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Deutsches Arzteblatt International Nov 2020
Topics: Colonic Neoplasms; Colorectal Neoplasms; Humans; Rectal Prolapse
PubMed: 33533329
DOI: 10.3238/arztebl.2020.0756 -
Evaluation of the Safety and Efficacy of Modified Laparoscopic Suture Rectopexy for Rectal Prolapse.Journal of the Anus, Rectum and Colon 2023There are many surgical options for the treatment of rectal prolapse. To date, the efficacy of mesh-free laparoscopic suture rectopexy remains unclear due to the limited...
OBJECTIVES
There are many surgical options for the treatment of rectal prolapse. To date, the efficacy of mesh-free laparoscopic suture rectopexy remains unclear due to the limited number of reports. This study aimed to evaluate the safety and efficacy of laparoscopic suture rectopexy.
METHODS
This observational cohort study is a retrospective cross-sectional analysis of a continuously maintained database. All patients underwent laparoscopic suture rectopexy for rectal prolapse between April 2012 and March 2018. The primary outcomes measured were recurrence rates and complications of laparoscopic suture rectopexy.
RESULTS
A total of 268 patients (29 male and 239 female) underwent laparoscopic suture rectopexy. Their mean age was 77 (19-95) years, and the mean prolapse length was 6.4 (3.5-20) cm. One patient suffered an intraabdominal abscess. Spondylitis developed in another patient following surgery. The median follow-up period was 45 (12-82) months. A total of 22 patients (8.2%) developed recurrence. The average time to recurrence was 15.6 (1-44) months. Multivariate analysis revealed a significant correlation between recurrence and prolapse length >7.0 cm (OR: 1.26, 95% CI: 1.38-1.42, < 0.01).
CONCLUSIONS
Laparoscopic suture rectopexy for complete rectal prolapse is a minimally invasive and safe procedure that may lead to lower recurrence rates.
PubMed: 37113587
DOI: 10.23922/jarc.2022-049 -
Cureus Mar 2021Introduction Most of the patients with rectal prolapse complain of fecal incontinence followed by constipation. Surgery is the only definitive treatment option for...
Introduction Most of the patients with rectal prolapse complain of fecal incontinence followed by constipation. Surgery is the only definitive treatment option for rectal prolapse. There are two approaches: either transanal/perineal or transabdominal. The abdominal procedures can be done in the open laparotomy method or laparoscopically. Suture rectopexy is a very old and popular method of treating rectal prolapse. Nowadays, rectopexy by laparoscopic approach is considered the gold standard treatment for rectal prolapse. The study has been conducted to compare both the procedures and their outcomes in terms of conditions associated with rectal prolapse. Methods All consecutive patients with full-thickness rectal prolapse who had attended the surgery outpatient department were included in the study. The patients had undergone either open suture rectopexy or laparoscopic rectopexy after randomization. Assessment of postoperative pain, mean days of hospital stay, constipation, and incontinence score along with operative time, recurrence within six months of follow-up, and time to resume bowel activity were done. The patients were followed up for 18 months at regular intervals. Results A total of 58 patients were included in the study: 27 in the open group and 31 in the laparoscopic group. The operative time was 102 minutes versus 129 minutes (p=0.0001) in the open and laparoscopic groups, respectively. The laparoscopic group had an earlier resumption of bowel activity (3.1 days vs. 1.4 days [p=0.0001]); fewer days of hospital stay (6.8 days vs. 2.5 days [p=0.0001]), less postoperative pain (mean visual analogue scale score for pain on postoperative day one 4.0 versus 3.1 [p=0.0035] and on postoperative day two 3.8 versus 2.2 [p=0.0001]). There was no significant difference in postoperative constipation score and incontinence score between the two groups. Conclusion Laparoscopic rectopexy results in lesser postoperative pain, lesser hospital stay, and better patient satisfaction than open rectopexy.
PubMed: 33936886
DOI: 10.7759/cureus.14175 -
Ultrasound in Obstetrics & Gynecology :... Mar 2017To examine the relationship of visual analog scale (VAS) 'bother' scores for obstructed defecation (OD) with demographic data, physical examination and sonographic...
OBJECTIVE
To examine the relationship of visual analog scale (VAS) 'bother' scores for obstructed defecation (OD) with demographic data, physical examination and sonographic findings of the posterior compartment.
METHODS
All patients seen at a urogynecology clinic between January and October 2013 were included. Patients were diagnosed with OD if they had any of the following: incomplete bowel emptying, straining with bowel movement or need for digitation. Patients used a VAS to rate OD bother on a scale of 0-10 (0, no bother; 10, worst imaginable bother). For each patient, a comprehensive history was obtained, the International Continence Society Pelvic Organ Prolapse Quantification was performed and four-dimensional translabial ultrasound volumes were recorded on maximal Valsalva maneuver. Linear and multiple regression models were used to correlate bother VAS scores with demographic, clinical and sonographic findings.
RESULTS
Among 265 patients included in the analysis, 61% had OD symptoms with a mean VAS bother score of 5.6. OD bother scores were associated with a history of previous prolapse surgery (P = 0.0001), previous hysterectomy (P = 0.0006), descent of the posterior compartment (Bp; P = 0.004) and hiatal dimensions (Pb and Gh + Pb; P = 0.006 and P = 0.004). OD bother was associated with the following sonographic findings: true rectocele (P = 0.01), depth of rectocele (P = 0.04), descent of rectal ampulla (P = 0.02), enterocele (P = 0.03) and rectal intussusception (P < 0.0001).
CONCLUSIONS
VAS bother scores are associated with both clinical and sonographic measures of posterior compartment descent. Rectal intussusception was most likely to result in highly bothersome symptoms of OD. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Aged; Constipation; Defecation; Female; Humans; Hysterectomy; Imaging, Three-Dimensional; Intussusception; Middle Aged; Pelvic Organ Prolapse; Pregnancy; Prospective Studies; Risk Factors; Severity of Illness Index; Visual Analog Scale
PubMed: 26611759
DOI: 10.1002/uog.15828 -
The Indian Journal of Surgery Dec 2015Perineal stapled prolapse resection is a new technique for external rectal prolapse introduced in 2007. We have done stapled perineal resection for 12 patients with full...
Perineal stapled prolapse resection is a new technique for external rectal prolapse introduced in 2007. We have done stapled perineal resection for 12 patients with full thickness rectal prolapse between January 2010 and April 2012. Elderly patients with comorbidities and young patients who want to avoid risk of nerve damage, with rectal prolapse up to 8-10 cms were included prospectively for perineal stapled rectal prolapse resection. Functional outcome, complications, operating time, and hospital stay were assessed in all patients. Perineal stapled prolapse resection was performed without major complications in a median operating time of 45 (range, 40-90) min and median Hospital stay was 3 days (3 to 11 days). Preoperative severe fecal incontinence and constipation improved postoperatively in 90 and 66 % of the patients, respectively, and there was no incidence of de novo onset or worsening of constipation in any of the patient. One patient developed small extra peritoneal collection which was managed by conservative treatment. No other complications occurred. At median follow-up of 36 months, all patients were well and showed no early recurrence of prolapse. Perineal stapled rectal prolapse resection is a new surgical procedure for external rectal prolapse, which is safe, easy, and quick to perform.
PubMed: 27011521
DOI: 10.1007/s12262-014-1190-7 -
BMJ Case Reports Dec 2019A 34-year-old man with recent-onset constipation presented with colonic obstruction due to a palpable rectal tumour. Colostomy relieved the obstruction and biopsy...
A 34-year-old man with recent-onset constipation presented with colonic obstruction due to a palpable rectal tumour. Colostomy relieved the obstruction and biopsy revealed carcinoma. During workup, full-thickness rectal prolapse occurred with the tumour at the apex of an intussusception. Imaging revealed a low rectal tumour and no metastases. An abdominal oncological rather than perineal resection of the rectum was planned. At laparotomy, the tumour was reduced and was seen to originate at the rectosigmoid junction. Surgery was successful and follow-up has been clear. Histology revealed an adenocarcinoma with microsatellite instability. Rectal prolapse due to tumour intussusception is very rare. In this young man, it was due to straining at stool because of constipation and tenesmus rather than pelvic floor abnormality. An associated colorectal tumour should be considered in patients with rectal prolapse. In such cases, surgical and adjuvant management may need to be modified.
Topics: Adenocarcinoma; Adult; Constipation; Diagnosis, Differential; Humans; Laparotomy; Magnetic Resonance Imaging; Male; Rectal Neoplasms; Rectal Prolapse
PubMed: 31892618
DOI: 10.1136/bcr-2019-230409 -
Open Veterinary Journal 2022Rectal prolapse (RP) is a serious illness of the rectum and small intestine causing serious health problems in domestic animals. However, there is paucity in the...
BACKGROUND
Rectal prolapse (RP) is a serious illness of the rectum and small intestine causing serious health problems in domestic animals. However, there is paucity in the estimation of the risk factors associated with this problem in calves.
AIM
In the present study, we investigated the prevalence and risk factors associated with the rectal prolapse in both bovine and buffalo calves in Egypt, highlighting the most appropriate treatment strategy.
METHODS
Forty-two calves (23 bovine and 19 buffalo) suffering from varying degrees of rectal prolapse were used. From the owners' anamnesis, the farm- and animal-level risk factors associated with each animal were collected. Fisher's exact tests were used to determine the distribution of frequencies in the different rectal prolapse grades. Descriptive statistics were calculated in the form of mean ± standard deviation (SD) using one-way analysis of variance. Crosstabs were used to determine Spearman's correlation between variables. According to the disease severity, the appropriate treatment strategy was accomplished either by medicinal or surgical interferences.
RESULTS
The final logistic regression form demonstrated that the statistical test, Hosmer and Lemeshow's goodness of fit, indicates a significant result ( = 8.91). Body score was the potential risk factor for the occurrence of RP in calves. Medicinal management along with dietary modification was sufficient to treat 70% of grade I in a successful manner, while 33.3% (grade I and grade II) were effectively treated surgically with reduction and application of purse-string sutures.
CONCLUSION
The current study advocates the valid role of resection of rectal mucosa combined with manual reduction and retention in treating calves suffering from grade II rectal prolapse. The final multivariate logistic regression model indicates that the calf's body score is a potential risk factor for the occurrence of RP.
Topics: Animals; Buffaloes; Cattle; Cattle Diseases; Egypt; Farms; Rectal Prolapse; Risk Factors
PubMed: 35603078
DOI: 10.5455/OVJ.2022.v12.i2.9 -
BJS Open Mar 2022
Topics: Humans; Rectal Prolapse
PubMed: 35307734
DOI: 10.1093/bjsopen/zrac042 -
Diseases of the Colon and Rectum Jul 2018Pelvic organ prolapse is prevalent among women with rectal prolapse.
BACKGROUND
Pelvic organ prolapse is prevalent among women with rectal prolapse.
OBJECTIVE
This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair.
DESIGN
A retrospective cohort.
SETTING
This study was performed at a single managed-care institution.
PATIENTS
Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included.
INTERVENTIONS
There were no interventions.
MAIN OUTCOME MEASURES
Full-thickness rectal prolapse recurrence was compared between 4 groups: abdominal repair without pelvic organ prolapse (AR-POP); abdominal repair with pelvic organ prolapse (AR+POP); perineal repair without pelvic organ prolapse PR-POP; and perineal repair with pelvic organ prolapse (PR+POP). Recurrence-free period and hazard of recurrence were compared using Kaplan-Meier and Cox proportional hazards methods. To identify potential confounding risk factors for rectal prolapse recurrence, the characteristics of subjects with/without recurrence were compared with univariable and multivariable analyses.
RESULTS
Overall, pelvic organ prolapse was present in 33% of 112 women and was more prevalent among subjects with rectal prolapse recurrence (52.4% vs 28.6%, p = 0.04). Median follow-up was 42.5 months; rectal prolapse recurrence occurred in 18.8% at a median of 9 months. The rate of recurrence and the recurrence-free period differed significantly between groups: AR-POP 3.8%, 95.7 months; AR+POP 13.0%, 86.9 months; PR-POP 34.8%, 42.1 months; PR+POP 57.1%, 23.7 months (p < 0.001). Compared with AR-POP the HR (95% CI) of rectal prolapse recurrence was 3.1 (0.5-18.5) for AR+POP; 14.7 (3.0-72.9) for PR-POP and 31.1 (6.2-154.5) for PR+POP. Compared with AR+POP, PR+POP had a shorter recurrence-free period (p < 0.001) and a higher hazard of recurrence (HR, 10.2; 95% CI, 2.1-49.3).
LIMITATIONS
The retrospective design was a limitation of this study.
CONCLUSIONS
Pelvic organ prolapse was associated with a higher rectal prolapse recurrence rate and earlier recurrence in women undergoing perineal, but not abdominal, repairs. Multidisciplinary evaluation can facilitate individualized management of women with rectal prolapse. Abdominal repair should be considered in women with concomitant rectal and pelvic organ prolapse. See Video Abstract at http://links.lww.com/DCR/A513.
Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Cohort Studies; Comorbidity; Digestive System Surgical Procedures; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Pelvic Organ Prolapse; Proportional Hazards Models; Rectal Prolapse; Rectum; Recurrence; Retrospective Studies; Young Adult
PubMed: 29528907
DOI: 10.1097/DCR.0000000000001023 -
BJS Open Jan 2022Several different procedures have been described for surgical treatment of rectal prolapse and consensus on the optimal approach has not been reached. The Swedish Rectal... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Several different procedures have been described for surgical treatment of rectal prolapse and consensus on the optimal approach has not been reached. The Swedish Rectal Prolapse Trial was performed with the aim to compare the outcomes after the most common surgical approaches to rectal prolapse.
METHOD
A multicentre randomized trial was conducted from 2000 to 2009. Patients were randomized between a perineal or an abdominal approach for correction of rectal prolapse (randomization A) if eligible for any procedures. Patients considered unsuitable for random allocation were only included in randomizations B or C. Patients in randomization B (perineal group) were randomized to Delorme's or Altemeier's procedures and those in randomization C (abdominal group) to suture rectopexy or resection rectopexy. Primary outcomes were bowel function and quality of life, measured using Wexner incontinence score and RAND-36, and secondary outcomes were complications and recurrence at 3 years.
RESULTS
During the study period, 134 patients were randomized: 18 in randomization A group, 80 in randomization B group and 54 in randomization C group; of these, 122 patients underwent surgery. Mean follow-up was 2.6 years. Improvements in Wexner and RAND-36 scores were seen but with no significant difference between the groups. Health change scores were significantly improved from baseline up to 1 year after surgery (P < 0.001). At 3 years, recurrence rates were two of seven patients for abdominal versus five of eight patients for perineal approach (P = 0.315), 18 of 31 patients (58 per cent) for Delorme's versus 15 of 30 patients (50 per cent) for Altemeier's (P = 0.611) and four of 19 patients (21 per cent) for suture rectopexy versus two of 21 patients (10 per cent) for resection rectopexy (P = 0.398). There were no significant differences regarding postoperative complications.
CONCLUSION
For all procedures, significant improvements from baseline in health change scores were noted after surgery. Recurrence rates were higher than previously reported. Registration number: NCT04893642 (http://www.clinicaltrials.gov).
Topics: Fecal Incontinence; Humans; Neoplasm Recurrence, Local; Quality of Life; Rectal Prolapse; Rectum
PubMed: 35045155
DOI: 10.1093/bjsopen/zrab140