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PubMed1996

Functional results after abdominal suture rectopexy for rectal prolapse or intussusception.

OBJECTIVE: To assess the functional outcome after suture rectopexy in patients with rectal prolapse or intussusception. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: 33 patients with rectal prolapse and 19 patients with intussusception treated by abdominal suture rectopexy 1969-1992. MAIN OUTCOME MEASURES: Bowel function evaluated by a questionnaire a median of 97 months after operation. RESULTS: 10/33 patients (30%) reported less constipation after rectopexy in the prolapse group compared with 3/19 (16%) in the intussusception group (p = 0.33). Rectal emptying improved in 14/33 (42%) and 1/19 (5%), respectively (p = 0.005), and incontinence in 12/33 (36%) and 3/19 (16%), respectively (p = 0.20). Seventeen patients (52%) with prolapse and 3 (16%) with intussusception described the result of operation as excellent or good (p = 0.02). CONCLUSION: There is a reasonable chance of improved rectal emptying and continence in patients undergoing suture rectopexy for rectal prolapse, whereas bowel symptoms commonly worsen postoperatively in patients treated for intussusception.

Adult↗
PubMed2004

Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children.

Parasitic infestations, mainly enterobiasis and amoebiasis, and poor toilet training practices are commonly associated with rectal prolapse in developing countries. Injection sclerotherapy is one of the commonly used modalities for treating partial rectal prolapse in children. Various materials are available for such injection, but each has its advantages and complications. Comparing different materials used in the treatment of such pathology form the basis of this study trying to define the best material with the least complications. Data records of 130 children with partial rectal prolapse referred to the Department of Pediatric Surgery at Al Galaa Teaching Hospital, Cairo, over a 3-year period were analyzed. Their ages ranged from 6 months to 12 years (mean 6.14 years +/-3.4). Forty-five patients (3 5%) responded to conservative treatment, and 85 patients (65%) required injection sclerotherapy and were divided into three groups: Group 1 (35 patients) was injected with 98% ethyl alcohol, group 2 (22 patients) was injected with phenol in almond oil 5%, and group 3 (28 patients) was injected with Deflux (Q-Med, Uppsala, Sweden). The follow-up period ranged from 2 months to 3 years; clinical data and all complications were recorded. Submucosal injection of the three sclerosing materials showed no mortality in this series, but in group 1, seven had recurrence on short-term follow-up that required reinjection, and long-term follow-up in this group showed a recurrence rate of 11% (four patients), plus two patients had mucosal sloughing and one girl developed a rectovaginal fistula. Group 2 showed abscess formation and mucosal sloughing in four patients (18%), and two developed perianal fistula. Group 3 showed immediate postoperative prolapse in two cases that ameliorated spontaneously. No patients had mucosal ulceration or abscess formation, and long-term follow-up showed no recurrence. Deflux had the lowest complication rate with no recurrence on long-term follow-up. Phenol in almond oil 5% injection should not be used for treating such conditions because of its high complication rate. Alcohol is commercially cheap and available and should be considered an alternative for Deflux.

Child↗
PubMed1981

Manometric evaluation of rectal prolapse and faecal incontinence.

Sixty-three patients with complete rectal prolapse and/or faecal incontinence have undergone anal manometry and the results have been compared with an equal number of age- and sex-matched controls. Maximal basal pressure (MBP) and maximum squeeze pressure (MSP) were measured before and at four months and a year after treatment. The anal pressures of normal subjects are presented. Patients with rectal prolapse alone had normal anal pressures, whereas patients with incontinence with or without prolapse had significantly lower basal and squeeze pressures than controls. Successful surgical treatment of prolapse or incontinence did not produce significant change in anal canal pressures, whereas the combination of pelvic floor exercises and a continence aid was associated with a significant rise in MSP.

Adult↗
PubMed1985

Rectal prolapse and cystic calculus in a burro.

A 7-year-old burro jack was examined because of recurrent rectal prolapse and severe cough. The prolapse was reduced manually and a cough associated with bronchopneumonia responded to antimicrobial therapy. The rectal prolapse recurred and again was reduced manually. During exploratory celiotomy a cystic calculus was identified and removed. Severe protracted cough and cystic calculus were thought to be contributing factors to recurrent rectal prolapse in this burro.

Animals↗
PubMed2001

Focal eosinophilic proctitis with associated rectal prolapse in a pony.

Focal intramural nodules were palpated in the rectal wall of a 12-year-old pony mare presented for rectal prolapse. Eosinophilic proctitis was diagnosed by examination of fine needle aspirates and biopsy of the largest rectal nodule. After treatment with a course of corticosteroids, the rectal nodule and accompanying peripheral eosinophilia resolved. There was no recurrence of the condition during the follow-up period of 20 months. Focal eosinophilic proctitis appeared to be an unusual cause of tenesmus and rectal prolapse in this case.

Adrenal Cortex Hormones↗
PubMed1986

Quadrant mucosal stripping and muscle pleating in the management of childhood rectal prolapse.

A new operation that has been found effective in the treatment of frequently recurring rectal prolapse in children is described. It involves excision of narrow strips of mucosa at three or four quadrants and inserting nonabsorbable sutures in the denuded area to pleat the prolapsed segment. The technique is simple, safe, and effective for both mucosal prolapse and full-thickness rectal prolapse. It is free from major complications. The controversy surrounding the predisposing factor, the nature of the prolapse, and the various suggested treatments are highlighted.

Child↗
PubMed1985

Anterior resection for complete rectal prolapse.

One hundred thirteen patients underwent anterior resection for complete rectal prolapse between 1968 and 1980. These patients were followed for an average of seven years; recurrence developed in eight patients (9 percent). Recurrences were found to occur at three months to eight years postoperatively, and the probability of a recurrence at two, five, and ten years was 3 percent, 6 percent, and 12 percent, respectively. Operative mortality was 1 percent and morbidity was 29 percent. Low anterior resection, with anastomosis in the deperitonealized portion of the colon, was found to increase morbidity without significantly decreasing recurrence when compared with high anterior resection. The effects of repair on patient continence were unpredictable. High anterior resection is preferable to low anterior resection in the treatment of rectal prolapse and offers results comparable to those of other repairs currently being performed.

Adolescent↗
PubMed1994

Delorme operation for rectal prolapse.

A consecutive series of 49 elderly patients of mean age 73 years with full-thickness rectal prolapse underwent the Delorme operation between 1986 and 1990. A standard technique was used, or supervised, by one surgeon. In this prospective series, 43 patients were reviewed clinically. The Delorme operation abolished rectal prolapse in 32 patients. Half of the 40 with faecal incontinence were rendered continent. Failure was related to previous anorectal surgery and/or psychiatric illness. Of the 11 patients in whom the first procedure failed, four were improved by a second Delorme operation. The Delorme operation is a suitable procedure for elderly and/or medically unfit patients with rectal prolapse. Good results have also been demonstrated for younger patients, suggesting that the operation may have wider application.

Adult↗
PubMed2004

Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty.

BACKGROUND: The management of full thickness rectal prolapse remains controversial. Although abdominal approaches have a lower recurrence rate than do perineal operations, they are associated with a higher morbidity. The aim of this study was to compare the outcomes of perineal rectosigmoidectomy with and without levatorplasty. METHODS: Between 1989 and 1999, a total of 109 consecutive patients (10 men) underwent 120 perineal procedures. These patients were retrospectively evaluated in two groups on the basis of the type of surgery received: perineal rectosigmoidectomy (PRS) or perineal rectosigmoidectomy with levatorplasty (PRSL). Subsequent functional outcome and physiological parameters were assessed. RESULTS: The patients had a mean age of 75.7 years (range, 23.0-94.8 years) and they were followed for an overall mean (in both groups combined) of 28.0 months (range, 0.4-126.4 months) after surgery. Mean duration of surgery was 78.1 min (SD=25.9) and 97.6 min (SD=32.3) in PRS and PRSL, respectively ( p=0.002, unpaired t test). There was no significant difference between the two groups in terms of hospital stay, morbidity or mortality. Recurrence rates and mean time interval to recurrence were, respectively, 20.6% and 45.5 months in PRS compared to 7.7% and 13.3 months in PRSL ( p=0.049, chi-square test; p=0.001, unpaired t test). Both groups had significant improvements in postoperative incontinence score ( p<0.0001, Wilcoxon's matched-pairs signed-ranks test), however, there were no significant changes in anorectal manometric findings and pudendal nerve terminal motor latency assessment. CONCLUSIONS: Perineal rectosigmoidectomy with levatorplasty is associated with a lower recurrence rate and a longer time to recurrence than perineal rectosigmoidectomy alone. Levatorplasty should be offered to patients when a perineal approach for rectal prolapse is selected.

Adult↗
PubMed2002

Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse.

BACKGROUND: The objectives of this study were to compare both subjective clinical outcomes and the objective stress response of laparoscopic and open abdominal rectopexy in patients with full-thickness rectal prolapse. Abdominal rectopexy for patients with rectal prolapse is well suited for a laparoscopic approach as no resection or anastomosis is necessary. METHODS: Forty patients with a full-thickness rectal prolapse were randomized before operation to a laparoscopic group and an open group. They agreed to conform to a clinical pathway (CP) of liquid diet (CP1) and full mobility (CP2) on day 1, solid diet (CP3) on day 2 and discharge (CP4) before day 5. Their compliance was monitored by an assessor blinded to the operative group, who also rated pain and mobility. Patient-controlled morphine use was documented. Neuroendocrine and immune stress response and respiratory function were measured. RESULTS: Some 75 per cent of all clinical pathway objectives of early recovery were achieved in the laparoscopic group compared with 37 per cent in the open group (P < 0.01). Significant differences in favour of laparoscopy were noted with regard to narcotic requirements, and pain and mobility scores. Differences in objective measures of stress response favouring laparoscopy were found for urinary catecholamines, interleukin 6, serum cortisol and C-reactive protein. No differences were noted in respiratory function but significant respiratory morbidity was greater in the open group (P < 0.05). None of the measured outcomes, subjective or objective, favoured the open group apart from operating time, which was significantly shorter (153 versus 102 min; P < 0.01). CONCLUSION: This study has demonstrated significant subjective and objective differences in favour of a laparoscopic technique for abdominal rectopexy. The advantages were all short term but no evidence of any adverse effect on longer-term outcomes was observed.

Analgesia, Patient-Controlled↗
PubMed1975

Treatment of rectal prolapse.

There are two schools of thought concerning the aetiology of rectal prolapse. On the one hand it was conceived to be a sliding hernia through a defect in the pelvic fascia, while on the other hand radiological studies have demonstrated prolapse to be represented by an intussusception of the rectum. Various operative procedures have been proposed for the treatment of rectal prolapse based on the belief in one or the other of these concepts. The anatomic defects which have been described with prolapse include a defect in the pelvic floor with diastasis of the levatores ani, loss of the normal horizontal position of the rectum, an abnormally deep cul-de-sac of Douglas, a redundant rectosigmoid, and a patulous anal sphincter. The popularly used procedure in Great Britain is that in which a sheet of Ivalon sponge is sutured to the sacrum and wrapped around the rectum thus anchoring it in place. Various authors have reported good results using this technique. The mortality and morbidity rate appear to be acceptable. In the U.S.A. a popular procedure is the Ripstein technique where a sheet of Teflon is wrapped around the rectum anteriorly anchoring the rectum to the sacrum. This technique also has its proponents who rport satisfactory results. Abdominal proctopexy and sigmoid resection, although not in common general use, has been found to be effective with an acceptable morbidity and mortality rate. These three procedures have some drawbacks but the one problem common to all the repairs so far developed for prolapse is their inability to guarantee to restore continence. Probably half the patients operated upon continue to be incontinent. Faradic stimulation of the sphincter has not proved to be as helpful as initially hoped.

Aged↗
PubMed2005

Surgically treated rectal prolapse: experience at a teaching hospital.

OBJECTIVE: To analyze our results regarding the surgical treatment of complete rectal prolapse performed at the Aga Khan University Hospital, from January 1988 to December 2003. METHODS: Files were retrieved from our medical records and data was reviewed for all adult patients admitted and operated upon for complete rectal prolapse during our study period. Long-term follow-ups were obtained through these files and also by contacting patients through telephone and letters. Data was recorded in a standardized two-page proforma and analysis was carried out between different variables using SPSS 10.0. RESULTS: A total number of twenty surgeries (n = 20) were performed. All patients had the presenting complaint of something coming out of anus, 70% (n = 14) patients complained of some bleeding per rectum, 30% (n = 6) had anal pain and 20% (n = 4) had faecal incontinence. Chronic constipation was found in 50% (n = 10) patients, obstructive uropathy in 30% (n = 6), weight loss, chronic cough and mental illness, each in 10 % (n = 2) of patients. Primary procedure was carried out in 70% patients. Mean operative time was 178 minutes; mean length of stay was 7 days with a mean follow-up of 25 months. Early complications were noted in 5% (n = 1) patients, and late complications in 30% (n = 6). Based on this data, comparative analysis was carried out between different variables. CONCLUSIONS: Surgery is the only treatment for rectal prolapse in adults. Several procedures are done suggesting that there is no standard treatment for this ailment. The number of male patients was higher, chronic constipation was the most common risk factor, abdominal rectopexy was the favored procedure, perineal procedures were associated with shorter operative time, hospital stay, and were done more often in females and elderly. Revision surgery was associated with longer operative time and hospital stay.

Adolescent↗
PubMed2004

Surgical treatment of rectal prolapse: experience and late results with 51 patients.

UNLABELLED: The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

Adult↗
PubMed2006

Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse.

PURPOSE: This study examines whether preoperative anal manometry and pudendal nerve terminal motor latency predict functional outcome after perineal proctectomy for rectal prolapse. METHODS: All adult patients treated by perineal proctectomy for rectal prolapse from 1995 to 2004 were identified (N = 106). Forty-five patients underwent anal manometry and pudendal nerve terminal motor latency testing before proctectomy and they form the basis for this study. RESULTS: Perineal proctectomy with levatoroplasty (anterior 88.9 percent; posterior 75.6 percent) was performed in all patients, with a mean resection length of 10.4 cm. Four patients (8.9 percent) developed recurrent prolapse during a 44-month mean follow-up. Preoperative resting and maximal squeeze pressures were 34.2 +/- 18.3 and 60.4 +/- 30.5 mmHg, respectively. Pudendal nerve terminal motor latency testing was prolonged or undetectable in 55.6 percent of patients. Grade 2 or 3 fecal incontinence was reported by 77.8 percent of patients before surgery, and one-third had obstructed defecation. The overall prevalence of incontinence (77.8 vs. 35.6 percent, P < 0.0001) and constipation (33.3 vs. 6.7 percent, P = 0.003) decreased significantly after proctectomy. Patients with preoperative squeeze pressures >60 mmHg (n = 19) had improved postoperative fecal continence relative to those with lower pressures (incontinence rate, 10 vs. 54 percent; P = 0.004), despite having similar degrees of preoperative incontinence. Abnormalities of pudendal nerve function and mean resting pressures were not predictive of postoperative incontinence. CONCLUSIONS: Perineal proctectomy provides relief from rectal prolapse, with good intermediate term results. Preoperative anal manometry can predict fecal continence rates after proctectomy, because patients with maximal squeeze pressures >60 mmHg have significantly improved outcomes.

Adult↗
PubMed1985

A stapler modification of the altemeier procedure for rectal prolapse. Experimental and clinical evaluation.

The Altemeier procedure remains one of the better alternatives in elderly patients with rectal prolapse too fragile to undergo an abdominal operation. The circular stapler was studied first in a dog model then in humans to ascertain whether it added anything to the previously well-described technique. A fixed rectal prolapse was created in dogs by means of a laparotomy. This was later repaired by a transanal technique using a stapler modification of the Altemeier procedure. The same perineal approach was then applied to two elderly female patients with complete rectal prolapse. It was found to improve the quality and ease of a difficult anastomosis. The stapler device allowed a higher colonic resection and may have improved the postoperative continence occurring in 50 per cent of the patients with this problem. The stapler anastomosis narrowed rapidly causing better retention of stool in the first several months after surgery. The two patients repaired in this manner have had no recurrences and are continent of solid stool 3 years after surgery.

Animals↗
PubMedDate not supplied

[Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results].

In recent years the number of patients with partial or total rectal prolapse has increased. Numerous techniques and surgical approaches have been described for its treatment. In this study we examine the main ones and stress the advantages of the transanal-perineal resection technique according to Altemeier and modified by Prasad, which we have used to treat the condition in the last 15 years. From 1988 to 2002, 269 patients with "haemorrhoidal prolapse" were referred to our department; 146 were females (54%), and the mean age was 58 years. Clinical examination and proctosigmoidoscopy revealed the presence of total rectal prolapse in 41 patients (15%, 32 F, 9 M), complicated in 4 cases by moderate incontinence and associated in 3 cases with post-haemorrhoidectomy stenosis. These 41 patients underwent transanal resection according to Altemeier. Thirty-four of them (83%) were operated on under local anaesthesia with sedation, 5 patients (12%) under peridural anaesthesia and 2 patients (5%) under narcosis. The mean hospital stay was 5 days and depended on the time of the first spontaneous evacuation. Check-ups were performed after 7 days, 1 months and every 3 months for 1 year. There was no postoperative mortality, and only 1 case of postoperative haemorrhage, which did not require reoperation, in a patient with a previous myocardial infarct who spontaneously continued to take salicylates up to 24 h before surgery. Thirty-three patients (80%) had their first postoperative evacuation within 48 h of surgery after taking sorbitol orally in the evening, 6 patients (15%) within 72 h, and 2 patients (5%) on postoperative day 4. No evacuative enemas were performed. We observed clinical healing in all patients 1 month after the operation, and regular, spontaneous evacuations without the use of oral laxatives. Stool or gas incontinence were never observed or reported. During the follow-up, only in 2% of cases did we observe partial recurrence of the prolapse. The choice between the numerous surgical techniques for correcting rectal prolapse, depends on the state of the disease, on the patient's general condition and on the surgeon's experience with the various techniques. The perineal approach proposed by Altemeier and modified by Prasad presents a low risk of mortality and immediate complications, as confirmed by our experience, even in high risk patients, and relatively easy execution. It would appear, moreover, to be the only technique capable of correcting the preoperative incontinence sometimes present.

Adult↗
PubMed2003

[Impact of rectal prolapse and rectocele on TVT results].

OBJECTIVES: The comorbidity between rectal repair surgery and stress urinary incontinence (SUI) repair by TVT (simplified suburethral sling procedure) is a poorly defined entity. The objective of this study was to evaluate the influence of this combination on the quality of postoperative voiding and urinary continence. METHODS: Retrospective analysis of 12 patients (group 1) simultaneously treated by TVT and rectocele repair by anterior rectal mucosectomy (Sullivan: 6 cases) or rectal prolapse repair (open rectal fixation: 6 cases). They were compared to a group of 12 randomly selected patients (group 2) treated by TVT alone during the same period. RESULTS: A significant post-voiding residual urine volume was observed in 4 women of group 1 versus only one woman of group 2. All patients subsequently and spontaneously resumed satisfactory voiding except for one woman of group 1, in whom self-catheterization had to be maintained. After a mean follow-up of 18 months for group 1 and 17 months for group 2, only one woman, in group 2, was still incontinent. CONCLUSION: Rectal repair surgery, combined with TVT, increases the risk of transient postoperative urinary retention. This surgical combination does not appear to modify the medium-term result of the urological procedure.

Female↗
PubMed1999

Complete rectal prolapse: evolution of management and results.

UNLABELLED: Optional treatment for complete rectal prolapse remains controversial. PURPOSE: We reviewed our experience over a 19-year period to assess trends in choice of operation, recurrence rates, and functional results. METHODS: We identified 372 patients who underwent surgery for complete rectal prolapse between 1976 and 1994. Charts were reviewed and follow-up (median, 64: range, 12-231 months) was obtained by mailed questionnaire (149 patients; 40 percent) and telephone interview (35 patients; 9 percent). Functional results were obtained from 184 responders (49 percent). RESULTS: Median age of patients was 64 (11-100) years, and females outnumbered males by nine to one. One-hundred and eighty-eight patients (51 percent) were lost to follow-up; 183 patients (49 percent) underwent perineal rectosigmoidectomy, and 161 patients (43 percent) underwent abdominal rectopexy with bowel resection. The percentage of patients who underwent perineal rectosigmoidectomy increased from 22 percent in the first five years of the study to 79 percent in the most recent five years. Patients undergoing perineal rectosigmoidectomy were more likely to have associated medical problems as compared with patients undergoing abdominal rectopexy (61 vs. 30 percent, P = 0.00001). There was no significant difference in morbidity, with 14 percent for perineal rectosigmoidectomy vs. 20 percent for abdominal rectopexy. Abdominal procedures were associated with a longer length of stay as compared with perineal rectosigmoidectomy (8 vs. 5 days, P = 0.001). Perineal procedures, however, had a higher recurrence rate (16 vs. 5 percent, P = 0.002). Functional improvement was not significantly different, and most patients were satisfied with treatment and outcome. CONCLUSIONS: We conclude that abdominal rectopexy with bowel resection is associated with low recurrence rates. Perineal rectosigmoidectomy provides lower morbidity and shorter length of stay, but recurrence rates are much higher. Despite this, perineal rectosigmoidectomy has appeal as a lesser procedure for elderly patients or those patients in the high surgical risk category. For younger patients, the benefits of perineal rectosigmoidectomy being a lesser procedure must be weighed against a higher recurrence rate.Patient satisfaction]

Colon, Sigmoid↗