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A variant of Lockhart-Mummery's technique is proposed. Packing retrorectal space by Spongel instead of the vaseline gauze, the post-operative care is simplified and the delay of hospitalisation really shortened. This technique has been always efficient in 25 cases.
Many of the reported series have tended to concentrate on recurrence rates rather than functional outcome, and virtually all have short follow-up of clinical outcome. There have been very few randomised trials making interpretation of results more difficult. Our own practice has evolved to perform a suture rectopexy performed laparoscopically in those patients without preoperative evacuation difficulties for the previously outlined reasons. Where there is evidence of slow transit constipation, a sub-total colectomy performed as an open procedure is offered. Mesh rectopexy is a suitable, safe alternative, particularly in the absence of preoperative evacuation difficulties (3, 24). The primary problem with this approach is the subjective nature of the preoperative assessment in relation to the patient's (and doctor's) definitions of evacuation difficulty or constipation. While debate continues as to whether the lateral ligaments should be divided, a more practical approach would be to preserve these ligaments if a sutured or mesh rectopexy is to be used, with division of the lateral ligaments when a resection is performed. These manoeuvres would reduce the risk of troublesome postoperative constipation, although recurrent mucosal or full-thickness prolapses have been described. The final decision for the choice of procedure should take account of basic preoperative abnormalities being present, i.e. motility disorders, the presence of neurogenic injury to the pelvic floor etc., combined with the age, gender and medical condition of the patient (43).
Rectum prolapse is a pathological condition which has long been considered as rare but whose occurrence has been progressively increasing in the past decades. There still exists a degree of uncertainty as to the disease etiopathology: moreover the exact relationship between rectum prolapse and psychic disorders which have been found in up to 50% of the patients with prolapse has not been clarified. Neither on the therapeutic level is there a common opinion as to the ideal surgical approach and over one hundred techniques have been suggested for the surgical correction of the prolapse. A study has been carried out on 10 patients suffering from psychiatric pathology of different kinds (oligophrenia, schizophrenic psychosis), hospitalized at Istituti Ospedalieri Opera Don Uva in Bisceglie. They suffered from complete rectum prolapse and underwent surgical intervention. In this study the etiopathogenetic problems of prolapse are investigated according to recent developments, with particular reference to the very peculiar implications they have in the psychiatric patient. Finally the surgical techniques correctly used and their possible application in the psychiatric patient are examined.
Active sclerosing therapy was performed in 119 children with prolapse of the rectum. The examination and preparation of the patients for the sclerosing therapy was carried out in the out-patient clinic. The patients had an active regimen after such a therapy. The patients stayed at the hospital for 14 days. The immediate and remote results were favourable.
Prolapse of the rectum in adults has a complex etio-pathogenesis which involves a number of anatomical and physiological factors which, with the impulse of effort, cause the viscus to protrude externally through the sphincter. About one hundred operations have been designed to treat this condition, inspired by various mechanisms which have been considered to be responsible or involving excision of the prolapsed viscus. The results have been disappointing in view of the high rate of recurrence. At the present time, we prefer operations which anchor the rectum to posterior osseous structures, which are well tolerated, even by elderly patients. The immediate and long term results of these operations are very satisfactory. The author presents his experience of one of these operations.
The majority of patients who suffer from full-thickness prolapse can be treated successfully and safely. The small proportion who remain incontinent of feces after correction of prolapse may at a later date be helped by postanal repair. If dietary indiscretion and abnormal patterns of defecation are major etiologic factors in this condition, then measures to improve dietary and defectory habits must be instituted mainly to prevent further problems after the deformity has been cured surgically. There seems no doubt that following rectopexy there is an increased tendency to constipation.
From four pelvic cavities of adults (2 males and 2 females) and one of neonate the authors studies structures between rectum ventrally and sacrum dorsally. Always they found an avascular space behind the perirectal fascia in which were embedded arteries of rectum and above the presacral fascia with inside median sacral artery and sympathic trunks. This avascular space permit to made there surgically procedures such Lockart-Mummery to attach rectum to sacrum.
Perineal rectosigmoidectomy with a hand-sewn anastomosis is thought to be the most appropriate procedure for elderly patients deemed unfit to tolerate a major abdominal operation. However, the use of a circular stapling device to perform the coloanal anastomosis following rectosigmoidectomy shortens the operative time and provides a more secure anastomosis than the traditional hand-sewn technique.
We present the case of a 22-month-old female child who presented with severe recurrent rectum prolapse. The patient was successfully managed using the laparoscopic simple suture rectopexy approach with 5-mm instruments employing two 3-0 nonabsorbable sutures on either side of the rectum to secure it to the presacral fascia. There was no blood loss, and the procedure was completed without complication. The child was followed up for a period of 24 months with good results.
Intussusception is very common in children all over the world, especially those under 2 years. This can be ileoileal, ileocolic, or colocolic, i.e. the immediate proximal part of the intestine telescoping into the distal portion of the intestine. Ileosigmoid intussusception involves the invagination of a loop of the ileum into the sigmoid colon, producing two obstructions: that involving the invaginated loop of terminal ileum and that of the sigmoidorectal intussusception. This can lead to ischaemia and necrosis of either the ileum or sigmoid colon. The case presented here is suspected to be the first one reported in the world scientific literature.
Eighteen patients with full-thickness prolapse of the rectum were randomized to rectopexy alone (group 1) or with sigmoidectomy (group 2). Three months postoperatively, seven patients in group 1 and two in group 2 complained of severe constipation. One patient in group 1 and three patients in group 2 remained incontinent. The results of colonic marker studies showed a significant increase in the number of markers at day 5 for those in group 1 (preoperative, 7.7 +/- 2.6; postoperative, 14.6 +/- 2.2; t test, p less than 00.1) but no significant increase in group 2 (preoperative, 4.6 +/- 2.2; postoperative 6.8 +/- 2.3; t test, p less than 0.01). No significant changes or differences between the groups were seen in the anorectal angle on videoproctogram. The results of anorectal physiologic studies done postoperatively showed no differences between the groups in maximum resting pressure, sphincter length or saline solution infusion test; however, the patients in group 1 had a significantly greater rectal compliance (group 1, 0.24 +/- 0.02 millimeters mercury per milliliter; group 2, 0.1 +/- 0.02 millimeters mercury per milliliter; p less than 00.1). This may occur because the redundant loop of sigmoid colon causes hold-up of intestinal content and kinking at the junction between the sigmoid colon and the rectum.
In the present work we have studied two consecutive series of patients who underwent a posterior abdominal rectopexy according to Wells or Ripstein. During the year of follow up no recurrences were observed. Functional results, evaluated according to a protocol, by history of the patient and manovolumetry, shoved an improvement of fecal continence in more than half of the incontinents in both series. However, constipation increased after Wells' rectopexy, while no major changes were observed after Ripstein's rectopexy. We conclude that the first surgical technique may offers worse functional results.
PURPOSE: This study was designed to examine the results of Delorme's procedure. METHODS: Thirty-two patients (24 males and 8 females, mean age, 70 years) underwent Delorme's procedure between 1978 and 1990 following symptoms lasting between two weeks and ten years. Thirteen patients had had 21 previous operations for prolapse. RESULTS: The mean operation time was 65 minutes. No blood transfusions were needed, there was no operative mortality, and only two patients had complications (one chest infection and one anastomotic dehiscence). No patients were lost to follow-up. Over a mean follow-up of 24 months (4 months to 4 years), 9 patients died of unrelated conditions. There were four recurrences (12.5 percent), two in patients who had each had two previous procedures. Incontinence improved in 46 percent. No patient became constipated and 50 percent of those constipated preoperatively improved. CONCLUSION: Although abdominal rectopexy is safe and has a low recurrence rate (< 5 percent), it involves the hazards of a laparotomy. In addition, up to 40 percent of patients become constipated after rectopexy which may be debilitating. Delorme's procedure has a low morbidity, results in good bowel function, and has a low recurrence rate. It can be performed on unfit patients with possible advantages over rectopexy and perhaps should be used more readily.
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Hepatocyte growth factor/scatter factor (HGF/SF) can stimulate growth of gastrointestinal epithelial cells in vitro; however, the physiological role of HGF/SF in the digestive tract is poorly understood. To elucidate this in vivo function, mice were analyzed in which an HGF/SF transgene was overexpressed throughout the digestive tract. Nearly a third of all HGF/SF transgenic mice in this study (28 of 87) died by 6 months of age as a result of sporadic intestinal obstruction of unknown etiology. Enteric ganglia were not overtly affected, indicating that the pathogenesis of this intestinal lesion was different from that operating in Hirschsprung's disease. Transgenic mice also exhibited a rectal inflammatory bowel disease (IBD) with a high incidence of anorectal prolapse. Expression of interleukin-2 was decreased in the transgenic colon, indicating that HGF/SF may influence regulation of the local intestinal immune system within the colon. These results suggest that HGF/SF plays an important role in the development of gastrointestinal paresis and chronic intestinal inflammation. HGF/SF transgenic mice may represent a useful model for the study of molecular mechanisms associated with a subset of IBD and intestinal pseudo-obstruction. Moreover, our data identify previously unappreciated side effects that may be encountered when using HGF/SF as a therapeutic agent.
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Rectal prolapse is defined as the invagination of the entire wall of the rectum into or through the lumen of the anal canal. In the main it is a disorder of elderly women. The leading symptom is a sensation of incomplete defecation. Patients commonly complain of incontinence of varying severity, tenesmus, unsuccessful straining, and the passage of blood and mucus in the stools. The diagnosis is based on the history and physical examination. Equipment-based diagnostic procedures serve treatment planning. For therapy, a range of possibilities are available. Anal prolapse is categorized as third-degree hemorrhoidal disease, and the diagnosis can be made by simple inspection. Reduction may be attempted during digital examination of the rectum. Treatment is determined by the clinical presentation.
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