Collective results of operations for rectal prolapse.
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Humans↗
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[On successful treatment of a second rectal prolapse].
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Humans↗
The teflon sling operation for repair of complete rectal prolapse.
Sixty-four cases of complete rectal prolapse have been treated by the Teflon sling operation since 1969. One case has recurred. No sepsis has occurred. Approximately 80% of patients followed are totally continent. This relatively simple operation seems to be the procedure of choice in this disease.
Adult↗
Lahaut's operation for rectal prolapse.
Thirty-four patients with complete rectal prolapse were treated by Lahaut's operation in which the mobilised rectosigmoid was implanted in the posterior rectus sheath. There were no prolapse recurrences, but one patient died postoperatively. Of the 12 patients with incontinence, 11 were improved by the procedure. Lahaut's operation is a simple and effective procedure which avoids the potential problems associated with a surgical implant of Ivalon or Teflon.
Adult↗
[Surgical treatment of rectal prolapse].
The experience with surgical treatment of rectal prolapse in 82 patients is presented. In stage I-II prolapse, the interventions on the external anal sphincter and prolapsing rectum are the operations of choice, and in stage III-IV-intraabdominal fixation of the rectum by the lavsan strip to the anterior longitudinal ligament of the vertebral column, the free ends of which are sutured to the lateral surfaces of the rectum. The incidence of recurrences of the disease was 2.9%.
Adolescent↗
[Rectal prolapse].
A variety of pathogenetic mechanisms underly rectal prolapse. Treatment is predominantly operative. Some of the basic surgical techniques are reviewed. The modification of posterior rectopexy with ampoxen, implicated at the Department of Surgery of the Medical Academy in Sofia, is presented. After exposure of the rectum at the side of the sacrum, the intestine is fixed to the presacral fascia. The aim is to create adhesions. Septic complications are avoided, which otherwise, with applications of other synthetic implants are quite common. Experience is recorded with the application of the method in three patients, who were followed up over a period of 2 years.
Humans↗
[Rectal prolapse. Abdominal or perineal approach? Current situation].
Rectal prolapse is a major challenge for the surgeon who has to resolve the anatomical problem and the functional disturbances in the same procedure. Abdominal procedures are the most appropriate in young patients, and the most common technique is rectopexia with or without resection. The use of mesh or sutures provides the same results and the choice depends on the surgeon's preference. Laparoscopic surgery has been demonstrated to have similar efficacy to conventional surgery and may become the option of the future. The perineal approach is the best option in elderly patients and in those with associated morbidity; the Delorme technique is simple to carry out, but rectosigmoidectomy provides better results.
Abdomen↗
[Rectal prolapse in children. Review of 260 cases].
Rectal prolapse is mostly seen in constipated children after prolonged straining at stool. In Morocco, it will occur in children suffering from digestive parasitosis or hypotrophic children following episodes of acute diarrhea. In order to evaluate the respective role of these factors and consequently adapt the management of this condition, a prospective study of 260 cases was conducted between 1979 and 1986 bearing on etiologic factors on the one hand and with a view to assessing the efficacy of medical treatment and of sclerosing injections on the other hand. As regards etiology, diarrhea in connection with digestive parasitosis appears as a predominating factor (62%). A deficient condition was also noted in 67 out of 160 children (42%). Medical treatment was successful only in 28% of cases, whereas 98% of our patients were cured by sclerosing injections without need for surgical treatment.
Adolescent↗
Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse.
Ivalon sponge rectopexy is a safe reliable procedure in the management of rectal prolapse. Sutured rectopexy is simpler and avoids the use of foreign material. Sutured rectopexy is mandatory if synchronous resection is to be considered. Sixty-three patients (62 women) with full-thickness rectal prolapse were entered into a prospective randomized trial of Ivalon sponge rectopexy (31 patients) versus sutured rectopexy (32). Twenty patients (32 per cent) had coexistent incontinence (ten in each group). The operation was performed in the standard manner with a sutured rectangle of sponge or sutures alone placed along the length of the sacrum. Postoperative morbidity occurred in nine patients (14 per cent) of whom three underwent a sutured procedure and six Ivalon rectopexy: wound infection in three, chest infection in two, urinary tract infection in two and thromboembolism in two. There were no deaths within 30 days. At a median follow-up of 47 months prolapse had recurred in two patients (3 per cent), one in each group, 14 (22 per cent) suffered from incontinence (of whom five had undergone a sutured procedure), while 25 (40 per cent) had developed constipation (of whom 15 had received Ivalon rectopexy). The medium-term results of rectopexy by suture alone are equivalent to those obtained following the conventional Ivalon procedure. These data suggest that Ivalon rectopexy could now be abandoned.
Adult↗
Rectal prolapse: a possibly underrecognized complication of anorexia nervosa amenable to surgical correction.
OBJECTIVE: Rectal prolapse is a complication of anorexia nervosa (AN) that may be more common than previously recorded experience would suggest. METHOD: In this report we document, for the first time, the association of (AN) and rectal prolapse in a series of three patients seen in the past three years. An extensive review of the literature using Medline over the period from 1966 to Jan 2000 failed to reveal any previous example of this association. RESULTS AND CONCLUSION: The finding could have significant health care implications if confirmed. It would suggest that patients with either the psychiatric or surgical problem may not be receiving the appropriate complementary referrals: psychiatrist to surgeon and vice versa. The importance of recognition of this association in anorectic patients is the availability of effective surgical therapy.
Adolescent↗
Clinical and manometric evaluation of rectal prolapse and incontinence.
The clinical presentation and manometric findings in 46 patients with rectal prolapse and/or incontinence are reported. Basal and maximal squeeze pressures in the anal canal of patients with prolapse alone did not differ from the pressures in age and sex-matched controls whereas anal pressures in both groups of patients with incontinence were significantly lower than in controls. Physiotherapy and faradism had no therapeutic value in rectal prolapse but gave improvement in 30 per cent of patients with incontinence. Rectopexy gave satisfactory results in all the patients with prolapse and improved incontinence in 70 per cent. Post-anal repair cured 87 per cent of patients with idiopathic anorectal incontinence or with persistent incontinence after rectopexy. No form of treatment was associated with any significant elevation of anal pressures.
Adolescent↗
Rectal prolapse in infancy: conservative versus operative treatment.
In infancy there are two types of rectal prolapse. One type is less pronounced and intermittent. This type occurred in 9 out of 17 children referred for rectal prolapse and ceased after a few weeks' conservative treatment. The other type is a more pronounced prolapse occurring at nearly each defecation and lasting several weeks or months. These patients may need an operation, especially when ulceration of the mucosa occurs. In our patients, a Lockhart-Mummery operation was used successfully in all but one patient. No complications were observed. Though less extensive treatment, such as submucosal injection of sclerosing agents, is recommended to be the first method of choice because pathoanatomically the prolapse in infancy is frequently a prolapse of the mucosa, in patients where this therapy does not succeed, a Lockhart-Mummery operation may be an alternative.
Child, Preschool↗
Rectopexy without resection for rectal prolapse.
Forty-three patients underwent simple posterior suture rectopexy for repair of rectal prolapse. Follow-up was obtained in 42 patients (mean 28 months). The recurrence rate was 2 percent (one patient). Postoperative morbidity and mortality were 20 percent and 0, respectively. The proportion of continent patients increased from 36 percent preoperatively to 74 percent postoperatively. Constipation increased after suture rectopexy but was managed conservatively. We believe that simple suture rectopexy offers a safe and effective alternative to other, more complex procedures for the treatment of rectal prolapse.
Aged↗
Rectoanal inhibition and incontinence in patients with rectal prolapse.
Thirty-five patients with complete rectal prolapse, 32 with neurogenic faecal incontinence and 33 controls underwent ambulatory recording using a computerized anal electromyographic and anorectal manometry system. Median resting anal pressures were 34 cmH2O in patients with prolapse, 51 cmH2O in those with neurogenic faecal incontinence and 94 cmH2O in controls. Median basal rectal pressures were 18, 21 and 21 cmH2O respectively. High-pressure rectal waves of median amplitude 71 cmH2O lasting 30-150 s and associated with inhibition of the electromyographic activity of the internal and sphincter and a fall in anal pressures were seen in all patients with prolapse but not in controls or those with neurogenic incontinence. These waves were abolished following successful resection rectopexy. Recovery of continence occurs by abolition of high-pressure rectal waves, which produce maximal inhibition of sphincter activity before operation.
Adult↗
Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data.
PURPOSE: This study was designed to determine what impact surgical technique, means of access, and method of rectopexy have on recurrence rates following abdominal surgery for full-thickness rectal prolapse. METHODS: Consecutive individual patient data on age, gender, surgical technique (mobilization-only, mobilization-resection-pexy, or mobilization-pexy), means of access (open or laparoscopic), rectopexy method (suture or mesh), follow-up length, and recurrences were collected from 15 centers performing abdominal surgery for full-thickness rectal prolapse between 1979 and 2001. Recurrence was defined as the presence of full-thickness rectal prolapse after abdominal surgery. Chi-squared test and Cox proportional hazards regression analysis were used to assess statistical heterogeneity. Recurrence-free curves were generated and compared using the Kaplan-Meier method and log-rank test, respectively. RESULTS: Abdominal surgery consisted of mobilization-only (n = 46), mobilization-resection-pexy (n = 130), or mobilization-pexy (n = 467). There were 643 patients. After excluding center 8, there was homogeneity on recurrence rates among the centers with recurrences (n = 8) for age (hazards ratio, 0.6; 95 percent confidence interval, 0.2-1.7; P = 0.405), gender (hazards ratio, 0.6; 95 percent confidence interval, 0.1-2.3; P = 0.519), and center (hazards ratio, 0.3; 95 percent confidence interval, 0.1-1.5; P = 0.142). However, there was heterogeneity between centers with (n = 8) and without recurrences (n = 6) for gender (P = 0.0003), surgical technique (P < 0.0001), means of access (P = 0.01), and rectopexy method (P < 0.0001). The median length of follow-up of individual centers varied from 4 to 127 months (P < 0.0001). There were 38 recurrences at a median follow-up of 43 (range, 1-235) months. The pooled one-, five-, and ten-year recurrence rates were 1.06, 6.61, and 28.9 percent, respectively. Age, gender, surgical technique, means of access, and rectopexy method had no impact on recurrence rates. CONCLUSIONS: Although this study is likely underpowered, the impact of mobilization-only on recurrence rates was similar to that of other surgical techniques.
Adolescent↗
Posterior sagittal anorectoplasty for pediatric recurrent rectal prolapse.
The recent use of the posterior sagittal anorectoplasty for repair of high imperforate anus has demonstrated several advantages: elimination of laparotomy, more direct approach, easier division of rectourethral fistula, more exact identification of the muscles of fecal continence, proper relocation of anorectum within these muscles and sphincters, and virtual elimination of postoperative anal prolapse. It is this latter advantage that attracted us to use this procedure for the repair of a recurrent rectal prolapse in a 1-year-old girl who also had a recurrent bladder exstrophy. The latter probably contributed to her constantly pushing out her rectum, which easily admitted two fingers. Two attempts were made to repair the rectal prolapse using the subcutaneous Thiersch's perianal technique; however, each was successful for only 6 weeks. When her recurrent bladder exstrophy was repaired, we also repaired her recurrent rectal prolapse using the posterior sagittal anorectoplasty. The midline sacrococcygeal incision was carried down to but not through the external sphincter, and the patulous rectum was plicated back to a normal size. Reapproximation of the levator sling and lower muscle complex then incorporated the plicated rectum. Both repairs remain intact after 1 year.
Anal Canal↗
Complete rectal prolapse clinical and functional outcome with Delorme's procedure.
INTRODUCTION: Many surgical techniques -both through the perineal and abdominal routes- have been described for the treatment of rectal prolapse. The aim of this work is to evaluate the clinical and functional outcome with Delorme's perineal procedure. PATIENTS AND METHODS: Twenty-one patients with complete rectal prolapse were studied from July 2000 to October 2005. Age, gender, anesthetic risk, and accompanying symptoms were all assessed. Diagnostic tests performed included: colonoscopy, anorectal manometry before and after surgery, and 360 masculine endoanal ultrasonography. Delorme's procedures were carried out by only one surgical team. RESULTS: No mortality occurred, and morbidity was minimal. Prolapse relapse rate was 9.52% with a mean follow-up of 34 months. Anal continence improved in 87.5% of patients, and no surgery-associated constipation ensued. Mean hospital stay was 2 (range 1-4) days. During the postoperative period no pain developed in 17 patients, and 4 patients had mild pain. Satisfaction with surgery was high in 16 cases (76.19%), moderate in 3 (14.28%), and low in 2 (9.52%). CONCLUSIONS: Delorme's procedure for the management of complete rectal prolapse is associated with low morbidity, improves anal continence, gives rise to no postsurgical constipation, and has an acceptable relapse rate. Patient satisfaction with this procedure is high because of its high comfortability (intradural anesthesia, short hospital stay, and little postoperative pain) and optimal results.
Adult↗
Perineal excision of rectal prolapse with posterior levator ani repair in elderly high-risk patients.
Perineal excision of rectal prolapse with simultaneous posterior levator ani repair was used to treat 41 elderly patients with rectal procidentia. The majority of the patients had significant associated risk factors. This procedure was performed with minimal morbidity and no mortality. A significant improvement in anal continence was seen in 78 percent of patients. The recurrence rate of rectal prolapse was 4.8 percent.
Aged↗