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Chaoui AM, Chaoui I, Olivier F, Geers J, Abasbassi M. Outcomes of robotic versus laparoscopic ventral mesh rectopexy for rectal prolapse. Acta Chir Belg 2024; 124:91-98. [PMID: 36905354 DOI: 10.1080/00015458.2023.2191073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/07/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Minimally invasive ventral mesh rectopexy is considered the standard of care in the surgical management of rectal prolapse syndromes in fit patients. We aimed to investigate the outcomes after robotic ventral mesh rectopexy (RVR) and compare them with our laparoscopic series (LVR). Additionally, we report the learning curve of RVR. As the financial aspect for the use of a robotic platform remains an important obstacle to allow generalized adoption, cost-effectiveness was also evaluated. PATIENTS AND METHODS A prospectively maintained data set including 149 consecutive patients who underwent a minimally invasive ventral rectopexy between December 2015 and April 2021 was reviewed. The results after a median follow-up of 32 months were analyzed. Additionally, a thorough assessment of the economic aspect was performed. RESULTS On a total of 149 consecutive patients 72 underwent a LVR and 77 underwent a RVR. Median operative time was comparable for both groups (98 min (RVR) vs. 89 min (LVR); p = 0.16). Learning curve showed that an experienced colorectal surgeon required approximately 22 cases in stabilizing the operative time for RVR. Overall functional results were similar in both groups. There were no conversions or mortality. There was, however, a significant difference (p < 0.01) in hospital stay in favor of the robotic group (1 day vs. 2 days). The overall cost of RVR was higher than LVR. CONCLUSIONS This retrospective study shows that RVR is a safe and feasible alternative for LVR. With specific adjustments in surgical technique and robotic materials, we developed a cost-effective way of performing RVR.
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Affiliation(s)
- Ahmed M Chaoui
- Department of Abdominal Surgery, AZ Damiaan, Ostend, Belgium
| | - Ismaël Chaoui
- Department of Abdominal Surgery, AZ Damiaan, Ostend, Belgium
| | | | - Joachim Geers
- Department of Abdominal Surgery, AZ Damiaan, Ostend, Belgium
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Thomas GP, Wong F, Vaizey CJ, Warusavitarne JH. Laparoscopic modified mesh rectopexy: medium-term results of a novel approach for external rectal prolapse. Colorectal Dis 2023; 25:2378-2382. [PMID: 37907714 DOI: 10.1111/codi.16804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/23/2023] [Accepted: 09/17/2023] [Indexed: 11/02/2023]
Abstract
AIM Rectal prolapse is a common and significantly debilitating condition. Surgical correction is usually required. The two most common abdominal approaches are ventral mesh rectopexy and posterior suture rectopexy. Both may be complicated, respectively, by either mesh-related complications or significant postoperative constipation. We report the outcome of a novel rectopexy operation which combines aspects of both the aforementioned approaches, for the treatment of external rectal prolapse (ERP). METHOD The technique involves laparoscopic partial posterior-lateral rectal mobilization of the rectum with posterior suture fixation to the sacral promontory and placement of an absorbable mesh in the rectovaginal space. Data were collected on postoperative complications, prolapse recurrence, mesh-related complications and the assessment of quality of life. RESULTS Eighty patients underwent a modified mesh rectopexy for ERP. Seventy-seven were women. The median age was 67.5 years. Almost a third had undergone a previous rectal prolapse repair. Recurrences were seen in 11 (13.8%). No mesh-related complications were seen. Eleven patients reported postoperative constipation. CONCLUSION The laparoscopic modified mesh rectopexy may be a safe and effective operation for the treatment of ERP.
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Affiliation(s)
- G P Thomas
- Sir Alan Parks Department of Physiology, St Mark's Hospital, London, UK
| | - F Wong
- Sir Alan Parks Department of Physiology, St Mark's Hospital, London, UK
| | - C J Vaizey
- Sir Alan Parks Department of Physiology, St Mark's Hospital, London, UK
| | - J H Warusavitarne
- Sir Alan Parks Department of Physiology, St Mark's Hospital, London, UK
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Galli R, Rosenberg R, Lamm S. [Intussusception and Rectal Prolapse: A Common Cause for Defecation Disorders]. Praxis (Bern 1994) 2023; 112:494-499. [PMID: 37855648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION A rectal prolapse is mainly a disease of the elderly population, occurring more frequently among women. The medical practitioner has an important role in the recognition and initiation of therapy for rectal prolapse. Appropriate therapy can have an important impact on symptom reduction and healthcare resources. Surgical therapy includes perineal or transabdominal surgery, with increasing use of minimally invasive techniques such as mesh rectopexy. This operation is indicated and feasible regardless of age. The management of the rectal prolapse in specialized pelvic floor centres with interdisciplinary expertise for diagnosis and therapy is recommended.
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Affiliation(s)
- Raffaele Galli
- Klinik für Allgemein- und Viszeralchirurgie, Kantonsspital Baselland, Liestal, Schweiz
| | - Robert Rosenberg
- Klinik für Allgemein- und Viszeralchirurgie, Kantonsspital Baselland, Liestal, Schweiz
| | - Sebastian Lamm
- Klinik für Allgemein- und Viszeralchirurgie, Kantonsspital Baselland, Liestal, Schweiz
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Kalev G, Marquardt C, Schmerer M, Ulrich A, Heyl W, Schiedeck T. Resection rectopexy as part of the multidisciplinary approach in the management of complex pelvic floor disorders. Innov Surg Sci 2023; 8:29-36. [PMID: 37842195 PMCID: PMC10576551 DOI: 10.1515/iss-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/22/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required. Methods All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications. Results Two hundred and eighty seven patients were assigned to one of the following groups: PG1 - patient group one: after resection rectopexy (n=141); PG2 - after ventral rectopexy (n=8); PG3 - after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4 - after combined resection rectopexy and trans-vaginal pelvic floor repair (n=76). The duration of follow-up was 14 months for PG1 (median, IQR 37 months), 11 months for PG2 (mean, SD 9 months), 7 months for PG 3 (median, IQR 33 months), and 12 months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. "De novo" constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade ≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499). Conclusions Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.
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Affiliation(s)
- Georgi Kalev
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Christoph Marquardt
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Marten Schmerer
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Anja Ulrich
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Wolfgang Heyl
- Department of Obstetrics and Gynecology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Thomas Schiedeck
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
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Yokoyama S, Tokunaga R, Maeda N, Yamane T, Ikuta Y. Laparoscopic Observation of Adhesive Rectal Fixation after Gant-Miwa-Thiersch Procedure for Rectal Prolapse: A Case Report. J Anus Rectum Colon 2023; 7:135-138. [PMID: 37113580 PMCID: PMC10129352 DOI: 10.23922/jarc.2022-052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/04/2022] [Indexed: 04/29/2023] Open
Abstract
In our previous report, we have noted an increase of computed tomography (CT) attenuation values in perirectal fat tissue after Gant-Miwa-Thiersch (GMT) procedure for rectal prolapse. Based on these results, we hypothesized that the GMT procedure may have a rectal fixation effect due to inflammatory adhesions extending to the mesorectum. Herein, we report a case of laparoscopic observation of perirectal inflammation after GMT. A 79-year-old woman with a history of seizures, stroke, subarachnoid hemorrhage, and spondylosis underwent the GMT procedure under general anesthesia in the lithotomy position for rectal prolapse measuring 10 cm in length. But rectal prolapse recurred 3 weeks after surgery. Therefore, an additional Thiersch procedure was performed. However, rectal prolapse still recurred, and laparoscopic suture rectopexy was performed 17 weeks after initial surgery. During rectal mobilization, marked edema and rough membranous adhesions were observed in the retrorectal space. The average CT attenuation value obtained 13 weeks after initial surgery was found to be significantly elevated in the mesorectum compared with the subcutaneous fat, especially in the posterior side (P < 0.05). These findings suggest that the extension of inflammation to the rectal mesentery after the GMT procedure may have strengthened adhesions in the retrorectal space.
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Affiliation(s)
- Sachio Yokoyama
- Department of Gastroenterological Surgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Ryuma Tokunaga
- Department of Gastroenterological Surgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Nana Maeda
- Department of Gastroenterological Surgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Taishi Yamane
- Department of Gastroenterological Surgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Yoshiaki Ikuta
- Department of Gastroenterological Surgery, Kumamoto City Hospital, Kumamoto, Japan
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Wallace SL, Kim Y, Lai E, Mehta S, Gaigbe-Togbe B, Zhang CA, Von Bargen EC, Sokol ER. Postoperative Complications and Pelvic Organ Prolapse Recurrence Following Combined Pelvic Organ Prolapse and Rectal Prolapse Surgery Compared to Pelvic Organ Prolapse Only Surgery. Am J Obstet Gynecol 2022:S0002-9378(22)00411-2. [PMID: 35654113 DOI: 10.1016/j.ajog.2022.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is a growing interest in combined pelvic organ prolapse and rectal prolapse surgery for concomitant pelvic floor prolapse despite a paucity of data regarding complications and clinical outcomes of combined repair. OBJECTIVE The primary objective of this study was to compare the <30-day postoperative complication rate in women undergoing combined POP + RP surgery with that of women undergoing pelvic organ prolapse-only surgery. The secondary objectives were to describe the <30-day postoperative complications, compare the pelvic organ prolapse recurrence between the 2 groups, and determine the preoperative predictors of <30-day postoperative complications and predictors of pelvic organ prolapse recurrence. STUDY DESIGN This was a multicenter, retrospective cohort study at 5 academic hospitals. Patients undergoing combined pelvic organ prolapse and rectal prolapse surgery were matched by age, pelvic organ prolapse stage by leading compartment, and pelvic organ prolapse procedure compared with those undergoing pelvic organ prolapse-only surgery from March 2003 to March 2020. The primary outcome measure was <30-day complications separated into Clavien-Dindo classes. The secondary outcome measures were (1) subsequent pelvic organ prolapse surgeries and (2) pelvic organ prolapse recurrence, defined as patients who complained of vaginal bulge symptoms postoperatively. RESULTS Overall, 204 women underwent combined surgery for pelvic organ prolapse and rectal prolapse, and 204 women underwent surgery for pelvic organ prolapse only. The average age (59.3±1.0 vs 59.0±1.0) and mean parity (2.3±1.5 vs 2.6±1.8) were similar in each group. Of note, 109 (26.7%) patients had at least one <30-day postoperative complication. The proportion of patients who had a complication in the combined surgery group and pelvic organ prolapse-only surgery group was similar (27.5% vs 26.0%; P=.82). The Clavien-Dindo scores were similar between the groups (grade I, 10.3% vs 9.3%; grade II, 11.8% vs 12.3%; grade III, 3.9% vs 4.4%; grade IV, 1.0% vs 0%; grade V, 0.5% vs 0%). Patients undergoing combined surgery were less likely to develop postoperative urinary tract infections and urinary retention but were more likely to be treated for wound infections and pelvic abscesses than patients undergoing pelvic organ prolapse-only surgery. After adjusting for combined surgery vs pelvic organ prolapse-only surgery and parity, patients who had anti-incontinence procedures (adjusted odds ratio, 1.85; 95% confidence interval, 1.16-2.94; P=.02) and perineorrhaphies (adjusted odds ratio, 1.68; 95% confidence interval, 1.05-2.70; P=.02) were more likely to have <30-day postoperative complications. Of note, 12 patients in the combined surgery group and 15 patients in the pelvic organ prolapse-only surgery group had subsequent pelvic organ prolapse repairs (5.9% vs 7.4%; P=.26). In the combined surgery group, 10 patients (4.9%) underwent 1 repair, and 2 patients (1.0%) underwent 2 repairs. All patients who had recurrent pelvic organ prolapse surgery in the pelvic organ prolapse-only surgery group had 1 subsequent pelvic organ prolapse repair. Of note, 21 patients in the combined surgery group and 28 patients in the pelvic organ prolapse-only surgery group reported recurrent pelvic organ prolapse (10.3% vs 13.7%; P=.26). On multivariable analysis adjusted for number of previous pelvic organ prolapse repairs, combined surgery vs pelvic organ prolapse-only surgery, and perineorrhaphy at the time of surgery, patients were more likely to have a subsequent pelvic organ prolapse surgery if they had had ≥2 previous pelvic organ prolapse repairs (adjusted odds ratio, 6.06; 95% confidence interval, 2.10-17.5; P=.01). The average follow-up times were 307.2±31.5 days for the combined surgery cohort and 487.7±49.9 days for the pelvic organ prolapse-only surgery cohort. Survival curves indicated that the median time to recurrence was not statistically significant (log-rank, P=.265) between the combined surgery group (4.2±0.4 years) and the pelvic organ prolapse-only surgery group (5.6±0.4 years). CONCLUSION In this retrospective cohort study, patients undergoing combined pelvic organ prolapse and rectal prolapse surgery had a similar risk of <30-day postoperative complications compared with patients undergoing pelvic organ prolapse-only surgery. Furthermore, patients who underwent combined surgery had a similar risk of recurrent pelvic organ prolapse and subsequent pelvic organ prolapse surgery compared with patients who underwent pelvic organ prolapse-only surgery.
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Ganapathi SK, Subbiah R, Rudramurthy S, Kakkilaya H, Ramakrishnan P, Chinnusamy P. Laparoscopic posterior rectopexy for complete rectal prolapse: Is it the ideal procedure for males? J Minim Access Surg 2022; 18:295-301. [PMID: 35313438 PMCID: PMC8973478 DOI: 10.4103/jmas.jmas_323_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background Rectal prolapse is more common in elderly women worldwide, but in India, it predominantly occurs in young- and middle-aged males. While ventral mesh rectopexy is proposed as the preferred procedure in females, the debate on the best procedure in men is still wide open. Methods A retrospective review of all adult male patients operated for external rectal prolapse (ERP) between January 2005 and December 2019 was performed. Patients either underwent modified laparoscopic posterior mesh rectopexy (LPMR) or laparoscopic resection rectopexy (LRR). The outcome was analysed in terms of recurrence, post-operative constipation, sexual dysfunction and other complications. Results A total of 118 male patients were included (LPMR: 106, LRR: 12). The mean age was 46.2 years (standard deviation [SD] 11.8, range: 21-88). The mean operating time was 108 min (SD: 24). The mean length of hospital stay was 4.8 days (SD: 1.4, range: 3-11 days). There was no anastomotic leak in the LRR group. Other complications included wound infection (n = 2), mesh infection with sigmoid colon perforation (n = 1), constipation (n = 4), sexual dysfunction (n = 2), urinary urgency (n = 3) and retention of urine (n = 4). There was no mortality in both the groups. During a mean follow-up of 5.2 years, recurrent ERP was noted in one patient and partial mucosal prolapse was seen in three patients. Conclusion LPMR/LRR is a safe and effective treatment for ERP in men with very low recurrence rates. Randomised trials comparing modified LPMR with LVMR are needed to establish the better procedure in males.
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Affiliation(s)
- Senthil Kumar Ganapathi
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Rajapandian Subbiah
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sathiyamoorthy Rudramurthy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Harish Kakkilaya
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Parthasarathi Ramakrishnan
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Stabile G, Romano F, Topouzova GA, Mangino FP, Di Lorenzo G, Laganà AS, De Manzini N, Ricci G. Spondylodiscitis After Surgery for Pelvic Organ Prolapse: Description of a Rare Complication and Systematic Review of the Literature. Front Surg 2021; 8:741311. [PMID: 34778360 PMCID: PMC8586200 DOI: 10.3389/fsurg.2021.741311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spondylodiscitis can be a rare complication of gynecological surgery, typically of procedures involving the sacrum and the sacrospinous ligament. This report presents a case of spondylodiscitis arising after a laparoscopic sacrocolpopexy with a mesh. We also review the literature finding 52 cases of spondylodiscitis following sacrocolpopexy and (or) rectopexy with or without a mesh. Methods: We performed a comprehensive search from the electronic databases MEDLINE (Pubmed), Scopus, Web of Science, Embase, CINAHL, and Google Scholar from 1990 to February 2021 in order to identify case reports or case series reporting on spondylodiscitis after rectopexy or sacrocolpopexy. Results: We identified 52 total postoperative spondylodiscitis. We examined the mean age of patients, the surgical history, the time from initial surgery to spondylodiscitis, the presenting symptoms, the diagnostic tools, the medical and surgical treatment, the type of mesh used, the surgical access, and the possible causes of spondylodiscitis. Conclusions: Diagnosis of spondylodiscitis may be challenging. From our review emerges that recurrent pelvic pain and lumbosciatalgia may be signals of lumbar spondylodiscitis. Magnetic resonance is the gold standard examination for spondylodiscitis. Surgical practice needs to be improved further in order to establish the best procedure to minimize the incidence of this complication. Awareness of symptoms, timely diagnosis, and treatment are fundamental to prevent irreversible complications.
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Affiliation(s)
- Guglielmo Stabile
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Federico Romano
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Ghergana A Topouzova
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesco Paolo Mangino
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Giovanni Di Lorenzo
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Nicolò De Manzini
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy.,University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Baracy Jr MG, Richardsona C, Mackeya KR, Hagglund KH, Aslam MF. Does ventral mesh rectopexy at the time of sacrocolpopexy prevent subsequent posterior wall prolapse? J Turk Ger Gynecol Assoc 2021; 22:174-180. [PMID: 34109716 PMCID: PMC8420747 DOI: 10.4274/jtgga.galenos.2021.2021.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To determine whether ventral mesh rectopexy at the time of sacrocolpopexy reduces the rate of future posterior wall prolapse. Material and Methods: This was a retrospective cohort study of women with pelvic organ prolapse (POP) who underwent sacrocolpopexy or without concomitant rectopexy at a single community hospital from December 1, 2015 to June 30, 2019. Preoperative pelvic organ prolapse quantification (POP-Q) and urodynamic testing was used in evaluation of POP. Patients were followed for 12-weeks postoperatively and a 12-week postoperative POP-Q assessment was completed. The incidence of new or recurrent posterior prolapse was compared between cohorts. Results: Women with POP (n=150) were recruited, of whom 41 (27.3%) underwent sacrocolpopexy while the remainder (n=109, 72.7%) did not receive rectopexy. Patient demographics did not statistically differ between cohorts. Post-surgical posterior wall prolapse was reduced in the robotic assisted sacrocolpopexy (RASC) + rectopexy group compared to RASC alone, however this did not reach statistical significance. There were no patients who underwent concomitant rectopexy and RASC that needed recurrent posterior wall prolapse surgery, compared to eight-percent of patients that underwent isolated RASC procedures. Conclusion: Our findings suggest a reduction in the need for subsequent posterior wall surgery when rectopexy is performed at the time of sacrocolpopexy. In our study, no future surgery for POP was found in the concomitant sacrocolpopexy and rectopexy group, while a small proportion of the RASC only group required future POP surgery. Our study, however, was underpowered to elucidate a statistically significant difference between groups. Future larger studies are needed to confirm a reduced risk of posterior wall prolapse in patients who undergo concomitant RASC and rectopexy.
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Affiliation(s)
- Michael G. Baracy Jr
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Casey Richardsona
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Kyle R. Mackeya
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, Michigan, United States of America
| | - Karen H. Hagglund
- Department Biomedical Investigations and Research, Ascension St. John Hospital, Michigan, United States of America
| | - Muhammad Faisal Aslam
- Department of Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Michigan, United States of America,Department of Female Pelvic Medicine and Reconstructive Surgery, Michigan State University, Michigan, United States of America
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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11
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Davalos G, Lan BY, Diaz R, Welsh LK, Roldan E, Portenier D, Guerron AD. Single-Center Experience with Magnetic Retraction in Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2019; 29:1033-1037. [PMID: 30990362 DOI: 10.1089/lap.2018.0744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Appropriate tissue retraction is essential in laparoscopic surgery, and colorectal operations often require an additional incision and trocar that can disturb visualization and maneuverability. Each incision carries an increased risk for complications as well as increased pain and cosmetic issues. Magnetic devices have been developed for a less invasive retraction. The objective of this study is to report our initial experience using magnet retraction. Methods: Ten consecutive patients who underwent laparoscopic colorectal procedures by a single surgeon using a magnetic retractor (Levita Magnetics® Surgical System, San Mateo, CA) between October 2017 and June 2018 at Duke Regional Hospital in Durham, NC, were included. Results: The cases included four single-port right colectomies, one sigmoidectomy, and five rectopexies. Nine cases were completed laparoscopically, as one right colectomy required conversion due to adhesions and bulky specimen. Indications included adenocarcinoma, diverticular disease, and rectal prolapse. The magnet was successfully used for uterus, colon, or colonic pedicle retraction. No intraoperative or 30-day complications were observed. Conclusion: Magnetic surgical retractors are a safe, dynamic, and incision-less option for surgical field exposure during laparoscopic colorectal surgery. Reduced trocars decrease tissue trauma, enhances maneuverability, and potentially improves outcomes; however, further studies are required.
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Affiliation(s)
- Gerardo Davalos
- 1Duke Surgery, Division of Metabolic and Weight Loss Surgery, Durham, North Carolina
| | - Billy Y Lan
- 2Duke Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery, Durham, North Carolina
| | - Ramon Diaz
- 1Duke Surgery, Division of Metabolic and Weight Loss Surgery, Durham, North Carolina
| | - Leonard K Welsh
- 1Duke Surgery, Division of Metabolic and Weight Loss Surgery, Durham, North Carolina
| | - Estefania Roldan
- 1Duke Surgery, Division of Metabolic and Weight Loss Surgery, Durham, North Carolina.,3School of Medicine, College of Health Sciences, San Francisco University of Quito, Quito, Ecuador
| | - Dana Portenier
- 1Duke Surgery, Division of Metabolic and Weight Loss Surgery, Durham, North Carolina
| | - Alfredo D Guerron
- 1Duke Surgery, Division of Metabolic and Weight Loss Surgery, Durham, North Carolina
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12
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Müller PC, Berchtold C, Kuemmerli C, Ruzza C, Z'Graggen K, Steinemann DC. Spondylodiscitis after minimally invasive recto- and colpo-sacropexy: Report of a case and systematic review of the literature. J Minim Access Surg 2018; 16:5-12. [PMID: 30416143 PMCID: PMC6945346 DOI: 10.4103/jmas.jmas_235_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Rectopexy and colpopexy are established surgical techniques to treat pelvic organ prolapse. Spondylodiscitis (SD) after rectopexy and colpopexy represents a rare infectious complication with severe consequences. We presented a case of SD after rectopexy and performed a systematic review. Methods: A systematic literature search was performed to identify case reports or case series reporting on SD after rectopexy or colpopexy. The main outcomes measures were time from initial surgery to SD, presenting symptoms, occurrence of mesh erosion or fistula formation and type of treatment. Results: Forty-one females with a median age of 59 (54–66) years were diagnosed with SD after a median of 76 (30–165) days after initial surgery. Most common presenting symptoms were back pain (n = 35), fever (n = 20), pain radiation in the legs (n = 9) and vaginal discharge (n = 6). A mesh erosion (n = 8) or fistula formation (n = 7) was detected in a minority of cases. The treatment of SD consisted of conservative treatment with antibiotics alone in 29%, whereas 66% of the patients had to undergo additional surgical treatment. If a revision surgery was necessary, more than one intervention was performed in 40%. Mesh and tack excision was performed in most cases (n = 21), whereas a neurosurgical intervention was necessary in 10 patients. Conclusion: Although a rare complication, surgeons performing rectopexy and colpopexy must be aware of the potential risk of SD Careful suture or tack placement into the anterior longitudinal ligament at the level of the promontory while avoiding the disc space is of paramount importance. Prompt diagnosis and multidisciplinary management are the cornerstones of a successful treatment.
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Affiliation(s)
- Philip C Müller
- Department of Surgery, Klinik Beau-Site, 3013 Bern, Switzerland
| | | | | | - Claudio Ruzza
- Department of Surgery, Klinik Beau-Site, 3013 Bern, Switzerland
| | | | - Daniel C Steinemann
- Department of Surgery, Pelvic Floor Unit, St. Clara Hospital Basel, 4016 Basel, Switzerland
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13
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Ahmad NZ, Stefan S, Adukia V, Naqvi SAH, Khan J. Laparoscopic Ventral Mesh Rectopexy: Functional Outcomes after Surgery. Surg J (N Y) 2018; 4:e205-e211. [PMID: 30377654 PMCID: PMC6205861 DOI: 10.1055/s-0038-1675358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023] Open
Abstract
Aims
Rectal prolapse is a debilitating and unpleasant condition adversely affecting the quality of life. Laparoscopic ventral mesh rectopexy (LVMR) is recognized as one of the treatment options. The aim of this study was to evaluate the functional outcomes after a standardized LVMR.
Methods
A cohort of patients who underwent LVMR from 2011 to 2015 were contacted and asked to fill questionnaires about their symptoms before and after the surgery. Three questionnaires based on measurement of Wexner fecal incontinence (WFI), obstructive defecation syndrome (ODS), and Birmingham Bowel and Urinary Symptom (BBUS) scores were used to assess the changes in postoperative functional outcomes. Some additional questions were also added to further assess bowel dysfunction.
Results
There were 58 female patients with a mean age of 62.74 ± 15.20 (26–86) years in this cohort. About 70% of the patients participated in the study and returned the filled questionnaires. There was a significant overall improvement across all three scores (WFI:
p
= 0.001, ODS:
p
= 0.001, and BBUS:
p
= 0.001). Some individual components in the scoring systems did not improve to patient's satisfaction. No perioperative complication or conversion to an open procedure was reported in this study. Three recurrences were seen in the redo cases.
Conclusion
LVMR is a promising way of dealing with rectal prolapse. A careful patient selection, appropriate preoperative workup, and a meticulous surgical technique undoubtedly transform the postoperative outcomes.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Samuel Stefan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Vidhi Adukia
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Abstract
Rectal prolapse is a common and self-limiting condition in infancy and early childhood. Most cases respond to conservative management. Patients younger than 4 years with an associated condition have a better prognosis. Patients older than 4 years require surgery more often than younger children. Multiple operative and procedural approaches to rectal prolapse exist with variable recurrence rates and without a clearly superior operation. These include sclerotherapy, Thiersch's anal cerclage, Ekehorn's rectopexy, laparoscopic suture rectopexy, and posterior sagittal rectopexy.
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Affiliation(s)
- Rebecca M Rentea
- Deparment of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D St Peter
- Deparment of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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16
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Hogan AM, Tejedor P, Lindsey I, Jones O, Hompes R, Gorissen KJ, Cunningham C. Pregnancy after laparoscopic ventral mesh rectopexy: implications and outcomes. Colorectal Dis 2017; 19:O345-O349. [PMID: 28710784 DOI: 10.1111/codi.13818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/11/2017] [Indexed: 12/14/2022]
Abstract
AIM Surgical management of rectal prolapse varies considerably. Most surgeons are reluctant to use ventral mesh rectopexy in young women until they have completed their family. The aim of the present study was to review outcomes of pregnancy following laparoscopic ventral mesh rectopexy from a tertiary referral centre over a 10-year period (2006-2016) and to review the impact on pelvic floor symptoms. METHOD We undertook a retrospective review of a prospectively compiled database of patients who had undergone laparoscopic ventral rectopexy in a single centre over a 10-year period. Pelvic floor symptom scores (Vaizey for incontinence and Longo for obstructive defaecation) were collected at initial presentation (pre-intervention), post-intervention and after child birth. RESULTS In all, 954 rectopexies were performed over this 10-year period. 225 (24%) patients were women and under 45 years of age (taken as an arbitrary cut-off for decreased likelihood of pregnancy). Eight (4%) of these patients became pregnant following rectopexy. The interval between rectopexy and delivery was 42 months (21-50). Six patients delivered live babies by elective lower segment caesarean section and two by spontaneous vaginal delivery. Six were first babies and two were second. No mesh related adverse outcome was reported. No difference in pelvic floor symptoms was demonstrated on comparison of post-rectopexy and post-delivery scores. CONCLUSION This study provides the first description in the English language literature of safe delivery by elective lower segment caesarean section or spontaneous vaginal delivery following laparoscopic ventral mesh rectopexy. No adverse impact on pelvic floor related quality of life was detected.
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Affiliation(s)
- A M Hogan
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - P Tejedor
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - I Lindsey
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - O Jones
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - K J Gorissen
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Oxford University Hospital, Oxford, UK
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Emile SH, Elfeki HA, Youssef M, Farid M, Wexner SD. Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta-analysis. Colorectal Dis 2017; 19:O13-O24. [PMID: 27943547 DOI: 10.1111/codi.13574] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/09/2016] [Indexed: 12/13/2022]
Abstract
AIM Internal rectal prolapse (IRP) is a unique functional disorder that presents with a wide spectrum of clinical symptoms, including constipation and/or faecal incontinence (FI). The present review aims to analyse the results of trials evaluating the role of abdominal rectopexy in the treatment of IRP with regard to regarding functional and technical outcomes. METHOD A systematic review of the literature for the role of abdominal rectopexy in patients with IRP was conducted. PubMed/Medline, Embase and the Cochrane Central Register of Controlled Trials were searched for published and unpublished studies from January 2000 to December 2015. RESULTS We reviewed 14 studies including 1301 patients (1180 women) of a median age of 59 years. The weighted mean rates of improvement of obstructed defaecation (OD) and FI across the studies were 73.9% and 60.2%, respectively. Twelve studies reported clinical recurrence in 84 (6.9%) patients. The weighted mean recurrence rate of IRP among the studies was 5.8% (95% CI: 4.2-7.5). Two hundred and thirty complications were reported with a weighted mean complication rate of 15%. Resection rectopexy had lower recurrence rates than did ventral rectopexy, whereas ventral rectopexy achieved better symptomatic improvement, a shorter operative time and a lower complication rate. CONCLUSION Abdominal rectopexy for IRP attained satisfactory results with improvement of OD and, to a lesser extent, FI, a low incidence of recurrence and an acceptable morbidity rate. Although ventral rectopexy was associated with higher recurrence rates, lower complication rates and better improvement of bowel symptoms than resection rectopexy, these findings cannot be confirmed owing to the limitations of this review.
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Affiliation(s)
- S H Emile
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - H A Elfeki
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - M Youssef
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - M Farid
- General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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19
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Abstract
Rectal prolapse is a debilitating condition with a complex etiology. Symptoms are most commonly prolapse of the rectum and pain with bowel movements or straining, with worsening fecal incontinence over time due to progressive stretching of the anal sphincters. Physical findings are fairly consistent from patient to patient-most notably diastasis of the levator ani muscles, deep pouch of Douglas, redundant sigmoid colon, a mobile mesorectum, and occasionally a solitary rectal ulcer. Evaluation includes a physical exam or imaging demonstrating the prolapse, and evaluating for other causes of pelvic floor dysfunction. Multiple surgical repairs are available, but treatment must be individualized based on patient symptoms and the presence or absence of constipation or other pelvic floor disorders. Mesh repairs have shown promising results, but carry the added risks of mesh erosion, infection, and mesh migration. The optimal repair has not been clearly demonstrated at this time.
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Affiliation(s)
- Kyla Joubert
- Division of Colon and Rectal Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jonathan A Laryea
- Division of Colon and Rectal Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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20
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Mäkelä-Kaikkonen J, Rautio T, Pääkkö E, Biancari F, Ohtonen P, Mäkelä J. Robot-assisted vs laparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial. Colorectal Dis 2016; 18:1010-1015. [PMID: 26919191 DOI: 10.1111/codi.13309] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023]
Abstract
AIM The purpose of this prospective randomized study was to compare robot-assisted and laparoscopic ventral rectopexy procedures for posterior compartment procidentia in terms of restoration of the anatomy using magnetic resonance (MR) defaecography. METHOD Sixteen female patients (four with total prolapse, twelve with intussusception) underwent robot-assisted ventral mesh rectopexy (RVMR) and 14 female patients (two with prolapse, twelve with intussusception) laparoscopic ventral mesh rectopexy (LVMR). Primary outcome measures were perioperative parameters, complications and restoration of anatomy as assessed by MR defaecography, which was performed preoperatively and 3 months after surgery. RESULTS Patient demographics, operation length, operating theatre times and length of in-hospital stay were similar between the groups. The anatomical defects of rectal prolapse, intussusception and rectocele and enterocele were similarly corrected after rectopexy in either technique as confirmed with dynamic MR defaecography. A slight residual intussusception was observed in three patients with primary total prolapse (two RVMR vs one LVMR) and in one patient with primary intussusception (RVMR) (P = 0.60). Rectocele was reduced from a mean of 33.0 ± 14.9 mm to 5.5 ± 8.4 mm after RVMR (P < 0.001) and from 24.7 ± 17.5 mm to 7.2 ± 3.2 mm after LVMR (P < 0.001) (RVMR vs LVMR, P = 0.10). CONCLUSION Robot-assisted laparoscopic ventral rectopexy can be performed safely and within the same operative time as conventional laparoscopy. Minimally invasive ventral rectopexy allows good anatomical correction as assessed by MR defaecography, with no differences between the techniques.
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Affiliation(s)
| | - T Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - E Pääkkö
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - F Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - P Ohtonen
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - J Mäkelä
- Department of Surgery, Oulu University Hospital, Oulu, Finland
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21
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Abstract
Rectal prolapse and vaginal prolapse have traditionally been treated as separate entities despite sharing a common pathophysiology. This compartmentalized approach often leads to frustration and suboptimal outcomes. In recent years, there has been a shift to a more patient-centered, multidisciplinary approach. Procedures to repair pelvic organ prolapse are divided into three categories: abdominal, perineal, and a combination of both. Most commonly, a combined minimally invasive abdominal sacral colpopexy and ventral rectopexy is performed to treat concomitant rectal and vaginal prolapse. Combining the two procedures adds little operative time and offers complete pelvic floor repair. The choice of minimally invasive abdominal prolapse repair versus perineal repair depends on the patient's comorbidities, previous surgeries, preference to avoid mesh, and physician's expertise. Surgeons should at least be able to identify these patients and provide the appropriate treatment or refer them to specialized centers.
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Affiliation(s)
- Karl Jallad
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brooke Gurland
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Dyrberg DL, Nordentoft T, Rosenstock S. Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients: A prospective follow-up study. Scand J Surg 2015; 104:227-32. [PMID: 25567855 DOI: 10.1177/1457496914565418] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 11/19/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The aim of this study is to examine the clinical and functional outcome of laparoscopic posterior rectopexy in a consecutive series of adult patients with full-thickness rectal prolapse. MATERIAL AND METHODS Preoperative data on demography, life-style practices, medication, comorbidity, and previous surgery for rectal prolapse were ascertained from patient charts. Information on operative procedure, and pre- and postoperative complications were recorded. Short- and long-term follow-up were done after a median of 60 days and 2 years after surgery. RESULTS Between 1 February 2009 to 1 June 2012, 81 laparoscopic posterior rectopexies were done. Male-to-female ratio was 4:77, median age 73 [57-80.5] years and median ASA Grade 2. Conversion to open surgery was done in 6.2%, the median operating time was 82 min [66 - 102] and median length of hospital stay was 2 days [2-5.7]. Minor and major complications were seen in 5.3% and 14.8%, respectively. The 30-day mortality rate was 1.2%. Constipation or incontinence improved or disappeared in 65.2% and 74.4%, respectively. The cumulated recurrence rate was 11.1% after a median observation time of 2 years. CONCLUSION Laparoscopic posterior rectopexy is a safe and well-tolerated procedure in older patients and can be done with acceptable complications and recurrence rates and short hospital stays. Laparoscopic posterior rectopexy seems to improve bowel function in many patients.
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Affiliation(s)
- D L Dyrberg
- Department of Gastroenterology, Surgical Unit, Hvidovre University Hospital, Hvidovre, Denmark
| | - T Nordentoft
- Department of Gastroenterology, Surgical Unit, Herlev University Hospital, Herlev, Denmark
| | - S Rosenstock
- Department of Gastroenterology, Surgical Unit, Hvidovre University Hospital, Hvidovre, Denmark
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23
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Unger CA, Paraiso MFR, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol 2014; 211:547.e1-8. [PMID: 25088866 DOI: 10.1016/j.ajog.2014.07.054] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/26/2014] [Accepted: 07/30/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our first objective was to compare peri- and postoperative adverse events between robotic-assisted laparoscopic sacrocolpopexy (RSC) and conventional laparoscopic sacrocolpopexy (LSC) in a cohort of women who underwent these procedures at a tertiary care center. Our second objective was to explore whether hysterectomy and rectopexy at the time of sacrocolpopexy were associated with these adverse events. STUDY DESIGN This was a retrospective cohort study of women who underwent either RSC or LSC with or without concomitant hysterectomy and/or rectopexy from 2006-2012. Once patients were identified as either having undergone RSC or LSC, the electronic medical record was queried for demographic, peri-, and postoperative data. RESULTS Four hundred six women met study inclusion criteria. Mean age and body mass index of all the women were 58 ± 10 years and 27.9 ± 4.9 kg/m(2). The women who underwent RSC were older (60 ± 9 vs 57 ± 10 years, respectively; P = .009) and more likely to be postmenopausal (90.9% vs 79.1%, respectively; P = .05). RSC cases were associated with a higher intraoperative bladder injury rate (3.3% vs 0.4%, respectively; P = .04), a higher rate of estimated blood loss of ≥500 mL (2.5% vs 0, respectively; P = .01), and reoperation rate for pelvic organ prolapse (4.9% vs 1.1%, respectively; P = .02) compared with LSC. Concomitant rectopexy was associated with a higher risk of transfusion (2.8% vs 0.3%, respectively; P = .04), pelvic/abdominal abscess formation (11.1% vs 0.8%, respectively; P < .001), and osteomyelitis (5.6% vs 0, respectively; P < .001). The mesh erosion rate for all the women was 2.7% and was not statistically different between LSC and RSC and for patients who underwent concomitant hysterectomy and those who did not. CONCLUSION Peri- and postoperative outcomes after RSC and LSC are favorable, with few adverse outcomes. RSC is associated with a higher rate of bladder injury, estimated blood loss ≥500 mL, and reoperation for recurrent pelvic organ prolapse; otherwise, the rate of adverse events is similar between the 2 modalities. Concomitant rectopexy is associated with a higher rate of postoperative abscess and osteomyelitis complications.
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Affiliation(s)
- Cecile A Unger
- Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.
| | - Marie Fidela R Paraiso
- Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - John E Jelovsek
- Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew D Barber
- Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Beri Ridgeway
- Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH
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Foppa C, Martinek L, Arnaud JP, Bergamaschi R. Ten-year follow up after laparoscopic suture rectopexy for full-thickness rectal prolapse. Colorectal Dis 2014; 16:809-14. [PMID: 24945584 DOI: 10.1111/codi.12689] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022]
Abstract
AIM Studies have shown that recurrence rates of full-thickness rectal prolapse (FTRP) 5 years after surgery can quadruple at 10 years. This study aimed to evaluate the impact of laparoscopic suture rectopexy for FTRP on recurrence rates and functional outcome at a median follow up of 10 years. METHOD Prospectively collected data for patients who underwent laparoscopic suture rectopexy for FTRP between 1993 and 2006 were analysed. Laparoscopic rectopexy consisted of circumferential mobilization of the rectum down to the levator followed by suture suspension to promontory. Patients with preexisting constipation or who were unfit for general anaesthesia were not included. Incontinence, quality of life and constipation were assessed by validated scores. Recurrence-free curves were generated using the Kaplan-Meier method. RESULTS One hundred and seventy-nine patients with a median age of 62 (15-93) years including 174 women and five men underwent laparoscopic suture rectopexy. There was no mortality. The 30-day complication rate was 4% (partial transection of the left ureter, pneumonia, urinary tract infection, urinary retention, superficial surgical site infection). Data on 172 patients (96%) were available at follow up. There were 10 recurrences of FTRP at 5-year follow up giving a crude recurrence rate of 6%. The actuarial 10-year recurrence rate was 20% (95% CI, 10.8-20.1). Follow-up continence (P < 0.0001) and quality of life were better than preoperatively: lifestyle (P < 0.001), coping (P < 0.001), self-perception (P < 0.005), embarrassment (P < 0.06). Constipation was unchanged. CONCLUSION Laparoscopic suture rectopexy led to few complications, a recurrence rate of 20%, improved continence and quality of life with no worsening of constipation at 10 years.
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Affiliation(s)
- C Foppa
- Division of Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA
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Germain A, Perrenot C, Scherrer ML, Ayav C, Brunaud L, Ayav A, Bresler L. Long-term outcome of robotic-assisted laparoscopic rectopexy for full-thickness rectal prolapse in elderly patients. Colorectal Dis 2014; 16:198-202. [PMID: 24308488 DOI: 10.1111/codi.12513] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/11/2013] [Indexed: 12/11/2022]
Abstract
AIM Full-thickness rectal prolapse is common in the elderly, but there are no particular practice guidelines for its surgical management. We evaluated retrospectively the perioperative and long-term clinical results and function in elderly and younger patients with complete rectal prolapse after robotic-assisted laparoscopic rectopexy (RALR). METHOD Seventy-seven patients who underwent RALR between 2002 and 2010 were divided into Group A (age < 75 years, n = 59) and Group B (age > 75 years, n = 18). Operative time, intra- and postoperative complications, length of hospital stay, short-term and long-term outcomes, recurrence rate and degree of satisfaction were evaluated. RESULTS There was no significant difference between the groups regarding operation time, conversion, morbidity or length of hospital stay. At a median follow-up of 51.8 (5-115) months, there was no difference in the improvement of faecal incontinence, recurrence and the degree of satisfaction. CONCLUSION Robotic-assisted laparoscopic rectopexy is safe in patients aged over 75 years and gives similar results to those in patients aged < 75 years.
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Affiliation(s)
- A Germain
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-lès-Nancy, France
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Abstract
BACKGROUND The introduction of robotics in colorectal surgery has been gaining increasing acceptance. However, experience remains still limited for pelvic floor disorders. We report herein our first cases of fully robotic rectopexy and promontofixation for rectal prolapse. METHODS From October 2011 to June 2012, five female patients underwent a robotic rectopexy at our institution. The patients were selected according to their primary pathology and their medical history for this preliminary experience. Four of them presented a rectal prolapse associated or not with a vaginal prolapse and the last patient presented a recurrent rectal prolapse 5 years after a laparoscopic repair. The study was approved by our local ethics committee. The robot da Vinci Si (Intuitive Surgical Inc, Sunnyvale, CA) was used with a 4-port setting in all cases. RESULTS The mean operative time was 170 minutes (range: 120-270). There was no conversion. The blood loss was minimal. One patient presented a retrorectal hematoma, treated conservatively with success. There was no other complication. The mean hospital stay was 3.6 days (range: 2-7). At 2 months, there was neither recurrence nor readmission. In comparison with the laparoscopic approach, there were no statistically significant differences. CONCLUSIONS Robotic rectopexy and promontofixation are feasible and safe. The outcomes are encouraging, but functional results and long-term outcomes are required to evaluate the exact role of robotics for rectal prolapse.
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Affiliation(s)
- Nicolas C Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Switzerland
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Abstract
Aim: To study the clinical outcome of laparoscopic suture rectopexy (LSRP) in children with persistent rectal prolapse (PRP). Materials and Methods: Nineteen cases of PRP were managed with LSRP from February 2005 to August 2009. Results: All were followed up for an average duration of 6 months. Only one child had recurrence and was managed with sclerotherapy. Conclusions: LSRP is safe, feasible in children and gives satisfactory results.
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Affiliation(s)
- Bipin Puri
- Consultant, Surgery and Pediatric Surgery, Army Hospital (R and R), Delhi, India
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Abstract
Rectoanal intussusception (RI) is a telescoping of the rectal wall during defecation. RI is an easily recognizable physiologic phenomenon on defecography. The management, however, is much more controversial. Two predominant hypotheses exist regarding the etiology of RI: RI as a primary disorder, and RI as a secondary phenomenon. The diagnosis may be suspected based on clinical symptoms of obstructive defecation. Diagnostic modalities include defecography as the gold standard. Dynamic pelvic magnetic resonance imaging (DPMRI) and transperineal ultrasound are attractive alternatives to defecography; however, their sensitivity is poor in comparison to the gold standard at this time. Management strategies including conservative measures such as biofeedback and surgical procedures including mucosal proctectomy (Delorme), rectopexy, and stapled transanal rectal resection (STARR) procedures have varied degrees of efficacy.
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Affiliation(s)
- Eric G Weiss
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA.
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Abstract
Despite the innovation of more than 100 surgical procedures for the treatment of complete rectal prolapse, no one procedure is best and applicable to all patients. Traditionally, procedures have been divided into abdominal and perineal approaches. The application of the laparoscopic approach to colon and rectal disease has allowed an additional less invasive method of therapy to treat rectal prolapse successfully. In comparison with conventional approaches, laparoscopy has achieved similar functional results and recurrence rates while reducing postoperative pain and hospital length of stay.
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Affiliation(s)
- David P O'Brien
- Division of Colon and Rectal Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA.
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Heemskerk J, de Hoog DENM, van Gemert WG, Baeten CGMI, Greve JWM, Bouvy ND. Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum 2007; 50:1825-30. [PMID: 17690936 PMCID: PMC2071956 DOI: 10.1007/s10350-007-9017-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Laparoscopic rectopexy has become one of the most advocated treatments for full-thickness rectal prolapse, offering good functional results compared with open surgery and resulting in less postoperative pain and faster convalescence. However, laparoscopic rectopexy can be technically demanding. Once having mastered dexterity, with robotic assistance, laparoscopic rectopexy can be performed faster. Moreover, it shortens the learning curve in simple laparoscopic tasks. This may lead to faster and safer laparoscopic surgery. Robot-assisted rectopexy has been proven safe and feasible; however, until now, no study has been performed comparing costs and time consumption in conventional laparoscopic rectopexy vs. robot-assisted rectopexy. METHODS Our first 14 cases of robot-assisted laparoscopic rectopexy were reviewed and compared with 19 patients who underwent conventional laparoscopic rectopexy in the same period. RESULTS Robot-assisted laparoscopic rectopexy did not show more complications. However, the average operating time was 39 minutes longer, and costs were euro 557.29 (or: dollars 745.09) higher. CONCLUSION Robot-assisted laparoscopic rectopexy is a safe and feasible procedure but results in increased time and higher costs than conventional laparoscopy.
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Affiliation(s)
- Jeroen Heemskerk
- Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands.
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