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PubMed1983

Experience with the one-stage perineal repair of rectal prolapse.

Our experience with 27 patients undergoing 33 Altemeier procedures for repair of rectal prolapse is presented. The overall recurrence rate during a 1- to 17-year follow-up period is 35 per cent (per patients) or 50 per cent (per operations). There was no mortality and only minimal morbidity, although we were dealing with an elderly group of patients (average age 61 years) with many associated diseases (2.8 diseases per patient). Of 13 patients with successful anatomic repair, ten described it as a success, one developed an anal stricture, and two patients claimed only partial success, despite a perfect anatomic repair, due to lack of improved continence. Our results with the Altemeier procedure for the repair of rectal prolapse are unsatisfactory. However, as the procedure is well tolerated by elderly and sick patients, it should be reserved for those.

Adult↗
PubMedDate not supplied

[Abdominal rectopexy in the treatment of rectal prolapse: how to foresee the functional result].

21 patients (19 women) who underwent rectal prolapse repair were prospectively studied. At the one year follow-up, 6 of the eleven incontinent patients (54 per cent) regained full continence and while three of the remaining 5 patients improved they still referred occasional imperfection of continence. Resting anal pressure and maximal squeeze pressure were both significantly lower in the five patients who remained incontinent, 23 (17-31) mm Hg vs 50 (31-52) mm Hg (p < = 0.02) and 52 (17-75) mm Hg vs 108 (89-110) mm Hg (p < = 0.02), respectively. Moreover the manometric results showed evidence that in patients who remained incontinent, the anal pressure in response to rectal distention, was significantly lower than patients who regained continence (p < = 0.05) both before and after operation. We conclude that incontinent patients with rectal prolapse who exhibit a markedly low minimal residual anal pressure on recto-anal reflex inhibition are less likely to improve after rectopexy and that this preoperative test may be a useful predictor.

Adult↗
PubMedDate not supplied

Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection.

Constipation and incontinence are frequent complications of rectal prolapse. Surgery should not only aim to correct prolapse but also improve bowel and sphincter function. From 1986-1991 42 patients with procidentia were treated by rectopexy and sigmoid resection. The mean age was 61.1 years. Thirty-nine patients were available for follow-up examination. Mean follow-up was 54 months. Functional data were collected prospectively before the operation and at follow-up and included clinical parameters, a constipation score, an incontinence score, anal manometry [mean resting pressure (MRP), mean maximum pressure (MMP)], proctography [anorectal angle (ARA)] and colonic transit studies [mean transit time (MTT), rectosigmoid transit time (RSTT)]. The postoperative complication rate was 7.1% (n = 3), mortality was 0%. No recurrence was seen. Constipation complaints improved from 43.6% to 25.6% (p < 0.001) and incontinence from 66.6% to 23.1% (p < 0.001). MRP increased from 36.5 mmHg to 46.0 mmHg and MMP from 90.5 mmHg to 103.0 mmHg (p < 0.001). ARA changed from 102 to 98 degrees (p < 0.001) and correlated with sphincter tone and continence. MTT decreased from 47.8 to 38.5 hours, segmental transit (RSTT) from 21.1 to 12.7 hours (p < 0.001). Our results indicate that rectopexy with sigmoid resection is a safe and effective procedure for rectal prolapse and improves functional disorders of bowel and sphincter.

Adult↗
PubMed1998

[Treatment of complete rectal prolapse with rectopexy to the pelvic floor with prosthesis and sigmoid resection. Anatomoclinical results of a prospective study].

UNLABELLED: BACKGROUND, AIM OF THE STUDY: Full thickness rectal prolapse in young adults with normal perineal structures is a disease of the rectum which is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. PATIENTS AND METHODS: Twenty patients (16 women and four men) of median age 41 years were operated on for full thickness rectal prolapse with normal perineal structures. The rectum was mobilised posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired, with a semi-absorbable prosthesis. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. RESULTS: There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in one patient. Mean hospital stay was 8.7 days. Mean follow up was 30 (range 9-75) months. No recurrence was seen. Pre-operatively, 18 patients (90%) complained of constipation mainly with emptying problems (15 patients) and 13 patients (65%) were incontinent. Post-operatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 13 patients (86.5%). Eight incontinent patients (61.5%) regained full continence. On the other hand, two patients with normal bowel function worsened and one patient with an altered rectal compliance after Delorme's operation became incontinent. CONCLUSIONS: In young adults with rectal prolapse and normal perineal structures undergoing prosthetic rectopexy and sigmoid resection: a) morbidity was low, b) anatomical control was obtained in all cases, c) emptying problems were corrected, d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.

Adult↗
PubMed1993

Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse.

OBJECTIVE: To report the long term results of abdominal rectopexy in patients with complete rectal prolapse. DESIGN: Ongoing prospective randomised study. SETTING: Department of Surgery, Westfälische Wilhelms-University, Münster. SUBJECTS: 47 patients with complete rectal prolapse operated on between 1982 and 1989. INTERVENTIONS: Abdominal rectopexy with absorbable mesh made of either polyglycolic acid (n = 17) or polyglactine 910 (n = 30). MAIN OUTCOME MEASURES: Postoperative complications and late results at a mean of 50.5 (range 2-102) months after operation. RESULTS: Thirteen patients (28%) developed postoperative complications, most of them minor; there was one enterocutaneous fistula. Thirty five patients (74%) were available for late follow up. There were no case of recurrent prolapse and 5 (14%) had developed mucosal prolapse. Of the 22 patients who had been incontinent before operation, 8 had become totally continent and 6 partially continent Overall continence improved in 18 (51%) of the 35 patients. Three patients who were continent before operation had become incontinent. CONCLUSION: Absorbable mesh is a suitable material for abdominal rectopexy.

Absorption↗
PubMed1981

Delorme's operation for complete rectal prolapse.

Twelve patients with a median age of 73 years were treated for complete rectal prolapse by Delorme's operation. The patients were mildly sedated, and local anaesthesia with lidocaine--adrenaline was administered submucously. No postoperative mortality or cardiopulmonary complications occurred. After a medial follow-up of 3 years, two recurrences were found. The Delorme procedure seems to be superior to the Thiersch operation, and the postoperative mortality and morbidity is equally low. Delorme's operation should be considered as an alternative treatment for complete rectal prolapse in patients who are not suitable for a transabdominal procedure.

Aged↗
PubMed1986

Delorme's operation: the first choice in complete rectal prolapse?

The Delorme operation has been used to treat 27 consecutive patients with complete rectal prolapse. The mean age in this group was 74 years and the average length of the prolapse was 12 cms. There was no postoperative mortality or morbidity. The follow-up ranges from 11 months to 64 months (mean 35 months) and so far there have been two recurrences. One of these has been successfully treated by a second Delorme operation. The second patient has declined further surgery. This low recurrence rate combined with the minor nature of the procedure suggests that the Delorme operation should be considered in all patients presenting with complete rectal prolapse.

Adult↗
PubMed1984

Complete rectal prolapse: repair by a simple technique.

A simple technique for the repair of complete rectal prolapse is described, and the results assessed. The method involves posterior rectopexy, suturing the rectum to the sacrum with paired interrupted linen sutures, thus avoiding the insertion of sheets of foreign material. The operation is suitable for all ages, and the minimal pelvic dissection required facilitates its use in high risk patients. The procedure was carried out in 23 patients, aged between 14 and 88, with a follow up period of between 2 months and 6.5 years. There was one postoperative death. The operation has a low morbidity and mortality, and the majority of the patients are now totally asymptomatic. There have been no recurrences of the complete rectal prolapse.

Adolescent↗
PubMed1989

Anorectal motility in children with complete rectal prolapse.

Anorectal manometry, defecography, and ultrasonographic study were performed in 36 children with complete rectal prolapse and 45 age- and sex-matched controls. Anorectal manometry disclosed that there was no significant difference in Pr, Pac, or length of HPZ between patients and controls. The rate of BRC of the smooth muscle of the anal canal and RC were significantly lower in patients. Rectoanal reflex was present in all patients and controls. Defecography and ultrasonographic examination confirmed the hypothesis that rectal prolapse starts initially as an intussusception of the rectum, then fully develops. In 29 cases patients were cured by conservative treatment, but seven patients required surgical treatment. Results of modified Sudeck's operation were, in general, satisfactory.

Adolescent↗
PubMed1994

[The value of defecography for diagnosis of rectocele and rectal prolapse].

The role of defecography with respect to rectoceles and to any grade of rectal prolapses has not been defined so far. Therefore, we studied 42 out of 45 patients that were submitted to a defecography between 1988 and 1992 for defecation disorders of unknown origin. In particular, we compared the diagnosis obtained by anamnestic data and the physical examination with the defecographic results and the definitive diagnosis with regard to the chosen therapies and the results. Rectocele and rectal prolapse were very frequent pathologies with 69% and 33% respectively. Of 23 patients with a clinically palpable rectocele, defecography was false negative in 4 and moreover, it did not provide any information about the functional relevance of the rectocele. Yet, it disproved the clinically diagnosed prolapses in 6 of 15 subjects, but revealed one in 5 of 27 patients that were presumed normal. On the other hand, a previously not diagnosed rectocele was detected in 6 out of 19 patients by means of defecography, but none of them proved to be of any clinical relevance. Of all rectoceles, only 48% were regarded responsible for the patients' symptoms and were therefore operated. Hereby, the indication for a surgical approach based more on anamnestic data and the proctological examination than on radiographic findings. Contrarily, the indication for a rectopexy--even if given only in 4 of those 14 patients with any grade of invagination--mainly based on the dynamics during defecation as documented by defecography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Rectal prolapse: 17-year experience with the posterior repair and suspension.

Using a posterior repair and rectal suspension procedure for those patients who need surgical treatment of rectal prolapse, we have treated 46 patients over a period of 17 years at Children's Mercy Hospital in Kansas City, MO. One patient with caudal dysgenesis died of multiple congenital anomalies following two unsuccessful attempts at posterior repair and suspension. Four patients developed a recurrence afterwards, which was found to be due to sigmoid intussusception and, presumably, had played a major part in their original prolapse. Two of these required resection, one from the transanal approach and one from the transabdominal approach. One resolved spontaneously and another is as yet unresolved. Three patients had minor mucosal prolapse that was transient and two patients had extrusion of silk sutures but continued to have a very satisfactory result. Overall, 42 patients had satisfactory resolution of their rectal prolapse. Three of the four patients who had unsatisfactory results had associated anomalies that contributed to their poor outcome.

Child↗
PubMed1984

Manometric studies in rectal prolapse.

Manometric studies of internal sphincter responses were carried out on 15 patients--14 with rectal prolapse and one with mucosal prolapse with proctitis cystica profunda. In all 12 patients studied preoperatively, the internal sphincter reflexes (inhibitory reflex) were absent or markedly obtunded. Anterior resection was performed on three of the patients in whom preoperative and postoperative manometric studies could be carried out. In one, the inhibitory reflex returned to normal after successful corrective surgery and in one, absence of the reflex persisted after anterior resection and this patient eventually had recurrent rectal prolapse.

Aged↗
PubMed1985

Treatment of rectal prolapse by sphincteric support using silastic rods.

The use of silastic perianal rings to control rectal prolapse in the elderly has been reviewed. Forty-one patients were treated over a 6 year period by a total of 52 operations. Their mean age was 80 years and there was no operative mortality. Prolapse was adequately controlled in 71 per cent of patients, and a further three patients had no recurrence despite failure and removal of the ring. The results of this procedure are inferior to those obtained by abdominal operations for rectal prolapse, but deserve serious consideration in those elderly patients who may be unfit for laparotomy.

Aged↗
PubMed1997

Intracellular Campylobacter-like organisms associated with rectal prolapse and proliferative enteroproctitis in emus (Dromaius novaehollandiae).

Rectal prolapse was the presenting clinical finding in a group of juvenile emus (Dromaius novaehollandiae). Gross findings included severely thickened and rugose distal rectal mucosae. Histologically, there were thickened villi, enterocyte hyperplasia, dilated glands filled with mucus and heterophils, and a dense infiltrate of heterophils, macrophages, lymphocytes, and plasma cells in the lamina propria. Examination of Warthin-Starry silver-stained sections revealed numerous apically located comma-shaped intracytoplasmic bacteria approximately 1 x 3 microns in size. Campylobacter-like organisms morphologically compatible with ileal symbiont intracellularis now known as Lawsonia intracellularis were seen via electron microscopy. Bacteria were further characterized by indirect immunofluorescence using monoclonal antibody specific for the 25-27-kd outer membrane protein of L. intracellularis.

Animals↗
PubMed1983

Repair of rectal prolapse using a puborectal sling procedure.

Many procedures have been described for the repair of rectal prolapse. Some are associated with a high recurrence rate and do not correct associated fecal incontinence. During the last four years, we have operated on 15 patients using a puborectal sling fashioned of polypropylene mesh. Nine were women and six were men, with ages ranging from 25 to 72 years. Eight patients had fecal incontinence. During a follow-up of six months to four years, rectal prolapse did not recur. Fecal incontinence was totally resolved in all cases. The morbidity and death rates were both 0%, and no long-term problems have been associated with use of the synthetic material. This procedure is a sound alternative for patients with complete rectal procidentia and fecal incontinence, as it corrects the associated anatomic defect of the anorectal angle.

Adult↗
PubMed2000

Evaluation of Delorme's procedure as a treatment for full-thickness rectal prolapse.

BACKGROUND: Delorme's procedure is a well tolerated perineal operation for full-thickness rectal prolapse. However, prolapse recurrence is common and reported recurrence rates vary widely. This study attempted to standardize outcome assessment for recurrence following primary and subsequent Delorme's operations. Patient and operative factors were analysed to identify any that might improve patient selection. METHODS: Some 101 primary and 17 secondary Delorme's procedures were carried out on 113 consecutive patients presenting with rectal prolapse, who were followed for a minimum of 12 months, unless death or recurrent prolapse intervened. The rate of prolapse recurrence was calculated using the Kaplan-Meier method of analysis. Patient age, sex, grade of incontinence, presence of diverticular disease, length of mucosal resection and position in the operative series were analysed to identify factors affecting recurrence. RESULTS: The predicted recurrence-free period for 50 per cent of patients undergoing primary and secondary Delorme's procedures was 91 (95 per cent confidence interval 77-105) and 27 (15-39) months respectively. None of the patient or operative factors analysed was related to recurrent prolapse. CONCLUSION: Delorme's procedure is a simple operation with satisfactory functional results which can be considered in all patients of all ages. However, high recurrence rates for primary and repeat operations should be explained to patients when planning their surgical management.

Adult↗
PubMed1980

A new concept for the management of rectal prolapse.

The various modified fixation procedures used for rectal prolapse take into account the pathophysiologic concept of complete prolapse of the rectum as a sliding hernia of the pouch of Douglas. The possibility of intussusception by reinforcement of the wall of the extensively mobilized rectum was successfully prevented by a new technique. The use of this simple technique in another form of prolapse, namely, prolapse of the terminal colostomy, convinced us to its usefulness.

Humans↗