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Chivate SD, Chougule MV, Chivate RS, Thakrar PH. Transanal rectopexy for external rectal prolapse. Ann Coloproctol 2022; 38:415-422. [PMID: 34674514 PMCID: PMC9816558 DOI: 10.3393/ac.2021.00262.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/14/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance. METHODS Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope. The procedure was supplemented by ultrasound-guided injection into the retrorectal space of a 2 mL solution of sodium tetradecyl sulfate/polidocanol mixed with air. Patients were functionally assessed before and 6 months after surgery with the Agachan constipation score and the Pescatori incontinence score. RESULTS There were 36 adult patients (26 males; the range of age, 23-92 years). The mean operative time was 27 minutes (range, 23-50 minutes) with no recorded perioperative morbidity. The median follow-up was 66 months (range, 48-84 months) with 1 (2.8%) recurrence presenting 18 months after surgery. There were 19 patients (52.8%) who presented with incontinence before surgery with 17 out of 19 (89.5%) reporting improvement in their Pescatori score (P<0.001). No patient had worsening incontinence and there were no de novo incontinence cases. Constipation scores improved in 23 out of 36 patients (63.9%) with a mean score reduction difference of 7.91 (P=0.001). CONCLUSION Transanal sutured sacral rectopexy with supplemental presacral sclerosant injection is safe and effective in the management of FTRP with sustained improvement in bowel function.
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Affiliation(s)
- Shantikumar Dhondiram Chivate
- Department of Surgery, Jeevan Jyot Hospital, Thane, India,Correspondence to: Shantikumar Dhondiram Chivate, M.S., FCPS, FAIS Department of Surgery, Jeevan Jyot Hospital, Mahatma Gandhi Rd, Naupada, Thane West, Thane, Maharashtra 400602, India Tel: +91-22-25380778, Fax: +91-22-25806456 E-mail:
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Laparoscopic resection rectopexy significantly affects preexisting urinary symptoms in female patients. Int J Colorectal Dis 2022; 37:1301-1307. [PMID: 35522318 PMCID: PMC9167198 DOI: 10.1007/s00384-022-04172-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE It has previously been noted that following rectopexy, some patients report changes in urinary function. So far, not much is known about the extent of such changes. This study assesses the effects of laparoscopic rectopexy on urinary symptoms. METHODS Prospective observational study with 100 consecutive female patients indicated for laparoscopic resection rectopexy. Stated urinary symptoms, pre- and postoperative "International Consultation on Incontinence Questionnaire" (ICIQ), supplemented by a "quality of life " (QoL) visual analogue scale, and residual urine measurements (RUM) were compared and correlated. RESULTS Postoperative QoL was significantly improved, irrespective of preexisting urinary symptoms. Twenty-four (24%) patients noticed improved urinary function. This corresponded with 42% of 45 patients who had positive preoperative ICIQ scores indicating preexisting urinary symptoms. Conversely, 14 (14%) patients noticed a postoperative increase of urinary complaints. The stated symptom change was only in part reflected by changes of the ICIQ scoring. Comparing ICIQ, 19 (19%) patients scored "better" postoperatively against 8% scoring worse; 5 of the 8 patients experienced "de novo" symptoms. The improved postoperative ICIQ scoring was highly significant. RUM did not sufficiently correlate to symptoms/ICIQ for any meaningful conclusion. CONCLUSIONS Laparoscopic resection rectopexy had predominantly beneficial and to a lesser extent detrimental effects on urinary symptoms. Effects were highly significant; they were mainly noted in patients with preexisting urinary complaints. So far, it is not possible to predict such effects on an individual basis. It appears likely that similar effects may be found for most of the alternative operative procedures for the treatment of rectal prolapse. Without more factual knowledge and awareness about the extent of potential "collateral" effects of pelvic floor repair procedures, expert guidance of patients appears limited.
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Laitakari KE, Mäkelä-Kaikkonen JK, Kairaluoma M, Junttila A, Kössi J, Ohtonen P, Rautio TT. Redo ventral rectopexy: is it worthwhile? Tech Coloproctol 2020; 25:299-307. [PMID: 33151385 PMCID: PMC7932956 DOI: 10.1007/s10151-020-02369-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP). METHODS This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life. RESULTS A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation. CONCLUSIONS Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.
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Affiliation(s)
- K E Laitakari
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland.
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland.
| | - J K Mäkelä-Kaikkonen
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
| | - M Kairaluoma
- Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - A Junttila
- Department of Surgery, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - J Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - P Ohtonen
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
| | - T T Rautio
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland
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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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Chavez J, Finsterbusch C, Olson C, Zimmern PE. Vaginal cuff perforation during robotic-assisted mesh recto-sacrocolpopexy. IJU Case Rep 2020; 3:83-85. [PMID: 32743477 PMCID: PMC7292113 DOI: 10.1002/iju5.12138] [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: 08/01/2019] [Accepted: 12/12/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION We report on the management of intraoperative vaginal cuff perforation during robotic-assisted mesh recto-sacrocolpopexy for vaginal vault prolapse with defecatory dysfunction. CASE PRESENTATION A 75-year-old woman with vaginal bulge and constipation was to undergo a joint robotic mesh recto-sacrocolpopexy. Intraoperatively, mesh was secured to the left posterior vaginal wall following dissection. Prior to contralateral suture placement, the vaginal cuff split open and exposed an end-to-end anastomotic sizer previously inserted in the vagina. Due to subsequent mesh erosion risk, we proceeded with vaginotomy closure with running and interrupted absorbable sutures, removal of mesh, direct suture rectopexy to the promontory, and enterocele defect correction by reapproximating the right and left wings of the peritoneum flaps over the rectum with running sutures. Patient reported satisfactory outcomes after 2 years. CONCLUSION We reviewed our experience with vaginal cuff perforation during robotic-assisted mesh recto-sacrocolpopexy prompting enterocele repair and rectopexy without mesh.
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Affiliation(s)
| | | | - Craig Olson
- UT Southwestern Medical CenterDallasTexasUSA
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Surgical Treatment of Rectal Prolapse: A 10-Year Experience at a Single Institution. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:164-170. [PMID: 35601372 PMCID: PMC8980170 DOI: 10.7602/jmis.2019.22.4.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022]
Abstract
Purpose Methods Results Conclusion
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Zawodnik A, Balaphas A, Buchs NC, Zufferey G, Robert-Yap J, Buhler LH, Roche B, Ris F. Does Surgical Approach in Pelvic Floor Repair Impact Sexual Function in Women? Sex Med 2019; 7:522-529. [PMID: 31521573 PMCID: PMC6963122 DOI: 10.1016/j.esxm.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Surgical routes used to correct complex pelvic floor disorders (CPFDs) may have a negative impact on women’s sexual function. Currently, there is no evidence concerning the impact of a specific surgical procedure on postoperative sexual function in women. Aim The aim of this study was to compare an abdominal approach with rectopexy and sacrocolpopexy to a perineal procedure with abdominal rectopexy, regarding female sexual function in cases of CPFDs. Methods Women who were operated for CPFDs between January 2003 and June 2010 were retrospectively asked to answer the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, the Miller Score of Incontinence, and a urinary incontinence frequency score. We also questioned them about their sexual function and satisfaction before and after the operation using visual analogic scores. Main Outcome Measure We compared the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 before and after the surgery in both groups, and we made an intragroup comparison. Results There were 334 women identified, but only 51 could be included. Globally, we found no statistically significant differences in terms of sexual function before and after surgery between the 25 groups. Intragroup comparison demonstrated that, within the perineal approach group, patients experienced a decrease in their sexual arousal after the procedure. The choice of surgical route for pelvic floor disorders does not seem to have an impact on the results of postoperative sexual function in women. This study adds to the limited literature on sexual outcomes of surgery for CPFD. It is limited principally due to its retrospective design and the small number of patients included. Conclusion Both surgical routes have very similar outcomes on most sexual questions. A perineal approach combined with abdominal rectopexy did, however, demonstrate a slight decrease in sexual arousal of the patients after the intervention. Zawodnik A, Balaphas A, Buchs NC, et al. Does Surgical Approach in Pelvic Floor Repair Impact Sexual Function in Women? Sex Med 2019;7:522–529.
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Affiliation(s)
- Astrid Zawodnik
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland.
| | - Alexandre Balaphas
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Nicolas Christian Buchs
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Guillaume Zufferey
- Department of General Surgery, Western Lemanic Hospitals Group (GHOL), Nyon, Switzerland
| | - Joan Robert-Yap
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland; Department of General Surgery, Western Lemanic Hospitals Group (GHOL), Nyon, Switzerland
| | - Leo H Buhler
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Bruno Roche
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
| | - Frédéric Ris
- Department of Visceral Surgery, Geneva University Hospitals (HUG) and Medical School, Geneva, Switzerland
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Hori T, Yasukawa D, Machimoto T, Kadokawa Y, Hata T, Ito T, Kato S, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Yoshimura T. Surgical options for full-thickness rectal prolapse: current status and institutional choice. Ann Gastroenterol 2018; 31:188-197. [PMID: 29507465 PMCID: PMC5825948 DOI: 10.20524/aog.2017.0220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/08/2017] [Indexed: 12/14/2022] Open
Abstract
Full-thickness rectal prolapse (FTRP) is generally believed to result from a sliding hernia through a pelvic fascial defect, or from rectal intussusception. The currently accepted cause is a pelvic floor disorder. Surgery is the only definitive treatment, although the ideal therapeutic option for FTRP has not been determined. Auffret reported the first FTRP surgery using a perineal approach in 1882, and rectopexy using conventional laparotomy was first described by Sudeck in 1922. Laparoscopy was first used by Bermann in 1992, and laparoscopic surgery is now used worldwide; robotic surgery was first described by Munz in 2004. Postoperative morbidity, mortality, and recurrence rates with FTRP surgery are an active research area and in this article we review previously documented surgeries and discuss the best approach for FTRP. We also introduce our institution's laparoscopic surgical technique for FTRP (laparoscopic rectopexy with posterior wrap and peritoneal closure). Therapeutic decisions must be individualized to each patient, while the surgeon's experience must also be considered.
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Affiliation(s)
- Tomohide Hori
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yoshio Kadokawa
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Toshiyuki Hata
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tatsuo Ito
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Shigeru Kato
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yusuke Kimura
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tsunehiro Yoshimura
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
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Abstract
BACKGROUND Information is needed on long-term functional results, sequelas, and outcome predictors for laparoscopic ventral mesh rectopexy. OBJECTIVE The purpose of this study was to evaluate long-term function postventral rectopexy in patients with external rectal prolapse or internal rectal prolapse in a large cohort and to identify the possible effects of patient-related factors and operative technical details on patient-reported outcomes. DESIGN This was a retrospective review with a cross-sectional questionnaire study. SETTINGS Data were collated from prospectively collected registries in 2 university and 2 central hospitals in Finland. PATIENTS All 508 consecutive patients treated with ventral rectopexy for external rectal prolapse or symptomatic internal rectal prolapse in 2005 to 2013 were included. INTERVENTIONS A questionnaire concerning disease-related symptoms and effect on quality of life was used. MAIN OUTCOME MEASURES Defecatory function measured by the Wexner score, the obstructive defecation score, and subjective symptom and quality-of-life evaluation using the visual analog scale were included. The effects of patient-related factors and operative technical details were assessed using multivariate analysis. RESULTS The questionnaire response rate was 70.7% (330/467 living patients) with a median follow-up time of 44 months. The mean Wexner scores were 7.0 (SD = 6.1) and 6.9 (SD = 5.6), and the mean obstructive defecation scores were 9.7 (SD = 7.6) and 12.3 (SD = 8.0) for patients presenting with external rectal prolapse and internal rectal prolapse. Subjective symptom relief was experienced by 76% and reported more often by patients with external rectal prolapse than with internal rectal prolapse (86% vs 68%; p < 0.001). Complications occurred in 11.4% of patients, and the recurrence rate for rectal prolapse was 7.1%. LIMITATIONS This study was limited by its lack of preoperative functional data and suboptimal questionnaire response rate. CONCLUSIONS Ventral mesh rectopexy effectively treats posterior pelvic floor dysfunction with a low complication rate and an acceptable recurrence rate. Patients with external rectal prolapse benefit more from the operation than those with symptomatic internal rectal prolapse. See Video Abstract at http://links.lww.com/DCR/A479.
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Yasukawa D, Hori T, Machimoto T, Hata T, Kadokawa Y, Ito T, Kato S, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Yoshimura T. Outcome of a Modified Laparoscopic Suture Rectopexy for Rectal Prolapse with the Use of a Single or Double Suture: A Case Series of 15 Patients. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:599-604. [PMID: 28555067 PMCID: PMC5459315 DOI: 10.12659/ajcr.905118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/20/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Surgery is considered to be a mainstay of therapy for full-thickness rectal prolapse (FTRP). Surgical procedures for FTRP have been described, but optimal treatment is still controversial. The aim of this report is to evaluate the safety and feasibility of a simplified laparoscopic suture rectopexy (LSR) in a case series of 15 patients who presented with FTRP and who had postoperative follow-up for six months. CASE REPORT Fifteen patients who underwent a modified LSR at our surgical unit from September 2010 were retrospectively evaluated. The mean age of the patients was 72.5±10.9 years. All 15 patients underwent general anesthesia, with rectal mobilization performed according to the plane of the total mesorectal excision. By lifting the mobilized and dissected rectum cranially to the promontorium, the optimal point for subsequent suture fixation of the rectum was marked. The seromuscular layer of the anterior right wall was then sutured to the presacral fascia using only one or two interrupted nonabsorbable polypropylene sutures. The mean operative time was 176.2±35.2 minutes, with minimal blood loss. No moderate or severe postoperative complications were observed, and there was no postoperative mortality. One patient (6.7%) developed recurrence of rectal prolapse one month following surgery. CONCLUSIONS The advantages of this LSR procedure for the management of patients with FTRP are its simplicity, safety, efficacy, and practicality and the potential for its use in patients who can tolerate general anesthesia.
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Kondo T, Tsuruta M, Hasegawa H, Okabayashi K, Shigeta K, Hayashida T, Kitagawa Y. The use of laparoscopic rectopexy to manage rectal prolapse with Pseudo-Meigs' syndrome in a 64-year-old female: a case report. Clin Case Rep 2017; 5:642-644. [PMID: 28469868 PMCID: PMC5412801 DOI: 10.1002/ccr3.918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 10/15/2016] [Accepted: 02/19/2017] [Indexed: 01/12/2023] Open
Abstract
We report a rare case of rectal prolapse with Pseudo‐Meigs’ syndrome in which laparoscopic bilateral oophorectomy and rectopexy were performed simultaneously and resulted in improved quality of life due to the loss of ascites and the repair of rectal prolapse. Laparoscopic surgery is feasible for rectal prolapse with Pseudo‐Meigs’ syndrome.
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Affiliation(s)
- Takayuki Kondo
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Masashi Tsuruta
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | | | - Koji Okabayashi
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Kohei Shigeta
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Tetsu Hayashida
- Department of Surgery Keio University School of Medicine Tokyo Japan
| | - Yuko Kitagawa
- Department of Surgery Keio University School of Medicine Tokyo Japan
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Yang SJ, Yoon SG, Lim KY, Lee JK. Laparoscopic Vaginal Suspension and Rectopexy for Rectal Prolapse. Ann Coloproctol 2017; 33:64-69. [PMID: 28503518 PMCID: PMC5426198 DOI: 10.3393/ac.2017.33.2.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/26/2017] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better functional outcome than perineal procedures. Nevertheless, ideal surgical methods are still not available. We propose a new surgical technique, laparoscopic vaginal suspension and rectopexy, for correcting a full-thickness rectal prolapse and/or middle-compartment prolapse. This study assessed the short-term outcomes for patients who underwent laparoscopic vaginal suspension and rectopexy. METHODS Between April 2014 and April 2016, 69 female patients underwent laparoscopic vaginal suspension and rectopexy to correct a rectal prolapse. Demographics, medical histories, and surgical and follow-up details were collected from their medical records. In addition to the clinical outcome, we repeated defecation proctography and a questionnaire regarding functional results three months after surgery. RESULTS No major morbidities or no mortalities occurred. The defecation proctography confirmed excellent anatomical result in all cases. Of 7 patients with combined middle-compartment prolapses, we observed good anatomical correction. During follow-up, full-thickness recurrence occurred in one patient. Preoperative fecal incontinence was improved significantly at 3 months (mean Wexner score: 12.35 vs. 7.71; mean FISI: 33.29 vs. 21.07; P < 0.001). Analysis of responses to the fecal incontinence quality of life (FIQOL) questionnaire showed overall improvement at 3 months compared to the preoperative baseline (mean pre- and postoperative FIQOL scores: 12.11 vs. 14.39; P < 0.004). CONCLUSION Laparoscopic vaginal suspension and rectopexy is a new combined procedure for the treatment of patients with rectal prolapses. It has excellent functional outcomes and minimal morbidity and can correct and prevent middlecompartment prolapses.
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Affiliation(s)
- Shi-Jun Yang
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Seo-Gue Yoon
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Ki-Yun Lim
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
| | - Jong-Kyun Lee
- Department of Surgery, Seoul Song Do Hospital, Seoul, Korea
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Leo CA, Campennì P, Hodgkinson JD, Rossitti P, Digito F, De Carli G, D'Ambrosi L, Carducci P, Seriau L, Terrosu G. Long-Term Functional Outcome after Internal Delorme's Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation. J INVEST SURG 2017; 31:256-262. [PMID: 28362517 DOI: 10.1080/08941939.2017.1300714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate long-term functional outcomes of Internal Delorme's Procedure (IDP) in patients refractory to conservative treatment for Obstructed Defecation Syndrome (ODS), and to compare those who received postoperative rehabilitation with those who did not. MATERIALS AND METHODS All patients with ODS refractory to nonoperative therapy were identified across three regional pelvic floor referral hospitals, and IDP was performed. Postoperatively selected patients received biofeedback therapy. Functional outcomes were established using the Cleveland Clinic Constipation (CCC) score and obstructed defecation score (OD score) preoperatively at 12 months and at the last available follow-up. Patient satisfaction was assessed with a visual analogue score. RESULTS From October 2006 to September 2013, IDP was performed in 170 patients: 77 received postoperative biofeedback and 93 did not. Mean follow-up was 6.3 years (range 1-8 years). CCC and OD scores improved significantly in both groups after 12 months and at the last follow-up (p > 0.05). When comparing two groups while there was no significant difference between CCC and OD scores at 12 months, score was significantly better in the group that received rehabilitation at the last follow-up (p = 0.001). Patient satisfaction was higher in the rehabilitation group (67%) compared with those without rehabilitation (55%). Clinical recurrence was recorded in nine patients who did not have postoperative rehabilitation. CONCLUSIONS It has been demonstrated that IDP is associated with good long-term functional outcomes. Patients receiving rehabilitation had a better long-term follow-up, a higher overall satisfaction, and lower recurrence rate when compared with the patients who did not receive postoperative rehabilitation.
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Affiliation(s)
- C A Leo
- a North West London NHS Trust, St Mark's Hospital Academic Institute , Middlesex , Harrow , UK
| | - P Campennì
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - J D Hodgkinson
- a North West London NHS Trust, St Mark's Hospital Academic Institute , Middlesex , Harrow , UK
| | - P Rossitti
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - F Digito
- c Department of Surgery , S. Antonio Hospital, S. Daniele del Friuli, Udine , Italy
| | - G De Carli
- d Department of Surgery , S. Maria del Prato Hospital , Feltre , Italy
| | - L D'Ambrosi
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - P Carducci
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - L Seriau
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - G Terrosu
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
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Silveira RK, Domingie S, Kirzin S, de Melo Filho DA, Portier G. Comparative study of safety and efficacy of synthetic surgical glue for mesh fixation in ventral rectopexy. Surg Endosc 2017; 31:4016-4024. [DOI: 10.1007/s00464-017-5439-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/30/2017] [Indexed: 01/05/2023]
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15
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Long-term outcome of perineal rectosigmoidectomy for rectal prolapse. Int J Surg 2016; 32:78-82. [DOI: 10.1016/j.ijsu.2016.06.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/10/2016] [Accepted: 06/20/2016] [Indexed: 11/21/2022]
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16
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Redo laparoscopic ventral mesh rectopexies: a multimedia article on the technical points. Tech Coloproctol 2016; 20:597-8. [PMID: 27095253 DOI: 10.1007/s10151-016-1467-x] [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: 11/20/2015] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
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17
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Brown H, Grimes C. Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016; 5:165-171. [PMID: 27547494 DOI: 10.1007/s13669-016-0148-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While it would be our hope to report that there have been significant gains in the understanding of the correlation between the posterior vaginal compartment and defecatory dysfunction in the last year, this is not the case. Instead, we review the highlights of management of posterior vaginal compartment and defecatory dysfunction including 1) defining and understanding the patient's symptoms; 2) considering systemic disorders, motility dysfunction, and mechanical causes that may be contributing; 3) encouraging conservative management as first-line therapy; and 4) recognizing which surgical options are likely to improve specific symptoms. This is then followed by an update on treatment options for fecal incontinence, which we now prefer to refer to as accidental bowel leakage. We are able to report on five exciting and innovative treatment approaches for accidental bowel leakage. As the scientific community increases focus on patient-centered outcomes, we are likely on the verge of having a greater understanding of how treatment options for posterior compartment prolapse and defecatory dysfunction can improve patient symptoms. This year, we can report that strong evidence based recommendations simply do not exist, and this area is ripe for future investigation.
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Affiliation(s)
- Heidi Brown
- University of Wisconsin-Madison School of Medicine & Public Health, Departments of Obstetrics & Gynecology and Urology, Female Pelvic Medicine & Reconstructive Surgery Section, 600 Highland Avenue, Box 6188 (H4/656), Madison, WI 53792, , Fax:
| | - Cara Grimes
- Columbia University Medical Cnter, Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, 622 West 168 Street, PH 16, Room 127, New York, NY 10032, Phone:212-305-0189
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