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At least 163 records · Page 9Linked to original sources
PubMed2005

External pelvic rectal suspension (the Express procedure) for full-thickness rectal prolapse: evolution of a new technique.

OBJECTIVE: The Délorme's operation for rectal prolapse is a safe procedure but has a high recurrence rate. We aimed to develop an operation akin to it, but designed to reduce this deficit. PATIENTS AND METHODS: Thirty-one consecutive patients with rectal prolapse were included in the study. Initially, a conventional Délorme's procedure was performed and sutures or strips of Gore-Tex were attached circumferentially to the apex of the prolapse, tunneled subcutaneously, and anchored to the external surface of the pelvis. Subsequently, the procedure was modified. Acellular porcine collagen strips were used and buried within the apex without plication of the denuded rectal musculature. Patients were formally assessed preoperatively and four months postoperatively by symptom and quality of life questionnaires and subsequently by regular clinical review. RESULTS: In the Gore-Tex group (N = 11; males:females = 10:1; mean age, 61 years) three patients underwent suture repair and eight had strip fixation. All suture repairs developed sepsis and one patient had a recurrence. Seven of the strip fixations (88 percent) developed sepsis that resulted in implant extrusion. There was one full-thickness and one mucosal recurrence after a median follow-up of 25 months. In the collagen group (N = 20; males:females = 2:18; mean age, 63 years), sepsis occurred in four patients, requiring surgical intervention in one patient (5 percent) (cf Gore-Tex group, P = 0.002). There was one mucosal and three full-thickness (15 percent) recurrences after a median follow-up of 14 months (cf Gore-Tex group, P = not significant). Significant improvements in symptom and quality of life scores were recorded in both groups at four months. CONCLUSION: A new, minimally invasive perineal procedure for rectal prolapse has been developed and initial data testify to its relative safety provided collagen is used. It remains to be seen whether long-term recurrence rates will be lower than those of conventional perineal procedures.

Aged↗
PubMed1996

[Rectal prolapse--choice of procedure and minimal invasive possibilities].

Diagnostic and pathomorphological findings support the notion that external and internal rectal prolapse with and without solitary rectal ulcer are merely different stages of one and the same disease. In view of the fact that, in the last resort, the aetiology of this disease remains largely unknown, the differential approach to therapeutic decision-making makes it necessary to give careful consideration to the individual situation of the patient, age, sex, case history and current findings. Although considerably in excess of 100 different surgical techniques have been reported for the treatment of rectal prolapse, only very few have finally been accepted in practice. In very old and high-risk patients, extra-abdominal corrective procedures (Delorme's procedure, peri-anal rectosigmoidal resection) performed under spinal or peridural anaesthesia, are given preference, despite the fact that the recurrence rate and the rate of persistent incontinence is higher than that seen with transabdominal techniques. In the case of younger patients and older patients unburdened by risk factors, the trans-abdominal procedures offer better functional results and lower recurrence rates. Here, anterior and posterior rectopexy and resection of the sigmoid with rectopexy are the most widely practiced procedures. With the further development of minimal invasive surgery, laparoscopic techniques are now also available, with the aid of which anterior and posterior rectopexy and intracorporeal sigmoid resection can be performed safely and reliably. These techniques will very likely further encourage the trend towards transabdominal procedures for the correction of rectal prolapse. These operative procedures may also be indicated in selected cases, in whom conservative treatment of intussusception and/or solitary rectal ulcer has failed.

Adult↗
PubMed1990

Internal rectal prolapse: rubber-band ligation as treatment for a neglected disease.

Internal rectal prolapse was diagnosed in 21 patients with signs and symptoms consistent with this syndrome. They all underwent rubber-band ligation of the excess mucosa--2.2 procedures per patient on average. Eight patients became asymptomatic and 13 significantly improved clinically. Six patients, in spite of the clinical improvement, had rectoscopic evidence of recurrence. No side effects or complications were noted. Internal rectal prolapse has to be considered in the differential diagnosis of anorectal syndromes. Rubber-band ligation is a safe, simple procedure, leading to resolution of symptoms, and may prevent progression to total rectal prolapse.

Adult↗
PubMed1988

The cause of rectal prolapse in children.

Fifty-four pediatric patients with rectal prolapse (RP) were identified by review of medical records from 1977 to 1987. Rectal prolapse was attributed to chronic constipation (15 patients), acute diarrheal disease (11 patients), cystic fibrosis (CF) (six patients), and neurologic/anatomic abnormalities (13 patients). In nine patients, no underlying cause was identified. The patients with CF did not differ from the other groups in terms of age at time of onset of prolapse, growth measurements, or number of episodes of prolapse. All patients with CF had a history of abnormalities or presented with signs and symptoms consistent with this diagnosis; none had a history of constipation. Although physicians can be reassured that CF is not a likely diagnosis in patients with RP and acute diarrheal disease or a clear history of constipation, a sweat test is indicated in all such cases as well as in those in which there is no apparent underlying cause. A sweat test is not usually indicated in patients with RP in association with underlying anatomic abnormalities.

Child↗
PubMed2005

[Rectal prolapse in adults--causes, diagnostic, treatment].

Despite progress in modern surgery, the choice of the surgical procedure of rectal prolapse is regarded with controversy. Selection criteria between the abdominal or perineal approach or between rectopexy and resection rectopexy are not yet proven. This article gives a review of the literature about rectal prolapse and an analysis of the outcome of posterior rectopexy and resection rectopexy--partly conventionally and partly laparoscopically--in 25 patients with rectal prolapse III degrees and IV degrees. All except for one patient were examined during a mean follow-up of 5.5 (3.1) years for the rectopexy group and 2.1 (0.7) years for the resection rectopexy group. Recurrence occurred in one patient in each group respectively. There was no significant difference concerning the continence function (p = 0.32) and constipation (p = 0.36) between both groups. No mesh-related complications such as infection, fistula or rectum stenosis were observed. According to the review of the literature and our data, we believe that the choice of the operative procedure for rectal prolapse should be based on individual criteria. Fit patients should be offered laparoscopic procedures such as resection rectopexy and rectopexy without colonic resection.

Adult↗
PubMedDate not supplied

Devadhar's operation for complete rectal prolapse: 25 years' experience.

BACKGROUND: Numerous abdominal and perineal operations have been described for the treatment of complete rectal prolapse. We describe our results with Devadhar's rectopexy, which avoids dissection in the presacral space and hence may be expected to have a low risk of sexual and urinary disturbances. METHODS: Case records of 72 consecutive patients (40 men), aged above 18 years, with complete rectal prolapse who were treated with Devadhar's operation were reviewed. RESULTS: The only complication observed was mucosal prolapse in 3 patients. None of the 40 men had erectile dysfunction or retrograde ejaculation after a median follow-up of 10 (range 3-48) months. No patient had disturbance in micturition. Two patients (2.7%) had recurrence of rectal prolapse. In four patients (8.5%), constipation persisted. CONCLUSION: Devadhar's rectopexy for complete rectal prolapse was not associated with disturbances in sexual or micturition function, and low rates of recurrence of prolapse.

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↗
PubMed2006

Surgery for rectal prolapse: Orr-Loygue ventral rectopexy with limited dissection prevents postoperative-induced constipation without increasing recurrence.

PURPOSE: Abdominal rectopexy is the preferred surgical technique for the treatment of total rectal prolapse. In many reported series, its results are impaired by induced constipation. Lateral rectal ligaments preservation could prevent constipation but increase recurrence rates. We report anatomic and functional results of abdominal Orr-Loygue ventral rectopexy with dissection limited to anterior and posterior rectal wall. METHODS: Consecutive patients with total rectal prolapse or intra-anal rectal prolapse associated to fecal incontinence or outlet obstruction were treated by abdominal rectopexy. Recurrences, correction of symptoms, and induced constipation were prospectively analyzed. RESULTS: Seventy-three patients were treated between 1993 and 2004. Recurrence was observed in 3 of 73 patients (4.1 percent) after a mean follow-up period of 28.6 (range, 6-84) months. Overall patient satisfaction (correction of prolapse, incontinence, and/or outlet obstruction) after the procedure was classified in three categories: Cured: n = 45 (61.6 percent); Improved: n = 24 (32.9 percent); Failure: n = 4 (5.5 percent). Postoperative constipation appeared in 2 of 36 (5.5 percent) preoperatively nonconstipated patients and worsened in 2 of 37 (5.4 percent) preoperatively constipated patients. CONCLUSIONS: Orr-Loygue abdominal ventral rectopexy with limited dissection and preservation of rectal lateral ligaments is a safe and effective procedure for the treatment of complete rectal prolapse, or internal prolapse associated with fecal incontinence or outlet obstruction. Preservation of lateral ligaments seems to prevent postoperative constipation without increasing the risk of prolapse recurrence.

Adult↗
PubMed2006

Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse.

BACKGROUND: Dynamic three-dimensional computed tomography (D-3DCT: high-speed helical scanning during defecation) was used for morphological evaluation of intrapelvic structures in patients with rectal prolapse and rectocele. METHODS: Twenty-five patients with rectal prolapse or rectocele diagnosed by conventional defecography (CD) or clinical findings were additionally investigated with D-3DCT. D-3DCT images were acquired using a multislice CT system with a 16-row detector during simulated defecation. Helical scanning was performed with a slice thickness of 1 mm, a helical pitch of 15 s/rotation, and a table movement speed of 35 mm/s. The contrast medium, 100 ml of iopamidol (370 mg/ml), was injected at a rate of 2.5 ml/s to enhance contrast with other structures, and scan start was triggered by using a function for automatically determining the optimal scan timing. RESULTS: Among the eight patients with rectocele, additional intrapelvic disorders were diagnosed in five (enterocele, 4; cystocele, 1; and uterine prolapse, 1) with D-3DCT. In the 17 patients with rectal prolapse, concomitant intrapelvic disorders were found in six (intussusception, 3; cystocele, 2; uterine prolapse, 2; rectocele, 1; and vaginal prolapse, 1). CONCLUSIONS: D-3DCT can be a useful diagnostic tool for investigation of pelvic pathology in patients with rectocele and rectal prolapse.

Adult↗
PubMed1993

Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children.

An old and simple operative technique for the treatment of rectal prolapse in children, first described by Ekehorn in 1909, has been reviewed. The technique consists of the insertion of a mattress suture (nonabsorbable and multifilament material) in the rectal ampulla through the lowermost part of the sacrum: the strands of the mattress suture are tied firmly over a piece of dry gauze at the level of the sacrococcygeal junction. By leaving the suture in place for 10 days, the local inflammation and infection causes firm adhesions between the rectal wall and the perirectal tissue so that the anorectal wall is bound to the surroundings (sacrorectopexy). The results of this retrospective study on 22 patients proves that this form of transsacral rectopexy in the management of rectal prolapse in children is effective (100%), simple and without complications compared to other techniques. There were no recurrences and no major morbidity. The overall surgical treatment of rectal prolapse in children is briefly reviewed.

Causality↗
PubMed2006

Technical and functional results after laparoscopic rectopexy to the promontory for complete rectal prolapse. Prospective study in 54 consecutive patients.

INTRODUCTION: Laparoscopic rectopexy for complete rectal prolapse offers short-term advantages compared with operations performed by laparotomy. The aim of this prospective study was to report technical and functional outcome after laparoscopic rectopexy to the promontory in consecutive patients operated on by a single surgeon. PATIENTS AND METHODS: From May 1996 to July 2004, 54 consecutive patients (47 women), median age 53 years (range: 16-84 years), underwent laparoscopic rectopexy to the promontory for complete rectal prolapse. Preoperative evaluation included physical examination, dynamic videoproctography and, in patients with constipation, colonic transit time (with radiopaque markers). Postoperative evaluation included the same examinations and a simple global quality-of-life questionnaire. RESULTS: Conversion to laparotomy was required for three patients during the learning curve. Median duration of operation was 157 minutes (range: 50-370). There was no mortality and morbidity was 5.5% (brachial plexus palsy in two patients and urinary tract infection in one). Median hospital stay was 3.5 days (range: 1-11). There were 4 recurrences (7.4%). Functional outcome at 12 months showed the presence of constipation in 20.3% of patients (persistence in eight and de novo in three) and the presence of outlet obstruction in 25.9% of patients (persistence in six and de novo in eight). Anal continence improved in 72.4% of the 29 patients who complained of this symptom. The global quality-of-life questionnaire showed a satisfactory result in 96% of patients. CONCLUSION: Laparoscopic rectopexy to the promontory is a safe and efficient procedure to treat complete rectal prolapse; morbidity is low. Functional outcome is at least equivalent to that obtained with open procedures in terms of continence, constipation and outlet obstruction.

Adolescent↗
PubMed2006

Laparoscopic rectovaginopexy for rectal prolapse.

BACKGROUND: Open rectovaginopexy is an effective procedure for the treatment of both rectal prolapse and anterior rectocele. This study investigates our results of laparoscopic rectovaginopexy (LRVP). METHODS: A consecutive series of 14 patients (median age, 73 years; range 24-92) with rectal prolapse was planned for LRVP. Pre-, per- and postoperative parameters were recorded. Followup was performed at the outpatients' clinic. RESULTS: The median length of hospital stay was 6 days (range, 3-14). There was one fatal cerebrovascular accident 14 days postoperatively; this patient was excluded from further analysis. Median follow-up was 7 months (range, 0.75-38). During follow-up, 11 of 13 patients (85%) experienced resolution or major improvement of their symptoms. Anal incontinence was diminished in 9 of 13 cases (69%). Constipation improved in 2 of 3 patients (66%). These three patients experienced a combination of both anal incontinence and costipation, preoperatively. Recurrence occurred in 2 patients (15%). Two others had a minor residual mucosal prolapse. No patients reported symptoms suggestive of operation-induced constipation or dyspareunia. CONCLUSIONS: LRVP is feasible, and seems to be an effective procedure for rectal prolapse. No operation-induced constipation was observed in this series. Taking into account the age and co-morbidities of these patients, morbidity and mortality may be considered acceptable.

Adult↗
PubMedDate not supplied

Anal sphincteric pressure studies in complete rectal prolapse.

Anal sphincteric pressure studies of patients with complete rectal prolapse demonstrated that: 1) The resting yield pressure of the internal anal sphincter in patients with complete rectal prolapse was not significantly different from that of control subjects. Thus, it seems to have no role in the etiology of prolapse. 2) The maximal sphincteric pressure of the external anal sphincter was significantly less in patients with prolapse than in controls. This suggested weakness in the effective functional power of the external anal sphincter in complete prolapse. 3) Anal continence could be achieved by the ability to maintain full contraction of the external anal sphincter for more than 40 seconds, which was the minimum for control subjects. Incontinent patients could not do this.

Adolescent↗
PubMedDate not supplied

[Two cases of colonic lipoma as a cause of rectal prolapse].

Two cases of submucosal colonic lipomas presenting as rectal prolapse are described. Both of them required resection by laparotomy. Colonic lipomas are a uncommon entity and they have not been documented as a cause of rectal prolapse.

Colonic Neoplasms↗
PubMed2002

Preserving the superior rectal artery in laparoscopic [correction of laparoscopis] anterior resection for complete rectal prolapse.

Anterior resection for the treatment of full thickness rectal prolapse has been around for over four decades. 1 However, its use has been limited due to fear of anastomotic leakage and related morbidity. It has been shown that high anterior resection is preferable to its low counterpart as the latter increases complication rates. 2 Although sparing the inferior mesenteric artery in sigmoid resection for diverticular disease has been shown to decrease leak rates in a randomized setting, 3 vascular division is current practice. We shall challenged this current practice of dividing the mesorectum in anterior resection for complete rectal prolapse developing a technique that allows the preservation of the superior rectal artery.

Digestive System Surgical Procedures↗
PubMed1996

Simplified sutured sacral rectopexy for complete rectal prolapse in adults.

OBJECTIVE: To assess the results of simplified sutured sacral rectopexy for complete rectal prolapse. DESIGN: Prospective study. SETTING: University hospital, India. SUBJECT: 65 patients with complete rectal prolapse treated by modified sutured sacral rectopexy. MAIN OUTCOME MEASURES: Morbidity, mortality and recurrence. RESULTS: During a follow-up of 2-10 years (mean 5.4 years) none of the patients developed a recurrence of complete prolapse of the rectum but 3(5%) developed mucosal prolapse. The incontinence improved in 12 of 16 patients (75%) and constipation improved in 5 of 6 (83.3%). CONCLUSION: We conclude that the simplified sutured sacral rectopexy is a simple operation for treating complete rectal prolapse in adults, and gives good results.

Adolescent↗
PubMed2004

The treatment of rectal prolapse in children with phenol in almond oil injection.

PURPOSE: The treatment of rectal prolapse in children is controversial. We report the results of injection sclerotherapy in children using phenol in almond oil (PAO) and discuss the occurrence of complications after the injection of PAO. METHODS: Nine children with rectal prolapse, aged from 2 years and 6 months to 14 years, were treated by PAO injection sclerotherapy between 1993 and 2000. The outcome of PAO injection sclerotherapy and the presence of complications were investigated from the point of anorectal function using anorectal manometry. RESULTS: All of the nine patients were cured after one to three injections without any complications. The manometric study showed that normal anorectal reflex and other parameters of the anorectum were found after injection sclerotherapy. Two of the 4 who had complained of constipation no longer had constipation after the therapy. CONCLUSIONS: PAO injection sclerotherapy is simple and should be recommended as a first method of treatment for rectal prolapse in children. PAO as a sclerosing agent did not cause any complications.

Adolescent↗
PubMed2005

Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years' experience.

PURPOSE: This study has been undertaken to audit a single-center experience with laparoscopically-assisted resection rectopexy for full-thickness rectal prolapse. The clinical outcomes and long-term results were evaluated. METHODS: The data were prospectively collected for the duration of the operation, time to passage of flatus postoperatively, hospital stay, morbidity, and mortality. For follow-up, patients received a questionnaire or were contacted. The data were divided into quartiles over the study period, and the differences in operating time and length of hospital stay were tested using the Kruskal-Wallis test. RESULTS: Between March 1992 and October 2003, a total of 117 patients underwent laparoscopic resection rectopexy for rectal prolapse. The median operating time during the first quartile (representing the early experience) was 180 minutes compared with 110 minutes for the fourth quartile (Kruskal-Wallis test for operating time = 35.523, 3 df, P < 0.0001). Overall morbidity was 9 percent (ten patients), with one death (<1 percent). One patient had a ureteric injury requiring conversion. One minor anastomotic leak occurred, necessitating laparoscopic evacuation of a pelvic abscess. Altogether, 77 patients were available for follow-up. The median follow-up was 62 months. Eighty percent of the patients reported alleviation of their symptoms after the operation. Sixty-nine percent of the constipated patients experienced an improvement in bowel frequency. No patient had new or worsening symptoms of constipation after surgery. Two (2.5 percent) patients had full-thickness rectal prolapse recurrence. Mucosal prolapse recurred in 14 (18 percent) patients. Anastomotic dilation was performed for stricture in five (4 percent) patients. CONCLUSIONS: Laparoscopically-assisted resection rectopexy for rectal prolapse provides a favorable functional outcome and low recurrence rate. Shorter operating time is achieved with experience. The minimally invasive technique benefits should be considered when offering rectal prolapse patients a transabdominal approach for repair, and emphasis should now be on advanced training in the laparoscopic approach.

Adult↗