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Journal of Pediatric Gastroenterology... Oct 2023
Topics: Humans; Rectal Prolapse; Rectal Neoplasms; Intestinal Polyps
PubMed: 37256836
DOI: 10.1097/MPG.0000000000003843 -
Techniques in Coloproctology Oct 2023
Topics: Humans; Rectal Prolapse; Rectum; Fecal Incontinence; Treatment Outcome
PubMed: 37278904
DOI: 10.1007/s10151-023-02829-8 -
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 -
Frontiers in Surgery 2024
PubMed: 38586240
DOI: 10.3389/fsurg.2024.1400636 -
Risk Management and Healthcare Policy 2023Procedure for Prolapse and Hemorrhoids (PPH), also known as circular stapled hemorrhoidectomy, is a common method of treating hemorrhoids due to its low risk of... (Review)
Review
Procedure for Prolapse and Hemorrhoids (PPH), also known as circular stapled hemorrhoidectomy, is a common method of treating hemorrhoids due to its low risk of complications and minimal postoperative pain. Several complications have appeared alongside the rise of treated cases, however, and this has led to a progressive slowing of the clinical use of PPH in recent years. Anastomotic stenosis is one of the most common complications of PPH, but the greater amount of tissue removed and the speed with which it can heal make it the best choice for patients with severe prolapsed annular hemorrhoids or rectal mucosal prolapse. Therefore, academics continue to comprehensively study PPH to take advantage of annular resection and reduce complications. In this paper, we analyzed the causes, intraoperative warnings, and postoperative therapy of anastomotic stenosis induced by PPH, with an eye toward scientific application in the anorectal field, based on the experience of clinical applications.
PubMed: 37525828
DOI: 10.2147/RMHP.S407021 -
Frontiers in Genetics 2023Classical-like Ehlers-Danlos syndrome (clEDS) is an autosomal recessive disorder caused by complete absence of tenascin-X resulting from biallelic variation in . Thus...
Classical-like Ehlers-Danlos syndrome (clEDS) is an autosomal recessive disorder caused by complete absence of tenascin-X resulting from biallelic variation in . Thus far, 50 patients from 43 families with biallelic variants have been identified. Accurate detection of variants is challenging because of the presence of the pseudogene , which can undergo non-allelic homologous recombination. Therefore, we designed a genetic screening system that is performed using similar operations to other next-generation sequencing (NGS) panel analyses and can be applied to accurately detect variants and the recombination of -derived sequences into . Using this system, we identified biallelic variants in nine unrelated clEDS patients. -derived variations were found in >75% of the current cohort, comparable to previous reports. The current cohort generally exhibited similar clinical features to patients in previous reports, but had a higher frequency of gastrointestinal complications (e.g., perforation, diverticulitis, gastrointestinal bleeding, intestinal obstruction, rectal/anal prolapse, and gallstones). This report is the first to apply an NGS-based screening for variants and represents the third largest cohort of clEDS, highlighting the importance of increasing awareness of the risk of gastrointestinal complications.
PubMed: 37712068
DOI: 10.3389/fgene.2023.1234804 -
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 -
Praxis Aug 2023A rectal prolapse is mainly a disease of the elderly population, occurring more frequently among women. The medical practitioner has an important role in the recognition...
A rectal prolapse is mainly a disease of the elderly population, occurring more frequently among women. The medical practitioner has an important role in the recognition and initiation of therapy for rectal prolapse. Appropriate therapy can have an important impact on symptom reduction and healthcare resources. Surgical therapy includes perineal or transabdominal surgery, with increasing use of minimally invasive techniques such as mesh rectopexy. This operation is indicated and feasible regardless of age. The management of the rectal prolapse in specialized pelvic floor centres with interdisciplinary expertise for diagnosis and therapy is recommended.
Topics: Humans; Female; Aged; Rectal Prolapse; Defecation; Intussusception; Treatment Outcome; Pelvic Floor; Rectum; Surgical Mesh; Laparoscopy
PubMed: 37855648
DOI: No ID Found -
The American Surgeon Dec 2023to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early.
METHODS
A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group. Experimental group: Thread-drawing during operation and anal enlargement after PPH. Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone. The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years.
RESULTS
The effective rate of mixed hemorrhoid treatment in the 4 groups was 100%. There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C.
CONCLUSION
Multipoint thread-drawing and anal enlargement after PPH can avoid postoperative rectal stenosis and can strengthen anastomosis and reduce bleeding, while being a simple procedure that can be easily popularized.
Topics: Humans; Hemorrhoids; Constriction, Pathologic; Prolapse; Anal Canal; Postoperative Complications; Anastomosis, Surgical; Rectal Prolapse
PubMed: 37257493
DOI: 10.1177/00031348231180925 -
Diseases of the Colon and Rectum Nov 2023
PubMed: 37540025
DOI: 10.1097/DCR.0000000000002638