External Rectal Prolapse Research Articles

Anal sphincter function in rectal intussusception and high and low "take-off" external rectal prolapse-A prospective observational study.

Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low "take-off". A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit. Clinical data, AAR, and conventional anal manometry were analysed according to the Oxford prolapse grade. A total of 108 (102 [94%] female, median age 62 years [range: 26-95]) patients were recruited into three groups according to prolapse grade: Oxford grades I and II (intrarectal RI, n = 34), Oxford grades III and IV (intra-anal RI, n = 35) and Oxford grade V (ERP, n = 39). As the grade of prolapse increased, resting AAR measurements of opening pressure, opening elastance, closing pressure, and closing elastance decreased (p < 0.001). Maximum resting pressure with manometry was reduced in ERP and intra-anal RI compared to intrarectal RI (p < 0.001). However, incremental squeeze function was not different between the three groups with either AAR or manometry (p > 0.05). There were no differences in AAR or manometry variables between grade IV RI (n = 18) and high take-off ERP (n = 20) (p > 0.05). By contrast, opening pressure (p = 0.010), closing pressure (p = 0.019) and elastance (p = 0.022) were reduced in low take-off ERP (n = 19). Increasing rectal prolapse grade is associated with reduced anal sphincter function at rest indicating internal anal sphincter dysfunction. Physiological differences exist between high and low take-off ERP with sphincter function in the former similar to that seen in grade IV RI.

Analysis of factors that indicated surgery in 400 patients submitted to a complete diagnostic workup for obstructed defecation syndrome and rectal prolapse using a supervised machine learning algorithm.

Patient selection is extremely important in obstructed defecation syndrome (ODS) and rectal prolapse (RP) surgery. This study assessed factors that guided the indications for ODS and RP surgery and their specific role in our decision-making process using a machine learning approach. This is a retrospective analysis of a long-term prospective observational study on female patients reporting symptoms of ODS who underwent a complete diagnostic workup from January 2010 to December 2021 at an academic tertiary referral center. Clinical, defecographic, and other functional tests data were assessed. A supervised machine learning algorithm using a classification tree model was performed and tested. A total of 400 patients were included. The factors associated with a significantly higher probability of undergoing surgery were follows: as symptoms, perineal splinting, anal or vaginal self-digitations, sensation of external RP, episodes of fecal incontinence and soiling; as physical examination features, evidence of internal and external RP, rectocele, enterocele, or anterior/middle pelvic organs prolapse; as defecographic findings, intra-anal and external RP, rectocele, incomplete rectocele emptying, enterocele, cystocele, and colpo-hysterocele. Surgery was less indicated in patients with dyssynergia, severe anxiety and depression. All these factors were included in a supervised machine learning algorithm. The model showed high accuracy on the test dataset (79%, p < 0.001). Symptoms assessment and physical examination proved to be fundamental, but other functional tests should also be considered. By adopting a machine learning model in further ODS and RP centers, indications for surgery could be more easily and reliably identified and shared.

Laparoscopic modified mesh rectopexy: medium-term results of a novel approach for external rectal prolapse.

Rectal prolapse is a common and significantly debilitating condition. Surgical correction is usually required. The two most common abdominal approaches are ventral mesh rectopexy and posterior suture rectopexy. Both may be complicated, respectively, by either mesh-related complications or significant postoperative constipation. We report the outcome of a novel rectopexy operation which combines aspects of both the aforementioned approaches, for the treatment of external rectal prolapse (ERP). The technique involves laparoscopic partial posterior-lateral rectal mobilization of the rectum with posterior suture fixation to the sacral promontory and placement of an absorbable mesh in the rectovaginal space. Data were collected on postoperative complications, prolapse recurrence, mesh-related complications and the assessment of quality of life. Eighty patients underwent a modified mesh rectopexy for ERP. Seventy-seven were women. The median age was 67.5 years. Almost a third had undergone a previous rectal prolapse repair. Recurrences were seen in 11 (13.8%). No mesh-related complications were seen. Eleven patients reported postoperative constipation. The laparoscopic modified mesh rectopexy may be a safe and effective operation for the treatment of ERP.

External rectal prolapse: Which operation and Why?

Background: External rectal prolapse is a rare condition and the only treatment option is surgery. In 10- 50% of patients (women) co-exist other anatomical and functional pelvic floor disorders and eventual should be corrected in the same time, requiring complex rectal and pelvic operations by a multidisciplinary team. Material and methods: A review of the literature based in Google Scholar and PubMed medical database was performed. The predominant surgical procedures in the literature were identified and the associated functional and anatomical pelvic floor disorders coexisting with the external rectal prolapse, the usefulness of preoperative examinations and the final surgical treatment were reviewed. Cross-references of the published articles were used to accomplish this review stud Results: There is a great variety of proposed surgical procedures for external full-thickness rectal prolapse. There is no surgical “gold standard” and the approaches vary. The procedures can be categorized into two main broad groups, abdominal and perineal ones. An important distinguishing factor is the potential use of prosthetic mesh which is popular but also involved in some rare but serious complications. The presence of comorbidities and individual patient characteristics makes the choice of procedure particularly complex. The input of pelvic floor multi-disciplinary team is required when prolapse of middle and anterior pelvic compartments is present. The number and variation of surgical options makes the process of the patient informed consent very important for the restoration of normal quality of life. Conclusions: External rectal prolapse is a condition which requires meticulous assessment and the surgical procedure of choice needs to be individualized according to the patient requirements.

Moving from Laparoscopic Synthetic Mesh to Robotic Biological Mesh for Ventral Rectopexy: Results from a Case Series.

Introduction: Laparoscopic ventral mesh rectopexy (VMR) is the standard procedure for the treatment of posterior pelvic organ prolapse. Despite significant functional improvement and anatomical corrections, severe complications related to mesh augmentation can occur in a few proportions of patients. In order to decrease the number of rare but severe complications, we developed a variant of the conventional VMR without any rectal fixation and using a robotic approach with biological mesh. The aim of this study was to compare the results of laparoscopic ventral rectopexy with synthetic mesh (LVMRS) to those of robotic ventral rectopexy with biological mesh (RVMRB). Methods: Between 2004 and 2021, patients operated on for VMR in our unit were identified and separated into two groups: LVMRS and RVMRB. The surgical technique for both groups consisted of VMR without any rectal fixation, with mesh distally secured on the levator ani muscles. Results: 269 patients with a mean age of 62 years were operated for posterior pelvic floor disorder: rectocele (61.7%) and external rectal prolapse (34.6%). 222 (82.5%) patients received LVMRS (2004-2015), whereas 47 were operated with RVMRB (2015-2021). Both groups slightly differed for combined anterior fixation proportion (LVMRS 39% vs. RVMRB 6.4%, p < 0.001). Despite these differences, the length of stay was shorter in the RVMRB group (2 vs. 3 days, p < 0.001). Postoperative complications were comparable in the two groups (1.8 vs. 4.3%, p = 0.089) and mainly consisted of minor complications. Functional outcomes were favorable and similar in both groups, with an improvement in bulging, obstructed defecation symptoms, and fecal incontinence (NS in subgroup analysis). In the long term, there were no mesh erosions reported. The overall recurrence rate was 11.9%, and was comparable in the two groups (13% LVMRS vs. 8.5, p = 0.43). Conclusions: VMR without rectal fixation is a safe and effective approach in posterior organ prolapse management. RVMRB provides comparable results in terms of recurrence and functional results, with avoidance of unabsorbable material implantation.

SP10.1 Post operative complications and functional outcome after ventral mesh and suture rectopexy for rectal prolapse: a single centre observational study

Abstract Aims Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. The aim of this study was to evaluate post op complications (early, late and mesh) and functional outcomes after a standardized LVMR. Methods All patients who underwent Rectopexy from February 2008 to April 2021 were included into the study. The patients were evaluated preoperatively, at 3 months and 1 year postoperatively. Surgical complications, mesh complications (mesh detachment, erosion and infection) and functional results in terms of faecal incontinence, recurrence and ODS were analysed. Results 95 patients (88 – LVMR; 7 - suture Rectopexy) who underwent Rectopexy were included in the study with a mean age of 68 and female predominance of 90 patients. 30 patients had external rectal prolapse (ERP), 45 patients had internal rectal prolapse (IRP) or intussusception, 20 patients had both ERP and IRP (Table 3). 53 patients had preoperative MRI scan and 15 patients had preoperative proctogram. (Table 4). 92 patients did not have any early complications. 13 patients had late postoperative complications including recurrent prolapse, stoma formation, suture migration and incisional hernia. Mesh complications were seen in 2 patients with mesh erosion and mesh detachment, both of whom had non-absorbable stitches used. There were no post op deaths documented. During the follow up period, 12 patient developed symptoms of ODS. Conclusion LVMR is a safe and effective treatment for rectal prolapse. Careful patient selection, appropriate preoperative workup, and meticulous surgical technique undoubtedly transforms postoperative outcomes.

Resection rectopexy as part of the multidisciplinary approach in the management of complex pelvic floor disorders.

Pelvic floor disorders are frequently caused byan organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required. All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications. Two hundred and eighty seven patients were assigned to one of the following groups: PG1- patient group one: after resection rectopexy (n=141); PG2- after ventral rectopexy (n=8); PG3- after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4- after combined resection rectopexy and trans-vaginal pelvic floor repair (n=76). The duration of follow-up was 14months for PG1 (median, IQR 37months), 11months for PG2 (mean, SD 9months), 7months for PG 3 (median, IQR 33months), and 12months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. "De novo" constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499). Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.

PD44-08 POSTOPERATIVE OUTCOMES AFTER ROBOTIC SACROCOLPOPEXY WITH CONCURRENT RECTOPEXY IN WOMEN WITH MULTICOMPARTMENT PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 May 2022PD44-08 POSTOPERATIVE OUTCOMES AFTER ROBOTIC SACROCOLPOPEXY WITH CONCURRENT RECTOPEXY IN WOMEN WITH MULTICOMPARTMENT PELVIC ORGAN PROLAPSE Shivani Gaitonde, Jessie Chen, Craig Olson, Philippe Zimmern, and Maude Carmel Shivani GaitondeShivani Gaitonde More articles by this author , Jessie ChenJessie Chen More articles by this author , Craig OlsonCraig Olson More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , and Maude CarmelMaude Carmel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic assisted sacrocolpopexy (RSC) is an established surgical approach to correct pelvic organ prolapse (POP). However, relatively little data has been published regarding utilization of simultaneous rectopexy for patients with POP and defecatory dysfunction. The objective of this study was to describe outcomes of RSC with rectopexy versus RSC alone for patients with multicompartment POP. METHODS: Following IRB approval, we performed a retrospective analysis of women undergoing RSC with or without concurrent rectopexy at a single academic institution from December 2013 to May 2021. Pre- and postoperative demographics, pelvic organ prolapse quantification (POP-Q) score and assessment of defecatory dysfunction were reported. The primary outcomes were postoperative POP-Q Bp score, recurrence of symptomatic POP (POP-Q Ba or Bp>0) and need for additional POP surgery within 1yr. Secondary outcomes included complication rates and persistence of defecatory dysfunction. RESULTS: Of 162 women included in this study, 35 patients underwent combo RSC with rectopexy (22%) while the remainder underwent RSC only (n = 127, 78%). Mean age was 65yr (range 34-90) and BMI was 28.2 (range 19.4-51.4). Preoperative Bp (-1.5 in combo vs 0 in RSC-only), stage of posterior prolapse (mean stage 2 in both) and presence of external rectal prolapse (6% in both) did not significantly differ between groups. 71% of combo patients reported preop defecatory dysfunction vs 50% RSC-only patients. Mean postop follow-up was 23mo (range 1-82). Significantly more patients in the RSC-only group required repeat POP surgery within 1yr (0% combo vs 6% RSC-only, p < 0.05). The most common repeat surgery was posterior colporrhaphy (6/8 patients). However, by 1yr there were no differences in presence of symptomatic recurrent POP (5% combo vs 4% RSC-only) or reported defecatory dysfunction (34% combo vs 30% RSC-only). Median postop Bp was -3 in both groups. No intraoperative complications were noted in the combo group, while 3 patients in the RSC-only group had enterotomies repaired primarily. 2 combo patients had postoperative ileus managed conservatively (6%), and 2 had UTI (6%). 14 RSC-only patients had UTI (11%). CONCLUSIONS: Compared to RSC alone, combined RSC and rectopexy for women with multicompartment POP is associated with improved durability of posterior compartment repair without significant increase in adverse events. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e711 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shivani Gaitonde More articles by this author Jessie Chen More articles by this author Craig Olson More articles by this author Philippe Zimmern More articles by this author Maude Carmel More articles by this author Expand All Advertisement PDF DownloadLoading ...

Use of colpocleisis associated to rectopexy as an approach to concomitant apical prolapse and external rectal prolapse

Use of colpocleisis associated to rectopexy as an approach to concomitant apical prolapse and external rectal prolapse

Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis.

BackgroundExternal rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP.MethodsThis was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle–Ottawa Scale and Cochrane tool.ResultsFifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, and several outcomes from RCTs were not consistent with those observed in non-RCTs.ConclusionThe overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic.

External rectal prolapse: abdominal or perineal repair for men? A retrospective cohort study.

BackgroundExternal rectal prolapse is a relatively rare disease, in which male patients account for a minority. The selection of abdominal repair or perineal repair for male patients has rarely been investigated.MethodsFifty-one male patients receiving abdominal repair (laparoscopic ventral rectopexy) or perineal repair (Delorme or Altemeier procedures) at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between March 2013 and September 2019 were retrospectively analysed. We compared the recurrence, complication rate, post-operative defecation disorder, length of stay, and quality of life between the abdominal and perineal groups.ResultsOf the 51 patients, 45 had a complete follow-up, with a median of 48.5 months (range, 22.8–101.8 months). A total of 35 patients were under age 40 years. The complication rate associated with abdominal repair was less than that associated with perineal repair (0% vs 20.7%, P = 0.031) and the recurrence rate was also lower (9.5% vs 41.7%, P = 0.018). Multivariate analysis showed that perineal repair (odds ratio, 9.827; 95% confidence interval, 1.296–74.50; P = 0.027) might be a risk factor for recurrence. Moreover, only perineal repair significantly improved post-operative constipation status (preoperative vs post-operative, 72.4% vs 25.0%, P = 0.001). There was no reported mortality in either of the groups. No patient's sexual function was affected by the surgery.ConclusionsBoth surgical approaches were safe in men. Compared with perineal repair, the complication rate and recurrence rate for abdominal repair were lower. However, perineal repair was better able to correct constipation.

Anüsden Rektal Lipom Prolapsusu: Nadir Bir Vaka

The rectal lipoma prolapse through the anus is a rare event. Only a few cases are reported in the literature. An 81-year-old women patient was admitted to the emergency department with a complaint of swelling in the anus. Rectal examination revealed a hyperemic, edematous mass protruding from the anal canal, measuring 80×80×50 mm. The patient was hospitalized and operated under general anesthesia. No complica- tions developed, and the patient was discharged on the first postopera- tive day. Histopathological diagnosis was identified as lipoma. Such lipomas can be confused with external rectal prolapse, rectoanal polyps with pedicles, and thrombosed hemorrhoids. Colonoscopy, CT, and CT colonography are the most im- portant diagnostic tools for these cases. Lipomas are treated by endo- scopic, laparoscopic, or open surgical interventions according to their size and localization.

Mid-term functional and quality of life outcomes of robotic and laparoscopic ventral mesh rectopexy: multicenter comparative matched-pair analyses

BackgroundThe aim of this study was to compare patients’ mid-term functional and quality of life (QoL) outcomes following robotic ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR).MethodsThe data of consecutive female patients who underwent minimally invasive ventral mesh rectopexy for external or symptomatic internal rectal prolapse at 3 hospitals in Finland between January 2011 and December 2016 were retrospectively collected. Patients were matched by age and diagnosis at a 1:1 ratio. A disease-related symptom questionnaire was sent to all living patients at follow-up in July 2018.ResultsAfter a total of 401 patients (RVMR, n = 187; LVMR, n = 214) were matched, 152 patients in each group were included in the final analyses. The median follow-up times were 3.3 (range 1.6–7.4) years and 3.0 (range 1.6–7.6) years for the RVMR and LVMR groups, respectively. The postoperative QoL measures did not differ between the groups. Compared with the LVMR group, the RVMR group had lower postoperative Wexner Incontinence Score (median 5 vs. median 8; p < 0.001), experienced significant ongoing incontinence symptoms less often (30.6% vs. 49.0%; p < 0.001) and reported less postoperative faecal incontinence discomfort evaluated with the visual analogue scale (median 11 vs. median 39; p = 0.005). RVMR patients had a shorter hospital stay (2.2 days vs. 3.8 days; p < 0.001) but experienced more frequent de novo pelvic pain (31.8% vs. 11.8%; p < 0.001).ConclusionRVMR and LVMR patients had equal functional and QoL outcomes. Those who underwent RVMR had lower mid-term anal incontinence symptom scores but suffered more frequent de novo pelvic pain.

Altemeier procedure for surgical treatment of full thickness external rectal prolapse (with video).

Altemeier procedure for surgical treatment of full thickness external rectal prolapse (with video).

Comments on: factors predicting the presence of concomitant enterocele and rectocele in female patients with external rectal prolapse.

Comments on: factors predicting the presence of concomitant enterocele and rectocele in female patients with external rectal prolapse.

Predictive Factors for Recurrence of External Rectal Prolapse after Laparoscopic Ventral Rectopexy.

Objectives: This study aimed to evaluate factors that contribute to the recurrence of external rectal prolapse (ERP) following laparoscopic ventral rectopexy (LVR). Methods: All patients who underwent LVR using synthetic meshes between 2011 and 2018 were prospectively included. A standard questionnaire including the Fecal Incontinence Severity Index (FISI) and Constipation Scoring System (CSS) was administered preoperatively and postoperatively. Defecography was performed 6 months postoperatively. Univariate and backward stepwise multivariate Cox analysis was performed to determine the prognostic factors of recurrence. Results: In total, 132 patients with a median follow-up of 46 months were included. The overall recurrence rate was 6.8% (n = 9), as confirmed by defecography at 6 months in six of the patients. None of the patients developed mesh erosion. FISI and CSS scores were significantly reduced at 3 months and remained significantly reduced for 3 years. Multivariate analyses revealed that the predictors of recurrence included male sex (hazards ratio, 11.3; 95% confidence interval, 3.0-43.0) and age >80 years (hazards ratio, 10.7; 95% confidence interval, 1.3-86.3). Eight patients with recurrence underwent surgery via Delorme's procedure (n = 7) and posterior rectopexy (n = 1). Two patients with new-onset rectoanal intussusception and one with uncorrected sigmoidocoele underwent repeat LVR. Conclusions: LVR is effective in treating ERP with low morbidity and low recurrence. Male patients and patients older than 80 years are at increased risk of recurrence. Hence, the LVR technique should be modified or coupled with other perineal procedures when treating ERP, especially in male patients.

679 Introduction of A Robotic Rectopexy Programme with Benchmarking to International Standards in Published Randomised Controlled Trials

Abstract Aim With the evolution of robotic surgery, the adoption of a robotic approach to perform rectopexy, in particular ventral mesh repair (VMR), is gaining popularity. We aimed to audit clinical outcomes following introduction of a robotic rectopexy (RR) programme and compare outcomes to internationally published randomised controlled trials (RCTs). Method Consecutive patients undergoing RR from July to December were included. The daVinci Xi surgical system (Intuitive, California) was used for all procedures using a modified left lower abdominal approach. Where VMR was performed, a 4 x 18cm Permacol mesh was used as standard and posterior fixation using ethibond. We compared operative times and 30-day clinical outcomes to international data. Results Over a six-month period, thirteen RR were performed (n = 1 sutured, n = 2 resection sutured, n = 10 VMR). All patients were female with a mean age of 60.4 years (SD 14.12). Mean time from 1st consultation to surgery was 10.7 months. Three patients had an external rectal prolapse and ten patients a rectocoele confirmed on dynamic MRI. Seven patients had co-existing urinary symptoms impacting on quality of life. Median docking time was 23 minutes and median robotic operative time was 194 minutes (156 minutes reported). There were no conversions (2.5% reported). Average length of stay was 5 days (4 days reported) and there were no 30-day morbidities (8.6% reported) or readmissions. Conclusions Robotic rectopexy can be performed with appropriate operative times and clinical outcomes and offers a superior operative platform for critical operative steps including rectal mobilisation and VMR mesh placement and suturing.

Trends in the surgical management of rectal prolapse: An Asian experience.

Posterior compartment pelvic floor prolapse (PCPFP) leads to anatomical distortion and functional impairment. Definitive management involves surgery. Ventral mesh rectopexy (VMR) has gained increasing popularity in the West as it emerges as a durable approach. Existing literature and evidence on safety and efficacy of PCPFP surgery in the Asian population remains sparse. Our study aims to review our institution's experience in surgery for PCPFP. All cases of PCPFP surgery in Singapore General Hospital between 2014 to 2019 were studied. Eighty-three patients had surgery performed for PCPFP, with the majority (83%) in the last 3 years. Median age was 63 years and 92% were female. Most patients (64%) had obstructive defecation symptoms, while the remaining had fecal incontinence, rectal bleeding, or anal discomfort. Main anatomical indication for surgery was external rectal prolapse (48%). Other indications were rectocele and/or rectal intussusception. The majority (66%) had abdominal rectopexy, while 28 underwent Delorme's procedure. Forty-five of the 50 VMRs were minimally invasive. Patients undergoing rectopexy were observed to be younger. Median length of stay was 3 days. Nine patients had early operative complications of which ileus was most common. Median length of follow-up was 12 months. The majority (93%) had initial symptom satisfaction. Eleven patients had anatomical recurrence with a median length of 9months to development. There was no significant difference in outcomes between abdominal vs perineal approach, or laparoscopic vs robotic VMR. Surgery for PCPFP has gained acceptance in our Asian institution with good symptom improvement, alongside low morbidity and recurrence.

Solitary rectal ulcer syndrome (SRUS): observational case series findings on MR defecography.

Radiological findings in solitary rectal ulcer syndrome (SRUS) are well described for evacuation proctography (EP) but sparse for magnetic resonance defecography (MRD). In order to rectify this, we describe the spectrum of MRD findings in patients with histologically proven SRUS. MRD from twenty-eight patients (18 female; 10 males) with histologically confirmed SRUS were identified. MRD employed a 1.5-T magnet and a standardized technique with the rectal lumen filled with gel and imaged sagittally in the supine position, before, during, and after attempted rectal evacuation. A single radiologist observer with 5 years' experience in pelvic floor imaging made the anatomical and functional measurements. Sixteen patients (10 female) demonstrated internal rectal intussusception and 3 patients (11%) demonstrated complete external rectal prolapse. Anterior rectoceles were noted in 12 female patients (43%). Associated anterior and middle compartment weakness (evidenced by excessive descent) was observed in 18 patients (64%). Cystocele was found in 14 patients (50%) and uterine prolapse was noted in 7 patients (25%). Enterocoeles were detected in 5 patients (18%) and peritoneocoele in 5 patients (18%). None had sigmoidocoele. Sixteen patients (57%) demonstrated delayed voiding and 13 patients (46%) incomplete voiding, suggesting defecatory dyssynergia. MRD can identify and grade both rectal intussusception and dyssynergia in SRUS, and also depict associated anterior and/or middle compartment descent. Distinction between structural and functional findings has important therapeutic implications. MRD can identify and grade both rectal intussusception and dyssynergia in patients with SRUS. MRD is an acceptable substitute to evacuation proctography in assessing anorectal dysfunctions when attempting to avoid ionizing radiation. SRUS influences the pelvic floor globally. MRD depicts associated anterior and/or middle compartment prolapse.

Laparoscopic posterior rectopexy for complete rectal prolapse: Is it the ideal procedure for males?

Background:Rectal prolapse is more common in elderly women worldwide, but in India, it predominantly occurs in young- and middle-aged males. While ventral mesh rectopexy is proposed as the preferred procedure in females, the debate on the best procedure in men is still wide open.Methods:A retrospective review of all adult male patients operated for external rectal prolapse (ERP) between January 2005 and December 2019 was performed. Patients either underwent modified laparoscopic posterior mesh rectopexy (LPMR) or laparoscopic resection rectopexy (LRR). The outcome was analysed in terms of recurrence, post-operative constipation, sexual dysfunction and other complications.Results:A total of 118 male patients were included (LPMR: 106, LRR: 12). The mean age was 46.2 years (standard deviation [SD] 11.8, range: 21–88). The mean operating time was 108 min (SD: 24). The mean length of hospital stay was 4.8 days (SD: 1.4, range: 3–11 days). There was no anastomotic leak in the LRR group. Other complications included wound infection (n = 2), mesh infection with sigmoid colon perforation (n = 1), constipation (n = 4), sexual dysfunction (n = 2), urinary urgency (n = 3) and retention of urine (n = 4). There was no mortality in both the groups. During a mean follow-up of 5.2 years, recurrent ERP was noted in one patient and partial mucosal prolapse was seen in three patients.Conclusion:LPMR/LRR is a safe and effective treatment for ERP in men with very low recurrence rates. Randomised trials comparing modified LPMR with LVMR are needed to establish the better procedure in males.