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Diseases of the Colon and Rectum Oct 2022
Topics: Humans; Intestinal Mucosa; Rectal Prolapse; Rectum; Treatment Outcome
PubMed: 35853176
DOI: 10.1097/DCR.0000000000002482 -
Techniques in Coloproctology Mar 2021Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional...
BACKGROUND
Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP).
METHODS
This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life.
RESULTS
A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation.
CONCLUSIONS
Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.
Topics: Finland; Humans; Laparoscopy; Postoperative Complications; Quality of Life; Rectal Prolapse; Rectum; Recurrence; Retrospective Studies; Surgical Mesh; Treatment Outcome
PubMed: 33151385
DOI: 10.1007/s10151-020-02369-5 -
Rectal Prolapse Following Repair of Anorectal Malformation: Incidence, Risk Factors, and Management.Journal of Pediatric Surgery Aug 2023The incidence and optimal management of rectal prolapse following repair of an anorectal malformation (ARM) has not been well-defined.
BACKGROUND
The incidence and optimal management of rectal prolapse following repair of an anorectal malformation (ARM) has not been well-defined.
METHODS
A retrospective cohort study was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium registry. All children with a history of ARM repair were included. Our primary outcome was rectal prolapse. Secondary outcomes included operative management of prolapse and anoplasty stricture following operative management of prolapse. Univariate analyses were performed to identify patient factors associated with our primary and secondary outcomes. A multivariable logistic regression was developed to assess the association between laparoscopic ARM repair and rectal prolapse.
RESULTS
A total of 1140 patients met inclusion criteria; 163 (14.3%) developed rectal prolapse. On univariate analysis, prolapse was significantly associated with male sex, sacral abnormalities, ARM type, ARM complexity, and laparoscopic ARM repairs (p < 0.001). ARM types with the highest rates of prolapse included rectourethral-prostatic fistula (29.2%), rectovesical/bladder neck fistula (28.8%), and cloaca (25.0%). Of those who developed prolapse, 110 (67.5%) underwent operative management. Anoplasty strictures developed in 27 (24.5%) patients after prolapse repair. After controlling for ARM type and hospital, laparoscopic ARM repair was not significantly associated with prolapse (adjusted odds ratio (95% CI): 1.50 (0.84, 2.66), p = 0.17).
CONCLUSION
Rectal prolapse develops in a significant subset of patients following ARM repair. Risk factors for prolapse include male sex, complex ARM type, and sacral abnormalities. Further research investigating the indications for operative management of prolapse and operative techniques for prolapse repair are needed to define optimal treatment.
TYPE OF STUDY
Retrospective cohort study.
LEVEL OF EVIDENCE
II.
Topics: Child; Humans; Male; Anorectal Malformations; Rectal Prolapse; Retrospective Studies; Incidence; Rectal Fistula; Urinary Fistula; Urethral Diseases; Risk Factors; Rectum
PubMed: 37173214
DOI: 10.1016/j.jpedsurg.2023.04.010 -
Acta Gastro-enterologica Belgica 2017Known since antiquity, rectal prolapse was first studied systematically by Hippocrates (460-377 BC) who recognized the predisposing factors and proposed several... (Review)
Review
Known since antiquity, rectal prolapse was first studied systematically by Hippocrates (460-377 BC) who recognized the predisposing factors and proposed several therapeutic approaches such as defecation positions, manual retraction and specific herbal or mineral based anti-haemorrhagic and pain-killing poultices. Hippocratic medicine avoided invasive surgical procedures probably due to a lack of knowledge in human anatomy. However, Hippocrates' views astonishingly lasted in time, presenting similarities to current medical theories on rectal prolapse.
Topics: Disease Management; History, Ancient; Humans; Rectal Prolapse
PubMed: 29560672
DOI: No ID Found -
Techniques in Coloproctology Oct 2023Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI).
METHODS
A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI.
RESULTS
Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47 months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant.
CONCLUSIONS
Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.
Topics: Humans; Rectal Prolapse; Network Meta-Analysis; Laparoscopy; Rectum; Digestive System Surgical Procedures; Fecal Incontinence; Surgical Mesh; Recurrence; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37150800
DOI: 10.1007/s10151-023-02813-2 -
Colorectal Disease : the Official... Jun 2023Rectal prolapse is considered rare in men but the prevalence can be high in certain populations. It is unclear which surgical approach offers lower recurrence rates and... (Review)
Review
AIM
Rectal prolapse is considered rare in men but the prevalence can be high in certain populations. It is unclear which surgical approach offers lower recurrence rates and better functional outcomes in men. The aim of this work was to determine the recurrence rates, complications and functional outcomes after prolapse surgery in men.
METHOD
The MEDLINE, EMBASE and Scopus databases were systematically searched to identify studies on outcomes following surgical management of full-thickness rectal prolapse in men (over 18 years of age) published between 1951 and September 2022. Outcomes of interest included recurrence rate after surgery, bowel function, urinary function, sexual function and postoperative complications.
RESULTS
Twenty-eight studies involving 1751 men were included. Two papers focused exclusively on men. Twelve studies employed a mixture of abdominal approaches, ten employed perineal approaches and six compared both. The recurrence rate varied across studies, ranging from 0% to 34%. Sexual and urinary function were poorly reported, but the incidence of dysfunction appears low.
CONCLUSION
The outcomes of rectal prolapse surgery in men are poorly studied with small sample sizes and variable outcomes reported. There is insufficient evidence to recommend a specific repair approach based on the recurrence rate and functional outcomes. Further studies are required to identify the optimal surgical approach for rectal prolapse in men.
Topics: Male; Humans; Adolescent; Adult; Rectal Prolapse; Defecation; Postoperative Complications; Recurrence; Perineum; Treatment Outcome
PubMed: 36847704
DOI: 10.1111/codi.16534 -
Techniques in Coloproctology Dec 2022
Topics: Adult; Humans; Rectal Prolapse; Surgical Mesh; Laparoscopy; Digestive System Surgical Procedures; Treatment Outcome; Rectum
PubMed: 36214921
DOI: 10.1007/s10151-022-02663-4 -
Journal of Pediatric Gastroenterology... Jan 2015Screening for cystic fibrosis (CF) is suggested in patients with rectal prolapse (RP). Little is known about the association between CF and RP in the era of newborn...
Screening for cystic fibrosis (CF) is suggested in patients with rectal prolapse (RP). Little is known about the association between CF and RP in the era of newborn screening for CF. Our retrospective review showed that 3.6% of patients with RP had CF, and 3.5% of patients with CF had RP. No demographic or clinical factors appear to predict the likelihood of RP in patients with CF. Sweat chloride testing for patients with RP has a low yield in the era of newborn screening but may still need to be considered in children with RP to avoid missing the rare child with CF.
Topics: Adolescent; Child; Child, Preschool; Chlorides; Cystic Fibrosis; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Neonatal Screening; Pancreas; Rectal Prolapse; Retrospective Studies; Risk Factors; Sweat; Wisconsin
PubMed: 25162364
DOI: 10.1097/MPG.0000000000000546 -
Colorectal Disease : the Official... Aug 2017
Topics: Fecal Incontinence; Humans; Laparoscopy; Rectal Prolapse; Rectum; Sacrum; Transcutaneous Electric Nerve Stimulation
PubMed: 28766900
DOI: 10.1111/codi.13752 -
Techniques in Coloproctology Oct 2015
Topics: Digestive System Surgical Procedures; Humans; Laparoscopy; Rectal Prolapse; Rectum
PubMed: 26351059
DOI: 10.1007/s10151-015-1358-6