Complete Rectal Prolapse Research Articles

Evaluation of Clinical Outcomes after Abdominal Rectopexy and Delorme's Procedure for Rectal Prolapse: A Prospective Study.

Complete rectal prolapse is characterized by protrusion of full thickness rectal wall through the anal orifice. Despite its rarity more than 100 surgical procedures have been described and there are no good evidence based recommendations for selection of a surgical procedure. This study was conducted to evaluate the clinical outcomes of commonly used procedures for rectal prolapse at our hospital. Twenty seven patients presenting with complete rectal prolapse between May 2011 to May 2013 were included in this prospective study. Patients underwent either Abdominal rectopexy or Delorme's procedure after evaluation, based on clinical judgment of experienced surgeons. Patient characteristics, complications, post-operative length of hospitalization and clinical outcomes were assessed. Patients were followed up for a mean duration of 14 months. Seventeen patients underwent Abdominal rectopexy (Posterior mesh rectopexy), ten patients underwent Delorme's procedure. No postoperative mortalities or major complications were noted. Post operative morbidity (minor) was 17% in Abdominal rectopexy group and 10% in Delormes group 0%. Incontinence improved in all six patients (100%) in rectopexy group, four patients (80%) in Delorme's procedure group. Two patients (11%) in rectopexy group reported increase in constipation post operatively. There was one recurrence in Delorme's procedure group with no recurrences in Abdominal rectopexy group. The treatment of rectal prolapse should be individualized to achieve best results. Abdominal rectopexy can be safely applied in most of patients with minimal post operative increase in constipation and recurrence by using posterior mesh rectopexy technique. Delorme's procedure can be performed with minimal morbidity and shorter hospital stay and good functional results with acceptable recurrence rate. Delorme's can be considered as an alternative to rectopexy not only in patients unfit for laparotomy but also in individuals with a short prolpase, avoiding a laparotomy.

Mesh erosion after laparoscopic posterior rectopexy: A rare complication

Laparoscopic posterior mesh rectopexy (LPMR) is now an accepted surgical treatment for complete rectal prolapse. It is associated with complications such as partial mucosal prolapse, fecal impaction, constipation, and rarely recurrence. Erosion of the mesh into the rectum after LPMR is very rare. We report herein the case of 40-year-old man who presented with mesh erosion into the rectum and managed successfully by the laparoscopic excision of mesh. This is probably the first such case managed by the laparoscopic approach.

A Case of Complete Rectal Prolapse in an In-Gilt

A seven-month-old in-gilt was presented with an intractable rectal prolapse. The prolapsed rectum was swollen, necrotic, and ulcerated. The pig was apparently healthy and had been ingesting high fibre feed materials, with little water. The pig was anaesthetized with 1.1 mg/kg body weight of xylazine and 10 mg/kg body weight of ketamine administered intramuscularly and intravenously, respectively. The prolapse was removed by placing a stay suture distal to the necrotic tissue and excising the tissue close to the apparently healthy part. A rectopexy was also performed. The pig was placed on prophylactic antibiotics and discharged.

Altemeier’s procedure for complete rectal prolapse in elderly and frail patients: should we be afraid of?

Background Complete rectal prolapse is more common in the elderly, with considerable effects on patient’s quality of life. Whenever co-existing morbidities render abdominal procedures impossible, perineal rectosigmoidectomy combined with levatorplasty as described by Altemeier is a viable option. However, performing a coloanal anastomosis without fecal diversion bears the risk of life-threatening (anastomotic) complications. We present our experience performing Altemeier’s procedure (AP) in a series of old and frail patients, and a review of literature.

Posterior Sagittal Mesh Rectopexy (PSMR) and Anal Encirclement with Polypropylene Mesh for Correction of Complete Rectal Prolapse-a New Application.

The posterior sagittal route is utilized as an alternative to the abdominal and perineal routes for the operation of a complete rectal prolapse (syn. procidentia). A mesh is interposed between the rectum and sacrum. The mesh also acts as a sling suspended from the sacrum. The levator muscle is repaired from behind. Anal encirclement is made to correct a patulous anus.

Precipitous intussusception with anal protrusion and complete overt rectal prolapse presenting with intestinal obstruction and an associated rectal adenoma in a young man: a case report

BackgroundIntestinal obstruction secondary to intussusception, occurring simultaneously with complete rectal prolapse, is an unusual entity among young adults. When it occurs the intussusceptum may protrude per anus. Few cases are cited in literature; each with a unique clinical presentation. There is apparently no uniform trend in its clinical and pathological picture.Case presentationA 38-year-old, African-Ugandan man presented with sudden occurrence of rectal prolapse for one day. He had otherwise been in good health. Symptoms were precipitous. A clinical diagnosis of intussusception of the lower gut with rectal prolapse, and intestinal obstruction, was made. The intussusception was found to have a polyp as the ‘lead point’. He was treated by manual reduction of the intussusception and the prolapse under general anesthesia. Histopathologic examination of the polyp showed it to be an adenoma. Definitive surgical treatment of the patient was not completed due to socioeconomic challenges.ConclusionsRectal prolapse and intussusception are commonly childhood conditions. Rectal prolapse alone is commoner in the middle-aged and elderly; females in particular. The finding of this combined clinical entity in a young, adult male is therefore a unique condition with an unusual presentation. It is the first case of its kind reported in East Africa. It is also an example of an adenoma constituting a ‘lead point’ for an intussusception at the gastrointestinal tract’s terminus. Even in the presence of a pre-existing adenoma, a relatively common lesion, other differential diagnoses acting as ‘lead points’ ought to be considered in perspective. This characteristic, along with other features described in this case, is useful knowledge for colorectal surgeons, general surgeons, gastrointestinal pathologists, and gastroenterologists given their involvement in the diagnosis and management of anorectal disease of peculiar presentation.

Colonic transit before and after resection rectopexy for full-thickness rectal prolapse

The objective of this study was to measure the change in colonic transit time after resection rectopexy for complete rectal prolapse. We prospectively carried out isotope colonic transit studies before resection rectopexy in 38 patients with full-thickness complete rectal prolapse and invited them to attend for a postoperative transit study at least 1year after resection rectopexy. Preoperatively, 27 (70%) patients had abnormally prolonged colonic transit times, while 11 had normal colonic transit. Twenty-two (61%) patients agreed to attend for a three-day colonic transit study. Resection rectopexy failed to correct delayed colonic transit in all patients with abnormal preoperative tests, while 4 patients developed new delayed transit and 2 with normal transit were unchanged. The study suggests that most prolapse patients have a pan-colonic motility disorder that is not corrected by rectopexy and resection of most of the left colon. If resection rectopexy fails to correct abnormal transit, this study questions the rationale for continuing to offer resection and supports less invasive surgical procedures such as ventral rectopexy.

Hand-assisted laparoscopic suture rectopexy for complete rectal prolapse complicated by a solitary ulcer and obstructed defecation: a case report and review of the literature

IntroductionSolitary rectal ulcer syndrome is a condition in which an ulcer occurs in the rectum. There is evidence that solitary rectal ulcer syndrome is associated with rectal prolapse either overt or occult and that stopping complete rectal prolapse may lead to rapid healing of the solitary rectal ulcer. A huge variety of operative techniques have been described in the literature to correct this condition. We present the case of a patient who underwent hand-assisted laparoscopic suture rectopexy for complete rectal prolapse complicated by a solitary ulcer and obstructed defecation.Case presentationA 32-year-old Caucasian woman presented to our institute complaining of having had difficulty with her bowel movements, a rectal prolapse and pain in the anal area for one and a half years. She was checked in hospital for suspected rectal carcinoma, however, the examination revealed rectal ulceration. A diagnosis of complete rectal prolapse complicated by a solitary ulcer and obstructed defecation was established. The symptoms persisted so a hand-assisted laparoscopic suture rectopexy was performed. After six months of follow-up, her bowel movements had improved, she was experiencing no pain and the rectal ulcer had healed.ConclusionA hand-assisted laparoscopic suture rectopexy is a feasible and safe surgical treatment of rectal prolapse with solitary rectal ulcer syndrome, providing complete recovery for patients with solitary rectal ulcer syndrome.

Stapled transanal longitudinal posterior proctectomy (STALPP) in total rectal prolapse: a 7-year experience

Surgical management of complete rectal prolapse is challenging. We present our results with the novel technique stapled transanal longitudinal posterior proctectomy (STALPP) in patients with complete rectal prolapse. We performed a retrospective study in two hospitals from January 2005 to December 2012. Twenty-one patients with complete rectal prolapse were included. In all patients, STALPP was performed. The study variables were operative time, intraoperative bleeding, number of cartridges used, length of rectum prolapsed through the anus, length of rectal wall resected, length of hospital stay and preoperative and postoperative Wexner continence score and manometric measurement of anal canal resting tone and squeeze pressure. The median length of prolapsed tissue was 13cm; the mean Wexner score in the preoperative and postoperative period was 15.95 and 4.95, respectively (p=0.025). The mean resting tone improved from 23.3 to 32.85mmHg postoperatively (p=0.03), as did maximal squeeze pressure from 31 to 62.7mmHg (p=0.003). Median operative time was 65min; median intraoperative bleeding was 12ml; there was no postoperative bleeding, and no reinterventions were required. The median number of cartridges used was 4. The median length of resected wall in the right posterolateral sector was 8 and 6cm in the left. The median length of hospital stay was 4days, and the mean follow-up period was 2years. No mortality was reported. Stapled transanal longitudinal posterior proctectomy is a safe and feasible surgical alternative for patients with complete rectal prolapse.

Abdominal recto(colpo)pexy for rectal prolapse: is a new era coming?

Much water has flown under the bridge since abdominal rectopexy was introduced to treat rectal prolapse but just recently it has regained popularity. Morbidity and risk related to general anesthesia were the major drawbacks making this surgical treatment often unsuitable for more fragile patients. On the other hand, transperineal techniques tend to be associated with less morbidity but a higher recurrence rate. Furthermore, worsening constipation or new onset constipation following abdominal approaches are functional sequelae difficult to prevent and to treat. Indeed postoperative constipation mainly affects functional outcome and is present in up to 52 % of patients [1]. Sigmoid resection associated with rectopexy has been proposed to reduce the risk of postoperative constipation [2] although the risk of anastomotic dehiscence and infection of nonabsorbable implants limit its application. It has been widely demonstrated that the laparoscopic approach is superior to the open approach in terms of morbidity, recovery time, hospitalization [3] and costs [4]. Age no longer seems to be a limit to the laparoscopic abdominal approach: postoperative complications do not differ significantly, and recurrence rates are low in the elderly [5]. It has also been shown that procedures with preservation of the lateral ligaments and limited lateral and posterior rectal dissection, including the ‘‘old’’ Orr-Loygue operation, are associated with good functional outcomes, minimizing postoperative constipation and not increasing recurrence, both in overt rectal prolapse and in rectal intussusception [6]. Since laparoscopic ventral rectopexy (LVR) was introduced by D’Hoore et al. in 2004 [7], several studies have been published confirming positive results in terms of constipation and fecal incontinence for both full rectal prolapse and rectoanal intussusception [5, 8, 9]. A limited rectal mobilization is performed only unilaterally reducing the risk of inferior hypogastric nerve injury and therefore leading to a lower incidence of postoperative constipation [7, 9]. Recently, we described a modification of LVR involving mesh fixation to the sacral hollow instead of the sacral promontory with a favorably low risk of postoperative constipation and excellent functional results [10]. Rectocolpopexy perfectly complies both with Petros’ ‘‘integral theory’’ about the perineal suspension system [11] and DeLancey’s studies on urogenital suspension systems [12]. The frequent association of complete rectal prolapse and rectoanal intussusception with middle compartment prolapse, rectocele and enterocele has been widely documented by both defecography and open magnetic resonance defecography studies [13, 14]. Tension-free rectal prolapse treatment and simultaneous suspension of the vagina with reinforcement of DeLancey support levels I and II antagonize the forces exerted on the central perineal tendon, addressing middle vaginal compartment disorders. The paper from Maggiori et al. [15], published in this issue, describes LVR results in 33 patients. This prospective study evaluates functional outcome and quality of life over a long period of time: a mean follow-up period of 42 months. The improvements in constipation and fecal incontinence, as well as quality of life, were statistically significant and, above all, they remained stable or even improved over the time. The longterm recurrence rate was favorably low: 6 %. One of the main fears and predictable complications was mesh erosion or extrusion through the vaginal or rectal wall. If this is a problem for transperineal approaches, there seems to be virtually no risk of these complications with the abdominal route. A. Infantino (&) A. Lauretta Department of Surgery, Santa Maria dei Battuti Hospital, Via Savorgnano, 2, 33078 San Vito al Tagliamento, PN, Italy e-mail: ainfantino@libero.it

完全直腸脱を合併した進行直腸癌の1例

完全直腸脱を合併した進行直腸癌の1例

STUDY OF CLINICAL AND FUNCTIONAL RESULTS OF ABDOMINAL RECTOPEXY USING PROLENE MESH FOR COMPLETE RECTAL PROLAPSE

Background and Objectives: There are many often confusing, surgical procedures available for treating complete rectal prolapse ranging from complex abdominal interventions to simple perineal procedures with varying results. The ideal procedure suitable in all cases is still an enigma. Many surgeons today believe that abdominal rectopexy has become the operation of choice not only in the young but even in the elderly patients, resulting in a low recurrence rate and restoration of continence in significant number of patients. The present study attempted to evaluate clinical and functional results of abdominal rectopexy using prolene mesh for complete rectal prolapse in our centre.Results: There was no mortality or recurrence in any patient. There was significant (100%) improvement in continence in a lone patient with incontinence. There was decrease in bowel frequency in 2 patients (13%), postoperatively but this did not result in clinical constipation in any of the patient. There were no major postoperative complications.Interpretation and Conclusion: Abdominal rectopexy using prolene mesh is a simple operation with satisfactory low recurrence rate, good functional out come with low morbidity and mortality. This procedure can be considered in all patients who areconsidered fit to undergo an abdominal procedure.

Ectopic pancreas in the ileum and rectal prolapse: A rare case and review of the literature

Ectopic pancreas in the ileum is a rare entity. Herein, we present a 45-year-old male admitted with complete rectal prolapse. Clinical evaluation of the patient did not reveal any predisposing factor. During abdominal rectopexy a nodule in the ileum was found which was excised and histologically reported as an ectopic pancreas. The simultaneous occurrence of rectal prolapse and ectopic pancreas in the ileum has not been reported in the literature. We present this case for its rarity and to inform that a thorough examination of the abdomen should be done to detect such incidental pathology.

完全直腸脱，不完全直腸脱に対する内肛門括約筋後方形成手術

完全直腸脱，不完全直腸脱に対する内肛門括約筋後方形成手術

Highlighting the role of nonsurgical (conservative) method in the management of complete rectal prolapse in an Indian male

We report a case of a 35-year-old male who presented to our emergency room with debilitating, complete, irreducible, edematous rectal prolapse along with retention of urine. Due to marked edema and inflammation, the reduction was unsuccessful under general anesthesia; hence a conservative approach was considered. With local sugar application for a week, the edema was reduced and via manual digital maneuver, the prolapse was reduced with anal encirclement the day after to maintain the reduction. With our experience, where laproscopic facilities were unavailable, we wish to highlight the role of nonsurgical/conservative conventional methods of management of such severe cases that are associated with edema and present to clinics/institutes where limited surgical facilities are available.

Comparative study between Delorme operation with or without postanal repair and levateroplasty in treatment of complete rectal prolapse

BackgroundRectal prolapse is a distressing and socially disabling condition. controversy exists regarding the preferred surgical technique for the treatment of complete rectal prolapse. ObjectiveWe compared Delorme operation alone or with postanal repair and levatroplasty in treating complete rectal prolapse. MethodsConsecutive patients treated for rectal prolapse at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive Delorme operation only (GI), or Delorme operation with postanal repair and levatorplasty (GII). Main outcome measuresThe primary outcome measure was recurrence rate; secondary outcomes included improvement of constipation, incontinence, operative time, anal manometery and postoperative complications. ResultsEighty-two consecutive patients with rectal prolapse were randomized. There was a significant difference between the two groups with longer operative time in group II. Recurrence rate after one year was (14.28% in GI, and 2.43% in GII, respectively (P = 0.043). Constipation improved in group I & II but there was a significant difference in constipation scores postoperatively between the two groups. There was improvement in continence mechanism in both groups postoperatively but being higher in group II and this produce a significant statistical difference (0.004). Mean satisfaction score was significantly higher in group II than group I. Both groups succeed to produce a significant change in resting and squeeze pressure before & after the operation. ConclusionsDelorme operation seems to be an effective procedure for treating complete rectal prolapse especially if combined with postanal repair and levatorplasty. Clinical trial registrationNCT01656369.

Mesh-free Ventral Rectopexy for Women with Complete Rectal and Uterovaginal Prolapse

Background:Mesh rectopexy may be associated with infective complications, erosion into the vagina or rectum, and disintegration or dislodgement. A mesh-free rectopexy will avoid these complications. Objective of the study was to perform mesh-free ventral rectopexy and assess its safety and effectiveness.Materials and Methods:Nine women with complete rectal and uterovaginal prolapse were treated with total abdominal hysterectomy, closure of the vaginal vault, extirpation of the pouch of Douglas and suture of anterior rectal wall to the posterior vaginal wall (ventral suture rectopexy). The ventral suture rectopexy was achieved by three pairs of interrupted silk sutures, 2.5 cm above each other, and the first pair very close to the pelvic floor. This composite structure (anterior rectal wall and posterior vaginal wall), sits astride the perineal body. Intussusception and subsequent prolapse of the sutured rectum and vaginal wall is prevented. Vaginal vault prolapse was prevented by the suture of each round ligament of the uterus to the corresponding lateral vaginal fornix. No mesh was used.Results:Nine multiparous women aged between 52 and 70 years had the procedure. The mean operative time was 135 minutes (range 110-220). The follow-up period was between 29 months and 7 years. Full continence was restored in all patients within eight weeks of the operation. Bowel habit returned to once daily in four patients and once every other day in the remaining five patients, within thirteen weeks of surgery. One patient had intermittent mucus discharge per rectum for six months. This stopped without a specific treatment. There has been no known recurrence in these nine patients. One patient developed wound infection as a complication. There was no mortality. All the patients are now asymptomatic.Conclusion:Ventral suture rectopexy is a safe and effective treatment for complete rectal prolapse in a selected group of patients.

Delorme's Procedure for Complete Rectal Prolapse: Does It Still Have It's Own Role?

PurposeAlthough there are more than a hundred techniques, including the transabdominal and the perineal approaches, for the repair of the rectal prolapsed, none of them is perfect. The best repair should be chosen not only to correct the prolapse but also to restore defecatory function and to improve fecal incontinence throughout the patient's lifetime. The aim of this retrospective review is to evaluate clinical outcomes of the Delorme's procedure for the management of the complete rectal prolapse.MethodsA total of 19 patients (13 females and 6 males) with complete rectal prolapses were treated by using the Delorme's procedure in St. Vincent's Hospital, The Catholic University of Korea, from February 1997 to February 2007. Postoperative anal incontinence was evaluated using the Cleveland Clinic Incontinence Score.ResultsAll 19 patients had incontinence to liquid stool, solid stool, and/or flatus preoperatively. Three (15.8%) patients reported recurrence of the rectal prolapse (at 6, 18, 29 months, respectively, after the operation). Information on postoperative incontinence was available for 16 of the 19 patients. Twelve of the 16 patients (75%) reported improved continence (5 [31.3%] were improved and 7 [43.7%] completely recovered from incontinence) while 4 patients had unchanged incontinence symptoms. One (6.3%) patient who did not have constipation preoperatively developed constipation after the operation.ConclusionThe Delorme's procedure is associated with a marked improvement in anal continence, relatively low recurrence rates, and low incidence of postoperative constipation. This allows us to conclude that this procedure still has its own role in selected patients.

I．直腸脱の総説―術式の歴史的背景とその選択方法―

I．直腸脱の総説―術式の歴史的背景とその選択方法―

Rectal Prolapse: Review According to the Personal Experience

The aim of treatment of rectal prolapse is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. Faced with a multitude of options, the choice of an optimal treatment is difficult. It is best tailored to patient and surgeon. Numerous procedures have been described and are generally categorized into perineal or abdominal approaches. In general, an abdominal procedure has associated with lower recurrence and better functional outcome than perineal procedures. The widespread success of laparoscopic surgery has led to the development of laparoscopic procedures in the treatment of complete rectal prolapse. In Korea, there has been a trend toward offering perineal procedures because of the high incidence of rectal prolapse in young males and its being a lesser procedure. Delorme-Thiersch procedure has appeal as a lesser procedure for patients of any age or risk category, especially for elderly low-risk patients, patients with constipation or evacuation difficulties, young males, and patients with symptomatic hemorrhoids or mucosal prolapse. Laparoscopic suture rectopexy is recommended for either low-risk female patients or patients who are concerned with postoperative aggravation of their incontinence.