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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 -
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 Sep 2016Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage,...
Rectal prolapse is associated with debilitating symptoms and leads to both functional impairment and anatomic distortion. Symptoms include rectal bulge, mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as discomfort, pressure, and pain. The only cure is surgical. The optimal surgical repair is not yet defined though laparoscopic rectopexy with mesh is emerging as a more durable approach. The chosen approach should be individually tailored, taking into account factors such as presence of pelvic floor defects and coexistence of vaginal prolapse, severe constipation, surgical fitness, and whether the patient has had a previous prolapse procedure. Consideration of a multidisciplinary approach is critical in patients with concomitant vaginal prolapse. Surgeons must weigh their familiarity with each approach and should have in their armamentarium both perineal and abdominal approaches. Previous barriers to abdominal procedures, such as age and comorbidities, are waning as minimally invasive approaches have gained acceptance. Laparoscopic ventral rectopexy is one such approach offering relatively low morbidity, low recurrence rates, and good functional improvement. However, proficiency with this procedure may require advanced training. Robotic rectopexy is another burgeoning approach which facilitates suturing in the pelvis. Successful rectal prolapse surgeries improve function and have low recurrence rates, though it is important to note that correcting the prolapse does not assure functional improvement.
PubMed: 27582654
DOI: 10.1055/s-0036-1584505 -
Annals of Medicine and Surgery (2012) Dec 2022Internal rectal prolapse in children is one of the causes of annoying and drug-resistant constipation. The disease causes a type of obstructive constipation due to the...
OBJECTIVES
Internal rectal prolapse in children is one of the causes of annoying and drug-resistant constipation. The disease causes a type of obstructive constipation due to the appearance of mucosal folds in the distal rectum. If the diagnosis is made in time according to the methods proposed by the author, the treatment can also be done with simple techniques. In this article, the treatment methods for this well-known disease are presented.
METHODS
This is a prospective cross-sectional study, Sixty children (36 girls and 24 boys) between the ages of 6 months and 15 years who have specific symptoms of this disease and different degrees after definitive diagnosis of anesthesia with Delshad-mash have been treated with the sclerosing solution under the rectal mucosa or excision prolapse.
RESULTS
Depending on the severity of the disease, treatment with a subcutaneous injection of sclerosing solution responds well. The condition resolves after years of suffering from high degrees of prolapsed mucosal excision.
CONCLUSION
Diagnosis of internal rectal prolapse can be made based on specific symptoms and barium enema radiology before the anesthesia test for children and determine the patient's treatment path and prevent additional operations such as colostomy-pulmonary with misdiagnosis of Hirschsprung.
PubMed: 36536742
DOI: 10.1016/j.amsu.2022.104886 -
International Journal of Surgery... 2011External rectal prolapse is defined as a full thickness extrusion of the rectum outside of the anus. In patients who are fit enough, it is usually treated with surgical... (Review)
Review
External rectal prolapse is defined as a full thickness extrusion of the rectum outside of the anus. In patients who are fit enough, it is usually treated with surgical intervention. The surgical focus has traditionally been on reduction of the prolapse, rather than improvement in function. Internal rectal prolapse is also well recognised, being a folding of the full thickness of the rectal wall that occurs on straining to defecate, but that does not protrude outside of the anus. It may present with either obstructed defecation or faecal incontinence.(1,2) In contrast to external prolapse surgery for internal rectal prolapse has enjoyed a poor reputation, in part due to the poor results of surgery in the late 1980s(3,4) but also because of the suggestion that internal prolapse is an incidental finding.(5) The introduction of surgical techniques that focus on functional outcomes in external prolapse surgery have led to a re-appraisal of the treatment of internal rectal prolapse.(6) This coupled with new evidence regarding the morphology of symptomatic internal prolapse has quashed the concept of internal prolapse as an untreatable and incidental phenomenon.(7,8) This article will outline the evolution of surgery for rectal prolapse, the use of laparoscopic ventral rectopexy in external prolapse and the evaluation and treatment of patient with internal rectal prolapse.
Topics: Humans; Laparoscopy; Rectal Prolapse
PubMed: 21521660
DOI: 10.1016/j.ijsu.2011.04.003 -
Contrast Media & Molecular Imaging 2022The main aim of this study was to explore the role of defecography in the preoperative diagnosis and postoperative evaluation of rectal prolapse surgery (modified Wells...
The main aim of this study was to explore the role of defecography in the preoperative diagnosis and postoperative evaluation of rectal prolapse surgery (modified Wells procedure). We collected and summarized the X-ray performance and then analyzed the results of 107 patients with defecatory dysfunction who underwent defecography from January 2020 to March 2021. Furthermore, the preoperative and 6-month postoperative defecography results and clinical symptoms of 25 patients who underwent rectal prolapse surgery (modified Wells procedure) were compared. Results showed that among the 107 patients with defecation dysfunction, women had worse defecography results than men ( < 0.01). A total of 25 patients successfully completed the surgery without complications such as infection and intestinal fistula and there was no recurrence at 12 months of follow-up. Compared with the preoperative results, anorectal angle during defecation, the depth of rectocele, and perineal descent were significantly improved after the surgery ( < 0.01). Moreover, the patient's feeling of obstructed defecation and incomplete defecation was significantly relieved compared to that before the procedure ( < 0.01). In conclusion, defecography can be used to diagnose rectal prolapse preoperatively and evaluate the surgical effect combined with clinical symptoms postoperatively, which provides a clinical reference.
Topics: Defecography; Female; Humans; Male; Rectal Prolapse; Rectocele
PubMed: 35480080
DOI: 10.1155/2022/2219330 -
Frontiers in Surgery 2023Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with...
Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with traces of blood and mucus and had experienced fatigue after hiking. After the initial evaluation, it became clear that prolapse bares a large rectal tumor as a leading point. The prolapse was reduced under general anesthesia, along with a tumor biopsy. Further workup confirmed locally advanced adenocarcinoma of the rectum, which was treated with neoadjuvant chemoradiation followed by curative surgery in another hospital after repatriation. Rectal prolapse affects people of all ages, but it is more common in older adults, particularly women. Treatment options vary depending on the severity of the prolapse and can range from conservative measures to surgical interventions. This case report highlights the importance of early recognition and appropriate management of rectal prolapse in the emergency setting and the possibility of an underlying malignancy.
PubMed: 37114157
DOI: 10.3389/fsurg.2023.1176726 -
Techniques in Coloproctology Nov 2017The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information... (Review)
Review
BACKGROUND
The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery.
METHODS
This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch-Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0).
RESULTS
Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch-Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2-85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1-5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1-8).
CONCLUSIONS
Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.
Topics: Comprehension; Consumer Health Information; Decision Making; Humans; Internet; Patient Education as Topic; Rectal Prolapse
PubMed: 29101494
DOI: 10.1007/s10151-017-1708-7 -
Acta Veterinaria Scandinavica Sep 2016True vaginal prolapse is a rare condition in dogs and it is occasionally observed in animals with constipation, dystocia, or forced separation during breeding. If a true...
BACKGROUND
True vaginal prolapse is a rare condition in dogs and it is occasionally observed in animals with constipation, dystocia, or forced separation during breeding. If a true prolapse occurs, the bladder, the uterine body and/or distal part of the colon, may be present in the prolapse.
CASE PRESENTATION
A 2-year-old intact non pregnant Central Asian Shepherd dog in moderate condition, was presented for a true vaginal and rectal prolapse. The prolapses were confirmed by physical examination and ultrasonography. Herniation of the urinary bladder was identified within the vaginal prolapse. The necrotic vaginal wall was resected, the urinary bladder was reduced surgically and fixed to the right abdominal wall to prevent recurrence. Rectal resection and anastomosis was necessary to correct the rectal prolapse. Recurrence of the prolapses was not observed and the dog recovered completely after the surgical treatment.
CONCLUSIONS
In our opinion, extreme tenesmus arising from constipation may have predisposed to the vaginal prolapse with bladder incarceration and secondarily to rectal prolapse. In the young female dog, true vaginal prolapse with secondary involvement of the urinary bladder and irreducible rectal prolapse is an exceptionally rare condition.
PubMed: 27660054
DOI: 10.1186/s13028-016-0235-2 -
Annals of Coloproctology Jun 2018Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal...
PURPOSE
Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients.
METHODS
Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients' satisfaction scores (0-10), and the occurrence of constipation.
RESULTS
No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation.
CONCLUSION
LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.
PubMed: 29991200
DOI: 10.3393/ac.2018.01.31