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PubMed2006

Combined Thiersch's procedure and subanodermal coagulation for complete rectal prolapse in the elderly.

BACKGROUND: The author describes a modification of Thiersch's procedure in patients with complete rectal prolapse by inducing fibrosis at the anal verge through circumferential subanodermal coagulation using a radiofrequency device. MATERIALS AND METHODS: An Ellman radiofrequency generator was used for coagulation. The postoperative events were recorded. The patients were followed over a period of 2 years to assess late outcome. RESULTS: Postoperative complications were observed in 2 patients. One of these developed suppuration in the tract of the encircling wire that needed removal, while the other had a recurrence due to loosening of the wire. At a 2-year follow-up, 3 patients developed recurrence while 1 had a persistent complaint of fecal incontinence. CONCLUSION: This study shows that a combined procedure of radiofrequency coagulation followed by Thiersch's circumanal wiring is quick and easy to perform with no formidable morbidity in elderly patients who are otherwise considered at high risk for definitive surgical procedures.

Aged↗
PubMed1984

Wells procedure for complete rectal prolapse. A ten-year experience.

A retrospective study evaluating 40 patients who underwent the Wells procedure for complete rectal prolapse has been carried out. The procedure is described in detail. Results show a 10 per cent (four patients) recurrence rate. Two have been successfully reoperated on. There was no mortality or morbidity related to the procedure. This relatively simple procedure can be tolerated by most patients presenting with the problem.

Adolescent↗
PubMed1992

Abdominal rectopexy for rectal prolapse: a comparison of techniques.

To compare the methods of abdominal rectopexy and to elucidate the mechanism by which rectopexy restores continence in patients with rectal prolapse, the role of sphincter recovery, rectal morphological changes and improved rectal sensation were assessed in 68 patients (eight men, 60 women) of median age 63 (range 18-83) years undergoing resection rectopexy (n = 29), anterior and posterior Marlex rectopexy (n = 20), posterior Ivalon rectopexy (n = 9) or suture rectopexy (n = 10). Preoperative and postoperative manometry, radiology and electrosensitivity measurements were made. Age and duration of follow-up were similar in all groups and the prolapse was controlled in all patients. Significantly improved continence was seen in all but the Ivalon group. There was no evidence of increasing postoperative constipation. Sphincter length and voluntary contraction were unaltered, but improved resting tone was seen in the resection and suture groups. This was not seen in the prosthetic groups. Improved continence correlated with recovery of resting pressure. Upper and sensation was improved in all groups. Radiological changes did not correlate with improved continence. We conclude that continence is improved by all rectopexy procedures but seems better without prosthetic material. Sphincter recovery seems to be the most important factor.

Adult↗
PubMed1989

[Surgical methods in anal and rectal prolapse].

Anal prolapse in adults is cured by the Milligan-Morgan procedure. Operation for the rectal prolapse has to repair procidentia, incontinence and obstipation. Procidentia and incontinence in low-risk patients are best repaired by abdominal rectopexy with or without plastic materials (Ripstein's procedure is preferred). Obstipation remains a long-term problem. Rectopexy in combination with sigmoid resection (Goldberg) improves obstipation, but there is leakage in 4% of the patients. The perineal approach offers no technical advantage. Perineal rectopexy, prolapse resection and Thiersch ring with modifications are preferred in high-risk cases. Posterior levator plastic improves remaining incontinence.

Fecal Incontinence↗
PubMed1997

Laparoscopic diagnosis of ischemic necrosis of the descending colon after rectal prolapse and rupture of the mesocolon in two postpartum mares.

Two mares were referred for evaluation after dystocia and rectal prolapse. Diagnostic laparoscopy, performed while the horses were standing, was used to evaluate the condition of the distal portion of the colon, rectum, uterus, and mesocolon. In both horses, laparoscopic observation revealed tears in the mesocolon of the descending colon. Exploration from the left or right flank was adequate. Because of the poor prognosis associated with the findings, euthanasia was elected at completion of laparoscopy. Tears in the mesocolon are not easily detected by use of traditional tests. Laparoscopy proved to be a more thorough means of evaluating the caudal portion of the abdomen including the digestive and urogenital tracts in these horses. As a less invasive diagnostic tool, laparoscopy can be performed earlier in the course of disease than alternative approaches for direct viewing. Furthermore, laparoscopy can be used to access the viability of tissues as well as the location and severity of lesions for prognostic purposes. The distal portion of the descending colon can also be evaluated to determine whether celiotomy with anastomosis or colostomy may be the surgical procedure of choice.

Animals↗
PubMed1997

Role of pudendal canal syndrome in the etiology of fecal incontinence in rectal prolapse.

BACKGROUND: The current communication investigates the role of pudendal canal syndrome in the genesis of fecal incontinence (FI) in complete rectal prolapse (CRP). METHODS: 89 patients with CRP (group A, 45 with FI, and group B, 44 without FI) were studied. Ten healthy volunteers in group C acted as controls. The subjects were assessed for rectal and rectal neck pressures, electromyographic (EMG) activity of the external anal sphincter (EAS) and levator ani, as well as for pudendal nerve terminal motor latency (PNTML). RESULTS: Group-A patients manifested perianal hypo- or anesthesia, diminished rectal neck pressure (p < 0.05) and EMG activity of EAS and levator muscle and prolonged PNTML (p < 0.05). In group B, rectal neck pressure was diminished (p < 0.05) in all patients. The EMG activity of the EAS and PNTML (p > 0.05) were normal in 34 patients, while the EMG activity was reduced and the PNTML prolonged (p < 0.05) in the remaining 10. The levator ani muscle showed diminished activity in the 44 patients of this group. CONCLUSION: The results of group A point to pudendal neuropathy as a cause of FI. In group B, 10 patients showed manifestations of subclinical pudendal neuropathy which may present later on with FI. The constant prolongation of PNTML in patients with FI postulates a relationship between the two. The cause of prolonged PNTML seems to be attributable to pudendal neuropathy due probably to pudendal nerve entrapment in the pudendal canal with a resulting pudendal canal syndrome. Therefore, pudendal canal syndrome is suggested to play a significant role in the genesis of FI in CRP.

Anal Canal↗
PubMed1997

Laparoscopic-assisted abdominoperineal proctosigmoidectomy for rectal prolapse. A new technique.

The inability to completely mobilize the redundant colon in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse is a main contributor to the recurrence rate associated with the procedure. However, the presence of a redundant sigmoid after the Ripstein procedure or other rectal sling operations is the main cause of the high rate of postoperative constipation and stool impaction. Low anterior resection as the definitive treatment is associated with the higher morbidity of laparotomy and the risk of anastomotic leak. We describe a laparoscopic-assisted surgical approach which combines the benefits of completely resecting the redundant sigmoid colon as well as the performance of extraperitoneal anastomosis at the level of the anus.

Aged↗
PubMedDate not supplied

Transanal resection of a colonic lipoma, mimicking rectal prolapse.

PURPOSE: Colonic lipomas are benign tumors usually asymptomatic. Occasionally, they may cause symptoms such as bleeding, intussusception, obstruction, or rectal prolapse. METHODS: We present a 44-year-old African-American female that presented with an 8 cm colonic lipoma protruding through the anal verge. We also reviewed all the reported cases in the English literature. RESULTS: The patient was treated successfully with transanal resection, which has rarely been done before for this large a tumor. CONCLUSIONS: Transanal resection of large benign tumors of the rectosigmoid is possible.

Adult↗
PubMedDate not supplied

[Our experience in the treatment of hemorrhoids and circumferential mucosal rectal prolapse using Longo muco-prolapsectomy ].

The authors report their experience with the treatment of hemorrhoid disease and circumferential mucosal rectal prolapse with the use of a mechanical suturing device, according to the Longo technique. Over the period from March 98 to December 2000, 106 patients were treated with the above-mentioned procedure (100 patients for haemorrhoids and 6 for circumferential prolapse). Twenty-one patients had grade 4, 77 grade 3 and only 2 grade 2 disease. One hundred patients were followed up over a median period of 16.5 months (for the group with haemorrhoids) and 19 months (for the prolapse group). In 81% of cases the procedure was one-day surgery. Mucohaemorrhoidectomy with a stapler was well tolerated in terms of severity of postoperative symptomatology: in 42% of the patients operated on there was no need for any analgesic treatment. The time to return to work was 9.9 days for self-employed subjects and 15.6 days for the others. Refinement of the procedure and better patient selection may improve the results achieved with this technique. Stapled haemorrhoidectomy may be regarded as a sound technique that should be part of the surgeon's armamentarium. We suggest an "eclectic" approach whereby the stapling procedure may be included among the possible therapeutic options, with a view to optimising the choice of therapy for each individual patient.

Adult↗
PubMed1974

Correction of rectal prolapse by anterior resection.

During the past three consecutive years low anterior resection with rectopexy has been used to correct complete rectal prolapse in nine patients. There have been no recurrences and only two complications, one a presacral abscess not related to anastomotic malfunction, and the other a fecal fistula in an 81-year-old woman, which resolved spontaneously without colostomy.

Adult↗
PubMed1995

Results of Delorme's procedure for rectal prolapse. Advantages of a modified technique.

PURPOSE: A retrospective study was undertaken to assess the results of Delorme's procedure for rectal prolapse and to determine the advantages of an innovative extended transrectal repair, which aims at performing a total pelvic floor repair. METHODS: A total of 85 patients, ranging in age from 21 to 97 years, were operated on. Sixty-five (82 percent) patients had varying degrees of fecal incontinence. Similar groups of patients were compared with regard to control of the prolapse and restoration of continence according to 1) age and medical condition and 2) operative technique: original vs. extended operation. RESULTS: Twelve patients (14 percent) developed postoperative complications. There was one perioperative death (1.2 percent). Eighty patients were followed for 6 to 136 (median, 33) months. Eleven (13.5 percent) developed recurrent full-thickness prolapse. The recurrence rate was significantly different 1) between 44 elderly and poor operative risk patients not suitable for abdominal surgery (22.5 percent) and 41 younger patients without concurrent medical conditions, electively submitted to perineal repair (5 percent) (P < 0.05), and 2) between the original procedure (21 percent of 44 patients) and the modified technique (5 percent of 41 patients) (P < 0.05). Forty five patients (69 percent) improved or regained full continence. No patient worsened. No residual dysfunction was induced. Restoration of continence was not influenced by selection of patients or surgical technique. CONCLUSIONS: Despite increased morbidity (22 percent; P < 0.05), advantages of the modified technique were 1) over the original procedure, a reduced recurrence rate, 2) over perineal proctectomy, the absence of coloanal anastomosis and better functional outcome, and 3) over abdominal rectopexy, a less aggressive approach without disturbing effects on bowel habits.

Adult↗
PubMed2005

[Rectal prolapse resection by trans-anal approach and stapling technique].

We are introducing a simplified cure, derived from Alteimeier's intervention, of rectal prolapse by perineal way resection using a linear cutting stapler. It's a reproducible, quick and easy technique, which permits the elderly patients to come back in their middle of life rapidly with few complications.

Age Factors↗
PubMed2003

Rectal prolapse: an unusual presentation of malakoplakia in a child.

A case of a young girl is presented. The main concern was recurrent rectal prolapse not responding to conservative and sclerotherapy. Colonoscopy showed diffuse colitis with superficial ulcerations and pseudopolyps. Colon biopsies finally showed classical features of malakoplakia confirmed by histopathological test. Conservative treatment failed and ultimately proctocolectomy was performed with ileoanal endorectal anastomosis.

Biopsy↗
PubMed2004

Injection sclerotherapy of rectal prolapse in children with 15 percent saline solution.

PURPOSE: A wide variety of sclerosing agents have been used in the treatment of rectal prolapse (RP) in children. We have used 15 % saline solution for the first time in the treatment. The aim of this study is to review the results of a 15 % saline solution and other sclerosing agents. PATIENTS AND METHODS: A total of 16 children with RP were treated by injection of 15 % saline solution. Under general anesthesia, the patient was placed in the lithotomy position. The left index finger was inserted into the rectum to control the position of the needle, a 20-gauge spinal needle was introduced through the perianal skin and was advanced. The saline was slowly injected, the needle was then withdrawn slightly, and the injection was continued until 2 - 3 ml of 15 % saline were injected. The injection was made into the submucosal tissue, the right perirectal area, the left perirectal area, and posterior to the rectum at 5 points. RESULTS: Conservative treatment had previously failed in all patients. Prolapse ceased in 15 (93.7 %) of the 16 children after the first injection. Only one patient required a second injection. There were no complications. CONCLUSIONS: The success rates and complications of the treatment reported in the literature differ for each sclerosing agent. 15 % saline is preferable because of the high cure rate, the safety of the procedure, the easy injection, and the lack of complications.

Child, Preschool↗