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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↗
PubMed1997

Functional problems in adult rectal prolapse and controversies in surgical treatment.

BACKGROUND: Rectal prolapse is a condition that has fascinated surgeons for a long time. To date, no single ideal surgical treatment has been identified. The aetiology of rectal prolapse remains highly controversial, but it is recognized that associated functional problems, such as incontinence and constipation, are common. The pathophysiology, and controversies surrounding continence and constipation, remain topics of debate. METHOD: All relevant papers derived from Medline and manual searching on rectal prolapse and associated functional problems were reviewed. RESULTS AND CONCLUSION: The surgical management of rectal prolapse has evolved from historical encirclement procedures to current minimally invasive ones. Successful management must include adequate attention to the associated functional problems in order to eradicate the basic abnormality.

Adult↗
PubMed2004

Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse.

BACKGROUND: Postoperative constipation is a common problem with most mesh suspension techniques used to correct rectal prolapse. Autonomic denervation of the rectum subsequent to its complete mobilization has been suggested as a contributory factor. The aim of this study was to assess the long-term outcome of patients who underwent a novel, autonomic nerve-sparing, laparoscopic technique for rectal prolapse. METHODS: Between 1995 and 1999, 42 patients had laparoscopic ventral rectopexy for total rectal prolapse. The long-term results after a median follow-up of 61 (range 29-98) months were analysed. RESULTS: There were no major postoperative complications. Late recurrence occurred in two patients. In 28 of 31 patients with incontinence there was a significant improvement in continence. Symptoms of obstructed defaecation resolved in 16 of 19 patients. During follow-up, new onset of mild obstructed defaecation was noted in only two patients. Symptoms suggestive of slow-transit colonic obstipation were not induced. CONCLUSION: Laparoscopic ventral rectopexy is an effective technique for the correction of rectal prolapse and appears to avoid severe postoperative constipation. The ventral position of the prosthesis may explain the beneficial effect on symptoms of obstructed defaecation.

Adult↗
PubMed2005

Prospective study of the effect of rectopexy on colonic motility in patients with rectal prolapse.

BACKGROUND: Patients with rectal prolapse have abnormal hindgut motility. This study examined the effect of rectal prolapse surgery on colonic motility. METHODS: Twelve patients undergoing sutured rectopexy were studied before and 6 months after surgery by colonic manometry, colonic transit study and clinical assessment of bowel function. The results were compared with those from seven control subjects. RESULTS: Before surgery colonic pressure was greater in patients than controls (P < 0.050). Controls responded to a meal stimulus by increasing colonic pressure; this increase was absent in patients. After rectopexy, colonic pressure reduced towards control values and patients' colonic pressure response to a meal returned. High-amplitude propagated contractions (HAPCs) were seen in all controls but in only three patients before and two patients after surgery. Three patients had prolonged colonic transit before and eight after rectopexy. CONCLUSION: Patients with rectal prolapse have abnormal colonic motility associated with reduced HAPC activity. Rectopexy reduces colonic pressure but fails to restore HAPCs, reduce constipation or improve colonic transit. These observations help explain the pathophysiology of constipation associated with rectal prolapse.

Adult↗
PubMed1978

Ergonovine testing for coronary artery spasm in patients with angiographic mitral valve prolapse.

Coronary artery spasm (CAS) has been postulated to be a pathophysiologic mechanism in the production of ischemic-like chest pain and ECG changes in patients with idiopathic mitral valve prolapse syndrome. To evaluate the possible role of symptomatic CAS evoked by ergonovine maleate, this agent was administered (0.05 to 0.4 mg IV) to 24 patients with chest pain and mitral valve prolapse who had no significant (less than 50%) coronary artery obstruction. Symptoms, ECG and blood pressure changes were monitored in all patients following ergonovine administration. No significant changes were observed in heart rate, systolic blood pressure, or double product. Six patients developed their typical chest pain. In two of these six with chest pain, ST segment shift greater than 1 mm were seen. Post-ergonovine left ventricular end-diastolic pressure (LVEDP) and coronary angiographic changes were also studied in subgroup of 12 of these patients, including five of the six chest pain responders. In the five chest pain responders, pain was associated with a significant rise in LVEDP, whereas no significant change occurred in those patients not experiencing chest pain (p less than 0.01). Chest pain was also associated with significant CAS (greater than 50% lumen reduction) in two patients, each with ST segment shifts greater than 1 mm. In summary, ergonovine stimulation failed to evoke symptoms, ECG or blood pressure changes in three quarters of mitral valve prolapse patients studied. Six patients developed chest pain. Chest pain was assoicated with ECG changes characteristic of CAS in two of these patients, each with angiographic CAS. Thus, symptomatic CAS induced by ergonovine was absent in the majority of these 24 patients with idiopathic mitral valve prolapse syndrome.

Adult↗
PubMed1982

Somatotype and idiopathic mitral valve prolapse.

Records from 18 subjects with angiographic idiopathic mitral valve prolapse, 28 subjects with merely exaggerated posterior mitral leaflet systolic bulging, and 100 subjects with normal hemodynamic and angiographic findings were compared with regard to age, sex, height, weight, ponderal index (height/3 square root weight), auscultatory and echocardiographic abnormalities. Chest x-ray films available for subjects with mitral valve prolapse were reviewed. The ponderal index of subjects with mitral valve prolapse (13.1 +/- 0.8) differed from that of subjects with merely exaggerated posterior mitral leaflet systolic bulging (12.6 +/- 0.7) (P less than 0.02) and from that of subjects without angiographic abnormality (12.3 +/- 0.8) (P less than 0.001). The three groups differed in ponderal index when equated statistically for age, height, weight, and sex (P less than 0.001). Among mitral valve prolapse patients, an asthenic habitus occurred independent of the presence of thoracic skeletal abnormalities.

Adolescent↗
PubMed1982

Pulsed doppler echocardiographic detection of mitral regurgitation in mitral valve prolapse: correlation with cardiac arrhythmias.

The incidence of mitral regurgitation in mitral valve prolapse was studied retrospectively in 88 consecutive hospital based patients with mitral valve prolapse using pulsed Doppler echocardiography. Pulsed Doppler findings of turbulence in the left atrium were predictive of angiographic findings of mitral regurgitation in 31 patients. On 24-hr Holter monitoring, patients with mitral valve prolapse and mitral insufficiency had a higher prevalence of ventricular arrhythmias than patients without mitral insufficiency (61 vs 22%; P less than 0.02). Detection of mitral insufficiency identified individuals with mitral valve prolapse who are at higher risk of ventricular arrhythmias.

Adolescent↗
PubMed2002

Carcinoma of the cervix in association with uterine prolapse.

BACKGROUND: Carcinoma of the cervix and a prolapsed uterus are common diseases in underdeveloped countries, but their association is quite rare. CASE: We report here the clinical characteristics of two Brazilian patients with carcinoma of the uterine cervix associated with a third-degree prolapsed uterus. The patients, respectively aged 69 and 73 years, were admitted with an ulcerated prolapsed uterus. Biopsy of the ulcerated cervical lesion confirmed epidermoid carcinoma. The patients underwent radical vaginal hysterectomy complemented with external irradiation. The first patient was lost to follow-up, whereas the second is alive, with no signs of disease, 2 years after surgery. CONCLUSION: When operable invasive cervical carcinoma is found in association with full prolapse, radical vaginal hysterectomy complemented with radiotherapy seems to be an adequate therapeutic option.

Aged↗
PubMed1997

Mucosal plication in the treatment of partial rectal prolapse.

A technique used for the treatment of 34 patients with partial rectal prolapse [20 children (mean age 4.2 +/- 1.4 years), 10 women, and 4 men (mean age 44.6 years)] is presented. The prolapsed mucosa protruded outside the anus in 26 patients and was inside the rectal neck in 8. Mucosal plication was performed; the prolapsed mucosa was reefed by multiple vertical pursestring sutures. Associated hemorrhoids and anal fissures were also corrected. The patients were followed up for a mean of 31.6 months. No straining at stool or recurrence of the mucosal prolapse occurred. The technique is simple, cost-effective, had no complications, and was performed on an outpatient basis.

Adult↗
PubMed1992

Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy.

The results and complications of perineal rectosigmoidectomy for complete rectal prolapse in 114 patients have been reviewed. Most patients were elderly and high risk by virtue of other concurrent medical conditions. Fourteen patients (12 percent) developed significant postoperative complications. Hospital stay was short (median, four days). Ten patients were lost to follow-up. The remaining 104 patients were followed for 3 to 90 months. Eleven patients (10 percent) developed recurrent full-thickness rectal prolapse, six of them underwent repeat perineal rectosigmoidectomy. Sixty-seven patients had fecal incontinence prior to surgery. Eleven patients underwent concomitant levatoroplasty; 10 of them either improved or regained full continence of feces postoperatively. Twenty-six of the 56 patients who underwent perineal rectosigmoidectomy alone improved or regained full continence. Rectal prolapse can be successfully treated by perineal rectosigmoidectomy in elderly, high-risk patients with minimal morbidity. Levatoroplasty dramatically improves fecal incontinence occurring in association with rectal prolapse.

Adult↗
PubMed1991

Anal encirclement with polypropylene mesh for rectal prolapse and incontinence.

Seventeen selected patients (mean age, 74 years)--14 with rectal prolapse and 3 with persisting anal incontinence after previous operations--underwent high anal encirclement with polypropylene mesh. There was no operative mortality. Prolapse recurred in 2 (15 percent) of the 13 patients followed up for 6 months or more (mean, 3.5 years). Three (27 percent) of the 11 patients with associated anal incontinence improved functionally, as did the three operated on for persisting incontinence, but only one patient regained normal continence. No breakage, cutting out, or infection related to the mesh was observed. Because of the risk of fecal impaction encountered in three of our patients, the procedure is not advocated for severely constipated patients. Despite the somewhat disappointing results regarding restoration of continence, we find this method useful in patients with rectal prolapse who are unfit for more extensive surgery, in controlling the prolapse to an acceptable degree.

Aged↗
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↗
PubMed1985

Abdominal repair of vaginal prolapse and the postoperative outcome as judged by a scoring system and X-ray colpography.

Three abdominal procedures were combined to suspend the prolapsed vagina in patients with post-hysterectomy vault prolapse and a narrow vagina and uterine prolapse with pelvic diseases (such as fibroids) necessitating laparotomy. We used Moschcowitz's method (obliteration of the cul-de-sac by purse-string sutures) Burch's method (fixation of the anterior vaginal wall to Cooper's ligament) and Williams and Richardson's method (suspension of the vaginal stump using fascial strips from the external oblique aponeurosis. The postoperative outcome of 8 operations was judged by a scoring system and by X-ray colpography with superimposition of films obtained at rest and during straining (subtraction technic). The scoring system indicated that the anterior vaginal wall and the vaginal vault were well supported by this combination procedures. However, the prolapse of the lower posterior vaginal wall needed an additional vaginal repair. The X-ray colpogram showed that the axis of the repaired vagina was slightly more vertical than normal. But displacement of the vagina on straining was within the normal range. Neither dyspareunia nor stress urinary incontinence were seen as complications of our procedures.

Adult↗
PubMed1999

Treatment of external anorectal mucosal prolapse with circular stapler: an easy and effective new surgical technique.

PURPOSE: The aim of this study was to demonstrate the feasibility, effectiveness, and reliability of a new technique for treating overt rectal mucosal prolapse using a stapler device. METHODS: Eighteen consecutive patients with overt rectal mucosal prolapse were selected for the study. Preoperative anal manometry and cinedefecography demonstrated no anal incontinence and the absence of full-thickness rectal prolapse. One or two purse strings were prepared 3 to 4 cm distally to the dentate line and tied on a 33 mm circular stapler introduced through the anus and then fired. RESULTS: The operation lasted an average of 15 minutes, and no local complications were recorded. Supplementary hemostatic sutures (2 to 6 stitches) were sometimes necessary. Seven patients did not require postoperative analgesia, whereas eight patients received one or two administrations of analgesics. Longer-lasting analgesic treatment (4 days) was necessary in only three patients. Sixteen patients were discharged after 48 hours, and only 1 after four days because of pulmonary infection. Patients resumed normal activities after a median period of three days. Median follow-up was 20 months. The prolapse was eliminated in all cases. No stricture was found at anal exploration, and no episodes of anal incontinence or bleeding were recorded. Postoperative manometry did not show significant changes compared with preoperative findings. CONCLUSIONS: This new surgical technique is safe, effective, and rapid, causing minimum or no postoperative pain and could be proposed to replace traditional surgery for this common condition.

Adult↗
PubMed1999

The effectiveness of perineal rectosigmoidectomy for the treatment of rectal prolapse in elderly and high-risk patients.

We report herein on the follow-up of ten consecutive patients who underwent perineal rectosigmoidectomy, and discuss the indications, surgical technique, and outcomes of this procedure. The median age of the patients was 79 years, with a range of 26 to 85 years, and eight patients had complicating medical conditions. Of five patients who underwent this procedure for a recurrent prolapse after another type of perineal procedure, four had previously undergone the Thiersch operation combined with the Gant-Miwa technique. The mean length of the excised rectum and sigmoid colon was 22.1 cm. Pain was minimal or absent in all patients and oral intake was commenced after 2 days. There were no mortalities, but anastomotic leakage occurred in one patient. The mean follow-up period was 3.5 years. Only one patient developed recurrent rectal prolapse 24 months after the operation. Of seven patients who underwent concomitant levatoroplasty for incontinence, five became fully continent within 3 weeks after the operation, while the remaining two improved after 2 months. We propose that perineal rectosigmoidectomy is indicated for patients who have suffered an early recurrence of prolapse after another transperineal repair; elderly or high-risk patients with incontinence; male patients; and patients with an incarcerated or gangrenous prolapsed rectal segment.

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↗
PubMed1987

Late results of silicone rubber perianal suture for rectal prolapse.

Twenty-one patients were reviewed five to 12 years after silicone rubber perianal suture for rectal prolapse. Sixteen patients (76 percent) were continent with control of prolapse and two patients (9 percent) suffered only from occasional prolapse or incontinence. Rebanding for silicone cutout or fracture was required in four patients and a second rebanding operation was needed in two. Silicone rubber perianal suture for rectal prolapse stands the test of time and might be recommended for more widespread use in younger patients.

Adult↗
PubMed2006

[Mitral valve prolapse: identification of high-risk patients and therapeutic management].

Mitral valve prolapse shows a wide spectrum from a benign anatomic variant to a progressive disease with severe cardiovascular morbidity and mortality. Echocardiography is the most important tool for diagnosis and risk stratification. Predictors for high risk are significant thickening of mitral leaflet of > 5 mm ("classic" prolapse), moderate to severe mitral regurgitation and reduced left ventricular function. These patients have an increased risk of infective endocarditis, cerebral ischemia and sudden cardiac death. Because of the risk for the development of severe mitral regurgitation requiring surgery short follow-up intervals are necessary. In mitral prolapse syndrome cardiac clinical signs (palpitation, rhythm disorders, syncope, etc.) are associated with a prolapse that can be treated symptomatically with drugs after exclusion of other causes and significant mitral regurgitation requiring surgery.

Humans↗