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Annals of Coloproctology Apr 2017Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better...
PURPOSE
Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better functional outcome than perineal procedures. Nevertheless, ideal surgical methods are still not available. We propose a new surgical technique, laparoscopic vaginal suspension and rectopexy, for correcting a full-thickness rectal prolapse and/or middle-compartment prolapse. This study assessed the short-term outcomes for patients who underwent laparoscopic vaginal suspension and rectopexy.
METHODS
Between April 2014 and April 2016, 69 female patients underwent laparoscopic vaginal suspension and rectopexy to correct a rectal prolapse. Demographics, medical histories, and surgical and follow-up details were collected from their medical records. In addition to the clinical outcome, we repeated defecation proctography and a questionnaire regarding functional results three months after surgery.
RESULTS
No major morbidities or no mortalities occurred. The defecation proctography confirmed excellent anatomical result in all cases. Of 7 patients with combined middle-compartment prolapses, we observed good anatomical correction. During follow-up, full-thickness recurrence occurred in one patient. Preoperative fecal incontinence was improved significantly at 3 months (mean Wexner score: 12.35 vs. 7.71; mean FISI: 33.29 vs. 21.07; P < 0.001). Analysis of responses to the fecal incontinence quality of life (FIQOL) questionnaire showed overall improvement at 3 months compared to the preoperative baseline (mean pre- and postoperative FIQOL scores: 12.11 vs. 14.39; P < 0.004).
CONCLUSION
Laparoscopic vaginal suspension and rectopexy is a new combined procedure for the treatment of patients with rectal prolapses. It has excellent functional outcomes and minimal morbidity and can correct and prevent middlecompartment prolapses.
PubMed: 28503518
DOI: 10.3393/ac.2017.33.2.64 -
International Journal of Surgery... 2014The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However... (Meta-Analysis)
Meta-Analysis Review
AIM
The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However the role of robotic assistance in laparoscopic rectopexy is still not demonstrated.
METHODS
A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library, and Google Scholar up to 30th June 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the data currently available regarding the incidence of recurrence rate of rectal prolapse, conversion rate, operative time, intra-operative blood loss, post-operative complications, re-operation rate and hospital stay in robot-assisted rectopexy (RC) compared to conventional laparoscopic rectopexy (LR).
RESULTS
Six studies were included resulting in 340 patients. The meta-analysis showed that the RR does not influence the recurrence rate of rectal prolapse, the conversion rate and the re-operation rate, whereas it decreases the intra-operative blood loss, the post-operative complications and the hospital stay. Yet, the RR resulted to be longer than the LR. Post-operative ano-rectal and the sexual functionality and procedural costs could not meta-analyzed because the data from included studies about these issues were heterogeneous and incomplete.
CONCLUSION
The meta-analysis showed that the RR may ensure limited improvements in post-operative outcomes if compared to the LR. However, RCTs are needed to compare RR to LR in terms of short-term and long-term outcomes, specially investigating the functional outcomes that may confirm the cost-effectiveness of the robotic assisted rectopexy.
Topics: Blood Loss, Surgical; Digestive System Surgical Procedures; Humans; Laparoscopy; Length of Stay; Operative Time; Postoperative Complications; Rectal Prolapse; Rectum; Recurrence; Robotic Surgical Procedures
PubMed: 25157988
DOI: 10.1016/j.ijsu.2014.08.359 -
Journal of the Anus, Rectum and Colon 2022We describe our experience with robotic posterior rectopexy for a patient with full-thickness rectal prolapse. To our knowledge, this is the first report of such a case...
We describe our experience with robotic posterior rectopexy for a patient with full-thickness rectal prolapse. To our knowledge, this is the first report of such a case in the literature. A 94-year-old woman presented with a history of gradually worsening rectal prolapse. On examination, we found that the rectum was completely prolapsed, and we observed a prolapsed intestinal tract. Surgery was indicated and robotic rectopexy was performed without intraoperative complications. The postoperative course was uneventful, and she was discharged 10 days after the operation. One year later, there were no signs of recurrence. Robotic surgery has become common in recent years. We used robotic surgery for rectopexy, including the suturing procedure. Suturing in robotic surgery is easier than that in laparoscopic surgery, and we demonstrated that robotic rectopexy could be safely and easily performed. The trial was registered in the UMIN clinical trial registry (number 000040378).
PubMed: 35128140
DOI: 10.23922/jarc.2021-028 -
The Indian Journal of Surgery Dec 2015The aim of the study was to assess the clinical and functional results of surgical treatment of female patients with rectal prolapse. In the period of 2003-2010, the...
The aim of the study was to assess the clinical and functional results of surgical treatment of female patients with rectal prolapse. In the period of 2003-2010, the group of 86 female patients (mean age of 67 ± 10) underwent surgery due to rectal prolapse. The group of 24 patients (27.9 %) suffered from mild anal incontinence. They were operated on with open sutured rectopexy (18 pts), Altemeier (45 pts) and Delorme procedure (23 pts). Prior to surgery and after operation, clinical and function results were obtained. The follow-up period amounted to 32 ± 11 months. In perineal approaches, we found mortality in one patient (1.4 %, Delorme) and anastomotic leak in four patients (5.9 %). The recurrence rate in the perineal group was 11.8 % (eight patients). We noted one recurrence in the rectopexy group (5.6 %). The Altemeier procedure revealed the most significant impact on the function of the anal sphincter muscles and resting pressures (42 ± 7 vs 53 ± 9 cm H2O; p = 0.0082). If anterior levatoroplasty was added, the benefits referred also to squeeze pressures (41 ± 8 vs 58 ± 9 cm H2O; p = 0.006 and 42 ± 10 vs 56 ± 9 cm H2O; p = 0.01). In the treatment of rectal prolapse, there is still no consensus about the operation of choice. Selection of the appropriate method should be based on clinical findings and patients' comorbidities to obtain maximal benefits and minimize the postoperative risk and failures.
PubMed: 27011522
DOI: 10.1007/s12262-014-1196-1 -
Clinics in Colon and Rectal Surgery May 2007Despite the innovation of more than 100 surgical procedures for the treatment of complete rectal prolapse, no one procedure is best and applicable to all patients....
Despite the innovation of more than 100 surgical procedures for the treatment of complete rectal prolapse, no one procedure is best and applicable to all patients. Traditionally, procedures have been divided into abdominal and perineal approaches. The application of the laparoscopic approach to colon and rectal disease has allowed an additional less invasive method of therapy to treat rectal prolapse successfully. In comparison with conventional approaches, laparoscopy has achieved similar functional results and recurrence rates while reducing postoperative pain and hospital length of stay.
PubMed: 20011387
DOI: 10.1055/s-2007-977491 -
Journal of the Anus, Rectum and Colon 2018Although various pelvic floor abnormalities are recognized to cause mucus discharge (MD), little is known about the exact distribution and frequency of diseases causing...
OBJECTIVES
Although various pelvic floor abnormalities are recognized to cause mucus discharge (MD), little is known about the exact distribution and frequency of diseases causing MD in evacuatory disorders. This study aimed to identify the most common diseases at evacuation proctography in patients with MD.
METHODS
Patients seen with symptoms of evacuatory disorder underwent proctography. Data for patients with MD who were not associated with fecal incontinence (FI) were prospectively entered into a database and analyzed retrospectively. The degree of MD was documented using FI Severity Index.
RESULTS
Sixty-two patients were included for analysis. Forty-nine (79%) had rectal intussusception (RI) or external rectal prolapse (ERP). Of those with RI, MD was observed more in patients with recto-anal intussusception (n = 22) than those with recto-rectal intussusception (n = 8). Of the 39 patients who were not associated with hemorrhoids or mucosal prolapse, 31 (79%) had RI or ERP. Meanwhile, of 582 patients who underwent proctography, 301 had RI and 96 had ERP. MD without FI was present in 13% (40/301) patients with RI and 9% (9/96) with ERP. Surgery was performed in 21 patients, and MD was cured in 20 (95%) postoperatively.
CONCLUSIONS
RI and ERP were common at proctography in patients with MD.
PubMed: 31559356
DOI: 10.23922/jarc.2018-003 -
Clinics in Colon and Rectal Surgery Jan 2021Rectal prolapse frequently occurs in conjunction with functional and anatomic abnormalities of the bowel and pelvic floor. Prolapse surgery should have as its goal not... (Review)
Review
Rectal prolapse frequently occurs in conjunction with functional and anatomic abnormalities of the bowel and pelvic floor. Prolapse surgery should have as its goal not only to correct the prolapse, but also to improve function to the greatest extent possible. Careful history-taking and physical exam continue to be the surgeon's best tools to put rectal prolapse in its functional context. Physiologic testing augments this and informs surgical decision-making. Defecography can identify concomitant middle compartment prolapse and pelvic floor hernias, potentially targeting patients for urogynecologic consultation or combined repair. Other tests, including manometry, ultrasound, and electrophysiologic testing, may be of utility in select cases. Here, we provide an overview of available testing options and their individual utility in rectal prolapse.
PubMed: 33536845
DOI: 10.1055/s-0040-1714246 -
World Journal of Gastroenterology Jun 2016External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic... (Review)
Review
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
Topics: Defecation; Fecal Incontinence; Humans; Laparoscopy; Postoperative Complications; Recovery of Function; Rectal Prolapse; Risk Factors; Robotics; Surgical Mesh; Treatment Outcome
PubMed: 27275090
DOI: 10.3748/wjg.v22.i21.4977 -
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 -
Surgery Jul 2015Fecal incontinence is frequently associated with rectal prolapse, but little is known about recovery after treatment of the prolapse.
BACKGROUND
Fecal incontinence is frequently associated with rectal prolapse, but little is known about recovery after treatment of the prolapse.
OBJECTIVE
We therefore aimed to investigate the long-term outcome of fecal incontinence in a cohort of patients suffering from full-thickness rectal prolapse.
DESIGN
A database of 145 patients diagnosed with full-thickness rectal prolapse was compiled prospectively over a 7-year period (2003-2010).
MAIN OUTCOME MEASURES
Patients were referred to a single institution and assessed by standardized questionnaires, anorectal manometry, endosonography, and evacuation proctography. Fecal incontinence was evaluated according to the Cleveland Clinic Score; continence improvement was defined by ≥50% improvement of the Cleveland Clinic Score.
RESULTS
Among the population studied (134 women, 11 men; median follow-up, 38.9 months [range, 21.2-67.2]), 103 patients (71%) underwent operation for their prolapse and 42 (29%) did not. According to the Cleveland Clinic Score, 139 patients (96%) suffered from fecal incontinence before treatment and 64 (46%) reported improvement at the end of the follow-up. Pretreatment history of incontinence symptoms for >2 years (hazard ratio [HR], 1.99; 95% CI, 1.14-3.46; P = .015) and ventral rectopexy (HR, 1.86; 95% CI, 1.026-3.326; P = .04) were associated with continence improvement. Patients who underwent an operative procedure other than ventral rectopexy had similar outcome as compared with nonoperated patients. Conversely, chronic pelvic pain precluded fecal incontinence improvement (HR, 0.32; 95% CI, 0.135-0.668; P = .0017).
LIMITATIONS
Follow-up, returned questionnaires, and the heterogeneous reasons put forth for declining surgery may introduce some methodologic bias.
CONCLUSION
Fecal incontinence in patients suffering from rectal prolapse is improved when ventral rectopexy is performed compared with other operative or medical therapies.
Topics: Aged; Defecography; Endosonography; Fecal Incontinence; Female; Humans; Male; Manometry; Middle Aged; Rectal Prolapse; Treatment Outcome
PubMed: 25869649
DOI: 10.1016/j.surg.2015.03.005