Rep 2014; 2014:bcr-2014-204822. [PMID: 24957588 DOI: 10.1136/bcr-2014-204822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ravikiran Naalla
- Department of General Surgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Raghunath Prabhu
- Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Rajgopal Shenoy
- Department of General Surgery, Kasturba Medical College, Manipal, Karnataka, India
| | | |
Collapse
|
19
|
Hata F, Nishimori H, Ikeda S, Yajima T, Nishio A, Ishiyama Y. A simple and safe procedure to repair rectal prolapse perineally using stapling devices. Case Rep Gastroenterol 2014; 8:39-43. [PMID: 24574948 PMCID: PMC3934783 DOI: 10.1159/000354970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Rectal prolapses are not life-threatening, however the bleeding and fecal incontinence associated with them significantly erode quality of life and can cause concern among patients' caregivers in nursing homes. Many procedures have been reported that repair rectal prolapses, and the procedure used depends on the severity of the prolapse; however, the treatments are yet to be established. Here we report a simple and safe procedure to repair rectal prolapse perineally using stapling devices. We performed this procedure on 5 patients within a short time. All patients were followed up for over 24 months and none had any recurrences of their rectal prolapses. No complications occurred during the operations and postoperative periods. Most patients who have prolapses are elderly and fragile, so the treatment must be easy, safe, and rapid. While rectal prolapse is not life-threatening, the goal of treatment is to alleviate its symptoms. The procedure we describe is consistent with this concept. We suggest that this procedure, which uses surgical stapling devices, might be a better option for the treatment of complete rectal prolapse. We will continue to surgically correct complete rectal prolapses and investigate the long-term outcomes of the procedure.
Collapse
Affiliation(s)
- Fumitake Hata
- Department of Surgery, Sapporo Dohto Hospital, Sapporo, Japan
| | | | | | - Tomomi Yajima
- Department of Surgery, Sapporo Dohto Hospital, Sapporo, Japan
| | | | | |
Collapse
|
20
|
Formijne Jonkers HA, Draaisma WA, Wexner SD, Broeders IAMJ, Bemelman WA, Lindsey I, Consten ECJ. Evaluation and surgical treatment of rectal prolapse: an international survey. Colorectal Dis 2013; 15:115-9. [PMID: 22726304 DOI: 10.1111/j.1463-1318.2012.03135.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM Validated guidelines for the surgical and non-surgical treatment of rectal prolapse (RP) do not exist. The aim of this international questionnaire survey was to provide an overview of the evaluation, follow-up and treatment of patients with an internal or external RP. METHOD A 36-question questionnaire in English about the evaluation, treatment and follow-up of patients with RP was distributed amongst surgeons attending the congresses of the European Association for Endoscopic Surgery and the European Society of Coloproctology in 2010. It was subsequently sent to all the members of the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology by e-mail. RESULTS In all, 391 surgeons in 50 different countries completed the questionnaire. Evaluation, surgical treatment and follow-up of patients with RP differed considerably. For healthy patients with an external RP, laparoscopic ventral rectopexy was the most popular treatment in Europe, whereas laparoscopic resection rectopexy was favoured in North America. There was consensus only on frail and/or elderly patients with an external prolapse, with a preference for a perineal technique. After failure of conservative therapy, internal RP was mostly treated by laparoscopic resection rectopexy in North America. In Europe, laparoscopic ventral rectopexy and stapled transanal rectal resection were the most popular techniques for these patients. CONCLUSION The treatment of RP differs between surgeons, countries and regions. Guidelines are lacking. Prospective comparative studies are warranted that may result in universally accepted protocols.
Collapse
|
21
|
Abstract
BACKGROUND Previous studies showed that perineal stapled prolapse resection for external rectal prolapse improves continence and has short operation times and low complication rates. OBJECTIVE The aim of this study was to assess the midterm recurrence rates, functional results, and patient satisfaction after perineal stapled prolapse resection. DESIGN This was a retrospective study. SETTINGS : The study was performed at a tertiary hospital in Switzerland. PATIENTS From November 2007 to October 2011, a total of 56 consecutive patients were included in the study. MAIN OUTCOME MEASURES Recurrence rates, functional results according to the Wexner incontinence scale, and patient satisfaction using a visual analog scale were determined. RESULTS The median age was 78.5 years (range, 24-94 years), and 2 patients were men. Midterm results were available for 46 (82%) of 56 patients after a median follow-up of 25.5 months (range, 2-47 months). In 10 cases (18%) data collection was not possible. The recurrence rate at 3 years was 19.7% (95% CI 4.2%-32.7%). The Wexner incontinence score improved from a median of 14.5 presurgery to 4.0 points (p < 0.0001) after surgery. Twenty-five patients (54%) stated that their bowel movements were regular postoperatively. On a visual analog scale that measured satisfaction, the median patient score was 9 (range, 0-10), indicating high patient satisfaction. LIMITATIONS Limitations included the retrospective study design and the lack of clinical examinations to determine recurrence rates. CONCLUSIONS Perineal stapled prolapse resection is an alternative technique for treating rectal prolapse with a recurrence rate similar to the Altemeier-Mikulicz or Delorme procedures. This technique is a quick and reliable procedure for use in patients with advanced age.
Collapse
|
22
|
Köhler K, Stelzner S, Hellmich G, Lehmann D, Jackisch T, Fankhänel B, Witzigmann H. Results in the long-term course after stapled transanal rectal resection (STARR). Langenbecks Arch Surg 2012; 397:771-8. [PMID: 22350643 DOI: 10.1007/s00423-012-0920-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 01/11/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Stapled transanal rectal resection (STARR) has recently been recommended for patients with obstructed defecation caused by rectocele and rectal wall intussusception. Our study investigates the long-term results and predictive factors for outcome. METHODS Between November 2002 and February 2007, 80 patients (69 females) were operated on using the STARR procedure and included in the following study. Symptoms were defined according to the ROME II criteria. Preoperative assessment included clinical examination, colonoscopy, video defecography, and dynamic MRI. Preoperatively and during follow-up visits, we evaluated the Cleveland Constipation Score (CCS) to rate the severity of outlet obstruction and the Wexner Incontinence Score to rate anal incontinence. Patients were asked to judge the outcome of the operation as improved or poor/dissatisfied. We performed a univariate analysis for 11 patient- and disease-related factors to detect an association with outcome. RESULTS The median follow-up was 39 months (range 20-78). Major postoperative complications (one staple line insufficiency, one urosepsis, one prolonged urinary dysfunction with indwelling catheter) were found in 3.8%. The result after STARR procedure was a success in the long-term follow-up in 62 patients (77.5%), although the improvement did not persist in 15 patients (18.7%). The mean value of the CCS decreased significantly from 9.3 before surgery to 4.6 after 2 years and increased again slightly to 6.5 after 4-6 years. The Median Wexner Incontinence Score was 3.3 at baseline, but rose significantly to 6.0. However, a third of patients who reported deteriorated continence developed the symptoms 1-4 years after surgery. Of the factors investigated for the prediction of outcome, we could only identify the number of pelvic floor changes in defecography or dynamic MRI as being associated with the success of the operation. CONCLUSION Our study indicates that STARR is a safe procedure. A significant improvement of symptoms is to be expected, but this improvement may deteriorate with time. Patients' satisfaction is also associated with the occurrence of urge to defecate or incontinence. It remains difficult to predict outcome.
Collapse
Affiliation(s)
- Katrin Köhler
- Department of General and Visceral Surgery, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, 01067 Dresden, Germany.
| | | | | | | | | | | | | |
Collapse
|