Management Of Complete Rectal Prolapse Research Articles

Study on aetiopathogenesis and management of rectal prolapse in tertiary care centre in Odisha, India

Introduction: Rectal prolapse refers to a circumferential, full-thickness protrusion of the rectum through the anus and also has been called complete prolapse, or procidentia. Internal prolapse occurs when the rectal wall intussuscepts but does not protrude, and is more accurately described as internal intussusception. In adults, rectal prolapse is far more common among women. The diagnosis is obvious on inspection, except in the case of concealed rectal prolapse. At present, the fixation of the rectum to the sacral hollow is considered to be the most rational operation in the surgical management of complete rectal prolapse. The present study is undertaken at S.C.B.Medical college hospital, Cuttack to evaluate the aetio-pathological factors associated with rectal prolapse and the different surgical methods available to repair them. Methods: A hospital-based Cross-sectional study was done among the patients Presenting .with Rectal Prolapse either attending Surgery Out-Patient Department or admitted to the Department through Emergency Department and giving consent for the study. Results: In the study 91.2% were complete and 8.8% were partial prolapse. The maximum age group showing thus prolapse was from 31-50 years age group, with males having more incidence of prolapse than females. Among the females, multi-porous were having increased incidence of prolapse.

Laparoscopic Ventral Mesh Rectopexy in the management of Complete Rectal Prolapse. Experience from a lower middle income Country

Objective: To analyze short term outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse (CRP).

Therapeutic management of complete rectal prolapse in a Jersey cross bred calf – A case study

Therapeutic management of complete rectal prolapse in a Jersey cross bred calf – A case study

Evaluation of Open Abdominal Ventral Rectopexy for Management of Complete Rectal Prolapse in Adult Male Patients

Abstract Background: Circumferential full-thickness protrusion of the rectal wall through the anus is not an uncommon surgical problem that is known as complete rectal prolapse. Many factors were accused for the pathogenesis of this clinical problem, such as straight rectum, weak fascial attachments of the rectum against the sacrum, a long redundant sigmoid colon, deep Douglas pouch, and a weak anus. Neurological illnesses, connective tissue disorders, and high parity were also found to be causes for rectal prolapse. In addition, rectal prolapse occurs more at the extremes of age. The multi-factorial etiologies of this disease resulted in a difficulty in planning for the proper treatment which is required to restore both anatomical and functional outcomes. Aim of Study: To evaluate open abdominal Ventral Rec-topexy (VR) for management of rectal prolapse in adult male patients regarding recurrence and post-operative complications. Patients and Methods: This is a retrospective study that included all adult male patients who underwent open VR for complete rectal prolapse in Colorectal Surgery Unit, Alexandria Main University Hospital during the period from January 2014 to December 2017. Data was retrieved through patients' files regarding pre-operative, operative and post-operative data, including pre-operative and post-operative Wexner score. Post-operative early and late complications were also reported. Post-operative urinary dysfunction (using International Prostate Symptom Score), sexual activity (using International Index for Erectile Function) and patients' satisfaction (using a scale from 1-5) were determined by communication with the patients through their contact numbers. Results: Thirty five patients were included in the study with a mean age of 36.3±12.9 years. Four patients (11.4%) had recurrence after a mean of 7.8±3.4 months. Out of 14 patients who reported pre-operative constipation, 10 patients reported improvement, while two patients reported newly developed constipation. Post-operatively, there was significant improvement of continence status. Patients showed satisfactory results regarding post-operative urinary dysfunction and sexual activity. Thirty patients (85.7%) were satisfied by the results of the operation.Conclusions: Ventral rectopexy for management of com-plete rectal prolapse in male patients seems to be safe and effective, with low recurrence rate and high patients' satisfac-tion regarding improved fecal incontinence, urinary dysfunction and maintained sexual activity. Prospective randomized control trials may be necessary to substantiate our results.

Laparoscopic ventral rectopexy: A viable option in procidentia with redundant sigmoid - An Indian perspective.

Introduction:Laparoscopic ventral mesh rectopexy (LVMR) has gained widespread acceptance for the management of complete rectal prolapse (CRP). However, there have been concerns considering its use in patients with a redundant sigmoid colon. This study was conducted to evaluate the anatomical and functional results following LVMR, particularly in cases of CRP with a redundant sigmoid colon.Materials and Methods:Retrospective analysis of 25 patients who underwent LVMR from January 2011 to September 2016 was performed. Patients were divided into two groups according to the duration of follow-up. Group A (long-term) with follow-up >3 years and Group B (mid-term) <3 years.Results:The study included 25 patients (M:F = 1.5:1) with a median age of 38 years. Eighty-eight percent of the patients had a redundant sigmoid colon. Significant improvement in post-operative Wexner score as compared to pre-operative values was seen in patients with pre-existing constipation (P < 0.0001). In patients presenting with faecal incontinence (FI), significant improvement in post-operative St. Mark's incontinence score was observed. Functional outcomes remain consistent in long-term follow-up (>3 years).Conclusions:LVMR seems to be a feasible surgical procedure with minimum morbidity and good long-term functional outcomes. It provides satisfactory results in patients with redundant sigmoid colon and improves pre-existing constipation and FI.

Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population.

To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse (CRP) in North Indian patients with inherent bulky and redundant colon. The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. Fifteen patients (9 female) with a median age of 50 years (range, 15-68) were included in the study. The median operative time was 200 min (range, 180-350 min) and the median post-operative stay was 4 d (range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo (range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17 (range, 5-24) to 6 (range, 0-23) (P < 0.001) and the fecal incontinence severity index score from 24 (range, 0-53) to 2 (range, 0-53) (P = 0.007). No de novo constipation or fecal incontinence was recorded during the follow-up. On personal conversation, all patients expressed satisfaction with the outcome of their treatment. Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.

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.

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.

Laparoscopic management of persistent complete rectal prolapse in children

Background Rectal prolapse is a relatively common condition in children. The multiplicity of surgical approaches used for rectal prolapse indicates that there is no single approach universally accepted and applicable to all cases. The laparoscopic approach promises to become the criterion standard for the management of full-thickness rectal prolapse in children. The aim of this study was to review our experience over the last 5 years and to evaluate the results that can be achieved by using laparoscopy in management of complete rectal prolapse in children. Patients and Methods Forty patients presented with complete rectal prolapse and fecal incontinence grades (3-4) according to Rintala scale (37 secondary to prolapse and 3 neuropathic) had been operated upon laparoscopically from August 2003 to August 2008. They were subjected to clinical examination, investigations, pre- and postoperative electromyogram activities for external sphincter, puborectalis, and pelvic floor muscles. The pathophysiologic changes for each case was identified and dealt with laparoscopically (laparoscopic suture rectopexy, laparoscopic mesh rectopexy, laparoscopic resection rectopexy, and laparoscopic levatorplasty). Results Among the 40 children with complete rectal prolapse, 22 were males and 18 females. Their median age was 9 years (range, 4-14 years). All cases (n = 40) showed a redundant rectosigmoid junction. Additional laxity of the pelvic floor was present in 32, rectoanal intussusception in 27, anterior wall rectoanal intussusception in 3, and rectosacral hernia in 5 cases. All procedures were completed laparoscopically. The median duration of surgery was 60 minutes (range, 50-70 minutes) for suture rectopexy, 90 minutes (range, 60-110 minutes) for mesh rectopexy, 110 minutes (range, 95-160 minutes) for resection rectopexy, and 120 minutes (range, 100-150 minutes) for laparoscopic levatorplasty. No intraoperative complications occurred in this study. Median postoperative hospitalization was 3 days (range, 2-5 days). Electromyogram studies showed statistically significant improvement during rest, minimal volition, and squeezing in all cases except those children with spina bifida and meningomyelocele. The only complications were postoperative constipation and external colonic fistula. Significant improvement of the continence score was achieved in all cases. The average follow-up time was 36 months. There were no recurrences. Conclusion The use of laparoscopy in the management of complete rectal prolapse is safe, effective, and associated with improved functional outcome. It saved the patients multiple operations and is associated with minimal postoperative pain and short hospital stay.

Complete rectal prolapse clinical and functional outcome with Delorme's procedure: Resultados clínicos y funcionales con la operación de Delorme

Many surgical techniques -both through the perineal and abdominal routes- have been described for the treatment of rectal prolapse. The aim of this work is to evaluate the clinical and functional outcome with Delorme's perineal procedure.Twenty-one patients with complete rectal prolapse were studied from July 2000 to October 2005. Age, gender, anesthetic risk, and accompanying symptoms were all assessed. Diagnostic tests performed included: colonoscopy, anorectal manometry before and after surgery, and 360 masculine endoanal ultrasonography. Delorme's procedures were carried out by only one surgical team.No mortality occurred, and morbidity was minimal. Prolapse relapse rate was 9.52% with a mean follow-up of 34 months. Anal continence improved in 87.5% of patients, and no surgery-associated constipation ensued. Mean hospital stay was 2 (range 1-4) days. During the postoperative period no pain developed in 17 patients, and 4 patients had mild pain. Satisfaction with surgery was high in 16 cases (76.19%), moderate in 3 (14.28%), and low in 2 (9.52%).Delorme's procedure for the management of complete rectal prolapse is associated with low morbidity, improves anal continence, gives rise to no postsurgical constipation, and has an acceptable relapse rate. Patient satisfaction with this procedure is high because of its high comfortability (intradural anesthesia, short hospital stay, and little postoperative pain) and optimal results.

Surgical treatment of rectal prolapse: experience and late results with 51 patients.

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. Retrospective study. Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

PERINEAL PROCTECTOMY FOR RECTAL PROLAPSE IN ELDERLY AND DEBILITATED PATIENTS

This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff. There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow-up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re-operated for recurrent symptomatic prolapses at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse. Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.

Transanal mucosal sleeve resection for the treatment of rectal prolapse in children

This is a report of a simple transanal operation performed on six patients (age range, 19 months to 18 years), who underwent unsuccessful nonoperative management of complete rectal prolapse for at least 1 month (range, 1 month to 13 years). All patients had normal sweat chloride levels, normal chest radiographs, and normal barium enemas. None of the patients were neurologically compromised. At the time of surgery, all but one patient had occurrence of reducible prolapse with minor straining or with every bowel movement. No severe mucosal ulcerations were present. Surgical therapy consisted of the transanal mucosal sleeve resection described herein. In this series, there were no anastomotic leaks, no clinically evident strictures and no recurrence of prolapse in 1.5- to 19-year follow-up. Surgical therapy for rectal prolapse in infants and children is rarely necessary. Various complicated or ineffective operations for the treatment of this condition have been recommended in the past. This technique offers a simple, safe, and effective method of treating complete, medically intractable rectal prolapse in children.

Transabdominal posterior proctopexy using an inverted T of synthetic material.

In the management of complete rectal prolapse, the data indicate that transabdominal mobilization of the rectum with secure fixation to the sacrum has no higher rate of recurrence than rectosigmoidectomy by any route, and has less risk than anterior resection. Of 17 patients with complete rectal prolapse who were operated on during a five-year period, 16 were managed by the above method; two by the Orr-Loygue method using polypropylene mesh: and 14 by positioning an inverted T-shaped piece of polypropylene posteriorly to anchor the mobilized rectum to the sacral promontory. There were no surgical deaths, rejections of polypropylene, or complete recurrences in two to 56 months of follow-up. One patient experienced a mucosal recurrence only. These 16 cases further support the practice of abdominal proctopexy without resection. The polypropylene T procedure overcomes a potential disadvantage of the Orr-Loygue procedure.