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PubMed1987

Multiple-flap anoplasty in the treatment of rectal prolapse after pull-through operations for imperforate anus.

Rectal prolapse is a frequent complication after pull-through operations for high imperforate anus. Mucosal prolapse causes soiling, occasional bleeding, and pain. Simple resection of the redundant mucosa is unsatisfactory and leads to frequent recurrences or strictures. In 1982, Millard and Rowe reported a technique designed to correct rectal prolapse using two perineal flaps, thus providing a skin-lined anal canal. We have operated on two patients using the same technique. A three-flap anoplasty was used in nine other patients. With an average follow-up of 13 months, none of out patients presented recurrence of the prolapse or a significant stenosis. This procedure is safe and physiologically sound. The skin-lined anal canal provides some sensation where it is lacking. The functional and esthetic results are gratifying and we are now using the three-flap anoplasty as a primary procedure in the correction of high imperforate anus.

Adolescent↗
PubMed1993

Anorectal dysfunction and rectal prolapse in progressive systemic sclerosis.

Our aim was to characterize the clinical spectrum of anorectal dysfunction among eight patients with progressive systemic sclerosis (PSS) who presented with altered bowel movements with or without fecal incontinence. The anorectum was assessed by physical examination, proctosigmoidoscopy, and anorectal manometry. There was concomitant involvement of the other regions of the digestive tract in all patients as determined by barium studies, endoscopy, or manometry: eight esophageal, three gastric, four small bowel, and two colonic. Seven patients had fecal incontinence, and four also had second-degree complete rectal prolapse. Abnormal anorectal function, particularly abnormal anal sphincter resting pressures, were detected in all patients; anal sphincter pressures were lower in those with rectal prolapse. Rectal capacity and wall compliance were impaired in seven of seven patients. Successful surgical correction of prolapse in three patients resulted in restoration of incontinence for six months and seven years in two of the three patients. We conclude that rectal dysfunction and weakness of the anal sphincters are important factors contributing, respectively, to altered bowel movements and fecal incontinence in patients with gastrointestinal involvement by PSS. Rectal prolapse worsens anal sphincter dysfunction and should be sought routinely as it is a treatable factor aggravating fecal incontinence in patients with PSS.

Aged↗
PubMed1996

[Sacral rectopexy-sigmoidectomy in the treatment of rectal prolapse syndrome. Anatomical and functional results].

UNLABELLED: Various options have been suggested to improve the functional results of abdominal rectopexy for rectal prolapse and to limit the risk of post-operative constipation. OBJECTIVES: In this prospective study, we evaluated the results of posterior abdominal rectopexy-sigmoidectomy to treat rectal prolapse syndrome in terms of morbidity, anatomic correction and bowel function. Patient benefits after surgery were assessed according to their pre-operative functional status. PATIENTS AND METHODS: Twenty patients (14 females, mean age: 42 years) were treated for rectal prolapse with sutured abdominal rectopexy and sigmoidectomy. RESULTS: (a) Thirteen patients had normal post-operative course. No anastomotic leak occurred. Mean hospital stay was 9.7 days. (b) Anatomical control was obtained in all cases for a mean follow-up of 31.2 months without recurrence. (c) Functional results: bowel movements per week remained unchanged pre- and post-operatively (18.6 +/- 33 vs 18.1 +/- 17). Constipation appeared or worsened in 2 patients (10%). Anal incontinence (n = 6-30%) never worsened post-operatively and improved in 3. CONCLUSIONS: This prospective clinical study confirmed the important functional disorders occurring in rectal prolapse syndrome. Rectopexy-sigmoidectomy is a valid option with stable mid-term results. Constipation was observed in 10% with no worsening of anal incontinence.

Adolescent↗
PubMed1989

Treatment of complete rectal prolapse with foreign material.

The results of treatment of complete rectal prolapse with Teflon mesh repair are described in 64 patients. Adequate fixation by posterior rectopexy was reached in all patients. In 23 per cent of the patients postoperative constipation was noticed that could adequately be managed with laxatives in most instances. After a mean follow-up of 30 months, none of the patients had complete recurrences. Four patients had new complaints of prolapse. These complaints were two times based on haemorrhoids, two other patients had a small mucosal prolapse. Modified Teflon mesh repair is recommended as a safe method to manage rectal prolapse with a high rate of success.

Adolescent↗
PubMed1997

Comparison of polyglycolic acid and polypropylene mesh for rectopexy in the treatment of rectal prolapse.

OBJECTIVE: To compare the efficacy of absorbable and non-absorbable mesh for rectal fixation in abdominal rectopexy. DESIGN: Prospective open study. SETTING: University hospital, Israel. SUBJECTS: 37 consecutive patients with complete rectal prolapse. INTERVENTIONS: Posterior abdominal rectopexy with non-absorbable mesh (Polypropylene, Prolene, Ethicon Ltd) in 17 patients and with absorbable mesh (Polyglycolic acid, Dexon, Davis & Geck) in 20. MAIN OUTCOME MEASURES: There was no operative mortality, and there were no significant differences between the groups in the incidence of postoperative complications. Mean (SD) follow up was 3.6(0.5) years and 3.8(0.7) years in the Dexon and Prolene groups, respectively. Preoperative and postoperative performance indices based on the Gastrointestinal Quality of Life Index were similar in both groups. CONCLUSIONS: Dexon mesh may be as effective as Prolene mesh in the treatment of complete rectal prolapse. A performance index seems to be a useful tool for evaluating the outcome of patients after repair of complete rectal prolapse.

Activities of Daily Living↗
PubMed1979

Rectal prolapse.

One hundred and twenty-seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an older age in females (mean age 55 years compared with 40 years for males). Although the diagnosis is usually obvious, the importance of recognizing occult prolapse is stressed, especially in association with benign rectal ulcer, localized proctitis and colitis cystica profunda. Examination of the patient in the squatting position may assit in showing occult prolapse. Associated incontinence occurred in 33 patients (26%). Since 1971 the policy of this Unit has been to perform a Ripstein repair for complete rectal prolapse wherever possible. One hundred and two Ripstein repairs have not been performed. A minimum follow-up period of two years is available for 53 patients, of whom 50 (94%) have had their prolapse cured. Control of prolapse usually improves continence; however, seven (13%) remained incontinent despite surgery. The Ripstein repair is strongly advocated as the most effective operation for cure of complete rectal prolapse.

Adolescent↗
PubMed1979

The injection treatment of rectal prolapse.

The injection of 5% phenol in oil into the rectal submucosa cured persistent rectal prolapse in 91 of 100 young children. This result supports the view that the common form of rectal prolapse in otherwise-healthy children primarily involves the mucosa and the muscular wall is only secondarily involved.

Child, Preschool↗
PubMed1989

Management of complete rectal prolapse.

There are two types of rectal prolapse viz, complete or procidentia and occult. Aetiology and management are usually different in children and adults. Control of prolapse by various methods of rectopexies, re-education of bowel habit and correction of sphincter dysfunction are the three phases of treatment in adults. Correction of malnutrition, digital reposition of the prolapse, submucous injection of 5% phenol in almond oil under general anaesthesia and lastly the Thiersch's operation are the methods of correction in children.

Adult↗
PubMed2003

Long-term follow-up of the modified Delorme procedure for rectal prolapse.

HYPOTHESIS: The modified Delorme operation is a safe, effective, and durable treatment for complete rectal prolapse. DESIGN: Retrospective analysis of outcomes in adult patients undergoing the modified Delorme operation. SETTING: Community-based tertiary referral center with a 5-year general surgery residency program. PATIENTS: A total of 52 consecutive patients undergoing surgery for the treatment of complete rectal prolapse during the 26-year period ending December 2001. INTERVENTIONS: Modified Delorme operation. Main Outcomes Measured Method of anesthesia, morbidity, mortality, recurrence rates, length of follow-up, and incontinence. RESULTS: In the 52 patients, the mean length of prolapse was 8.2 cm. The mean operating time was 75 minutes. Forty-five patients were administered general anesthesia, 4 were administered spinal anesthesia, and 3 were administered local anesthesia. The mean postoperative stay was 4.9 days for 1975 through 2001 and 2.8 days for 1990 through 2001. No patients died as a result of the procedure. Patients were followed up for 61.4 months. Major medical comorbidities occurred in 40 patients. Preoperative incontinence was present in 12 patients, 10 of whom improved after the procedure, and postoperative incontinence in 8. The recurrent postoperative prolapse rate at 5 years was 6% (3/52) and the recurrent postoperative prolapse rate to the end of the study was 10% (5/52). Two patients (4%) had complications that required operative intervention in the postoperative period. CONCLUSIONS: The modified Delorme operation is a safe and effective surgical treatment for complete rectal prolapse. The risk of recurrent prolapse is low, and the procedure may be safely performed in patients with significant medical comorbidities.

Adult↗
PubMed1999

Selection criteria for internal rectal prolapse repair by Delorme's transrectal excision.

PURPOSE: The aim of this study was to review our results of Delorme's transrectal excision for internal rectal prolapse, with a view to determining preoperative selection criteria associated with a satisfactory outcome. METHODS: Between 1992 and 1998, 20 patients with internal rectal prolapse underwent Delorme's transrectal excision. The last patient was excluded from the study because of a follow-up period shorter than six months. The remaining 19 patients were prospectively followed up and classified into two groups according to their preoperative selection criteria. Group I consisted of eight patients operated on between January 1992 and October 1993 who were selected for surgery after medical treatment during a three-month period failed to improve symptoms. Initial results were reviewed, with a follow-up of at least six months, to assess predictive criteria correlating with poorer surgical outcome. These adverse criteria were used to exclude patients from selection into Group II, which included 11 patients operated on between June 1994 and June 1997. In each group the degree of improvement of symptoms was graded: Grade 1 = complete improvement with resolution of all symptoms; Grade 2 = significant improvement with resolution of dyschezia but not of other symptoms; Grade 3 = no improvement; and Grade 4 = worsened condition or reoperation. The two groups were compared according to ultimate outcomes. RESULTS: Of the Group I patients, three had preoperative chronic diarrhea, one had proximal internal rectal prolapse with rectosacral separation at defecography, and the other two were incontinent to liquid stool. An additional patient had incontinence to liquid stool but no diarrhea. Three other patients had major perineal descent (>9 cm). Results were Grade 1 for one patient, Grade 2 for one patient, Grade 3 for five patients, and Grade 4 for one patient (subsequent abdominal rectopexy). Data review showed that proximal internal prolapse with rectosacral separation at defecography, preoperative chronic diarrhea, fecal incontinence, and descending perineum (>9 cm on straining) were associated with a poorer outcome (Grades 3 and 4). These adverse criteria were used to exclude patients from selection into Group II. In this group results were Grade 1 for seven patients and Grade 2 for four patients. During the course of follow-up (mean, 43; standard deviation, 19; range, 8-73 months), outcome was better in Group II (P = 0.007). CONCLUSION. These data suggest that a favorable outcome can be achieved after Delorme's transrectal excision for internal rectal prolapse by applying stringent patient-selection criteria.

Adult↗
PubMed1989

Functional results after posterior abdominal rectopexy for rectal prolapse.

One hundred sixty-five cases of abdominal rectopexy using polypropylene (Marlex) mesh for rectal prolapse were reviewed. Six patients were men and 159 were women. Thirty patients have not been evaluated after surgery, 22 having died of interrecurrent disease and 8 have had their surgery during the last two months. Incontinence was observed in 95 patients (58 per cent) before surgery, whereas it persisted in only 21 of 135 patients (16 percent) after surgery. Forty patients (24 percent) claimed constipation before surgery, whereas 60 of 135 patients (44 percent) had constipation after rectopexy. Recurrence of full-thickness rectal prolapse was found in only 2 patients-(1.5 percent). Mucosal prolapse occurred in 9 patients (7 percent) after surgery. These results indicate that abdominal posterior rectopexy using Marlex mesh is an effective operation for rectal prolapse, but persistent incontinence occurs in one third of patients and almost half become constipated after the procedure.

Adolescent↗
PubMedDate not supplied

[The functional recovery of the internal anal sphincter and the restoration of continence after rectopexy for rectal prolapse].

Eleven patients with full thickness rectal prolapse underwent ambulatory fine wire electromyography (EMG) of the internal anal sphincter (IAS), external anal sphincter and puborectalis muscle, and anorectal manometry using a computerised system. Examinations were performed preoperatively and at 3 months following rectopexy. The median preoperative IAS EMG frequency was 0.21 Hz (range = 0.05-0.30) and the median preoperative resting anal pressure (RAP) was 13 cmH2O (range = 2-84 cmH2O). A significant improvement in the IAS EMG frequency (median = 0.31 Hz; 0.23-0.47 Hz; p < 0.02) and RAP (median = 30 cmH2O; 20-84 cmH2O; p < 0.01) was noted post-rectopexy but these parameters remained significantly different from a group of normal controls (median IAS EMG frequency = 0.48 Hz; 0.25-0.61 Hz; median RAP = 76 cmH2O; 22-120 cmH2O). We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent recto-anal inhibition.

Adult↗
PubMed1984

[Delorme's operation in the treatment of rectal prolapse].

The Delorme operation for complete rectal prolapse is a mucosal stripping and longitudinal plication of the muscular wall of the rectum. It is a safe and easy procedure using peridural or local anesthesia with no post-operative morbidity or mortality. In the largest series published, the recurrence rate was 10 per cent. In our view, this operation, superior to the Thiersch procedure, is mainly recommended for elderly and poor risk patients who are unsuitable for a transabdominal approach.

Humans↗
PubMed2004

[Rectal prolapse in adults].

The etiology of rectal prolapse is unclear. Diagnosis is easy by local inspection. The ideal surgery would repair the prolapse, correct any functional problems such as incontinence or constipation, be minimally invasive and cost-effective, and result in minimal morbidity and recurrence. The best surgical repair remains controversial-whether by the transanal/perineal or abdominal approach-with or without resection and rectopexy. There are no prospective-randomized studies that convincingly answer the numerous questions. The best possible option today seems to be the abdominal/laparoscopic method with a resection rectopexy according to Frykman and Goldberg.

Adult↗
PubMed1992

Improvement of continence after abdominal rectopexy for rectal prolapse.

Twenty-seven patients with rectal prolapse and faecal incontinence were treated by abdominal rectopexy. They were studied clinically and by anal manometry both pre- and postoperatively. Postoperatively eleven patients gained full continence, eight had incontinence for flatus, six were incontinent for liquid stools and only two had daily soiling--none was totally incontinent. Those patients who gained continence had significantly higher maximal basal pressure (MBP) (p less than 0.05) postoperatively as compared to those who remained incontinent. There was an inverse correlation between MBP and grade of postoperative incontinence (p less than 0.02). The postoperative increase of MBP correlated (p less than 0.05) with improving incontinence score. Such changes did not occur with the maximal voluntary contraction pressure (MVCP). Our results suggest that functional recovery of the internal anal sphincter is better in postoperatively continent patients.

Adult↗
PubMed1987

Rectal prolapse: relationship with joint mobility.

Joint mobility was assessed in 25 patients who had undergone surgery for complete rectal prolapse and in 25 age- and sex-matched control subjects. A significant increase in extensibility of the fifth finger was found in the patients with rectal prolapse. It was further found that there was a progressive decrease in joint mobility with age in both groups. The pathophysiology of rectal prolapse is complex. Factors considered to be important include rectal intussusception associated with the commonly observed lack of rectal fixation within the sacral hollow, with a deep Pouch of Douglas and weak pelvic floor musculature. The joint hypermobility demonstrated in these patients suggests an underlying connective tissue abnormality which perhaps contributes to the lack of rectal fixation within the pelvis and to the rectal wall intussusception.

Adolescent↗
PubMed1983

Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients.

One hundred and six consecutive patients were seen between January 1973 and January 1982 with a circumferential full thickness rectal prolapse. One hundred were treated by abdominal rectopexy using a rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum and to the lateral ligaments of the mobilized rectum. There were only 9 men in the series and 23 per cent of the patients were over the age of 80 years. Sixty-seven of the patients gave a history of faecal incontinence. Previous unsuccessful treatment for rectal prolapse included a Thiersch wire or a Silastic perianal sling in 19, electrical therapy in 12, rectopexy with polyvinyl alcohol sponge (Ivalon) in 5 and pelvic floor repair in 2. There were no operative deaths following Marlex mesh rectopexy. Twelve patients had their operation performed under spinal anaesthesia because they were considered unfit for general anaesthesia. No patient developed a recurrent rectal prolapse, but 24 of the 67 patients who had incontinence experienced persistent incontinence after rectopexy (36 per cent); 10 of these patients subsequently had a postanal repair with good results. Rectopexy had no influence on anal canal pressures. Marlex mesh rectopexy is a safe and effective operation for rectal prolapse. It appears to be superior to other operations in that, so far, there has been no recurrence.

Adult↗
PubMed1987

Rectal prolapse in young adults.

Electromyographic studies in young adults with rectal prolapse have shown that there are a group of persons who cannot pull their prolapses in who have got very abnormal electromyograms. If this group are treated with major pelvic floor surgery the electromyogram appears to return to almost normal in two years. There are other young adults with rectal prolapse who can pull the prolapse in by contracting their own pelvic floors whose electromyograms approximate more closely to the normal. This latter group were treated with the insertion of circumanal nylon. It seems possible to differentiate the two groups without using electromyography on the basis of whether or not they can pull in the prolapse by contracting the pelvic floor and therefore the selection between patients for major surgery and minor surgery can be a clinical one. Further it would seem that as an initial operation, even the patients who are in the bad group can be treated by good bowel training and in a lesser operation, that if the bowel is kept in, the electromyograph returns to normal and hopefully in some of the patients major surgery is avoided.

Adult↗