Procedure For Prolapse Research Articles

Sacrocolpopexy: The Way I Do It.

Sacrocolpopexy (SCP) is an established surgical procedure for apical vaginal vault prolapse. There remains significant variation amongst surgeons in both the surgical steps and concomitant surgeries utilised when undertaking an SCP. This review article is aimed at summarising the evidence and providing a detailed update of SCP in modern practice, reviewing contemporary evidence behind its indications, efficacy, outcomes, surgical steps, and complications. Sacrocolpopexy remains the gold standard for post-hysterectomy apical prolapse based on good long-term outcomes, patient satisfaction and low complication rates. SCP with concomitant total hysterectomy is not recommended owing to high rates of mesh exposure. The laparoscopic approach remains the preferred option in terms of low morbidity, quicker recovery and lower cost than alternative access options. For optimal outcomes an SCP should be performed with monofilament mesh, using absorbable sutures and with a paravaginal repair for cystocele. Although SCP has become increasingly utilised for apical prolapse, its established efficacy regarding anatomical outcomes, patient satisfaction, and complications is in the context of post-hysterectomy prolapse. SCP with concomitant total hysterectomy has higher rates of mesh exposure. The efficacy and safety of SCP with sub-total hysterectomy or hysteropexy have not been clearly established and require further assessment through well-designed, rigorous randomised controlled trials.

Evaluation of iliococcygeal fixation procedure for pelvic organ prolapse: preoperative properties and short term postoperative outcomes

Aim: The aim of this study was to evaluate the short-term outcomes of patients who underwent iliococcygeal fixation (ICF) for the surgical treatment of pelvic organ prolapse (POP) and to assess the safety and feasibility of the ICF procedure. Patients and Methods: Our study is retrospectively done with the data of 50 POP patients who underwent ICF in our clinic within the dates 01.04.2022 and 31.03.2024. A total of 44 women were found to be eligible for follow-up. Demographic data and pre- and post-operative clinical data at 3 months were assessed. Results: According to the findings of our study, the difference between the median duration of surgery in NSD and CS patients is statistically significant, and the duration of surgery is longer in NSD patients (80 minutes (70-85) vs 60 minutes (50 -67,5), (p<0,05)). Only one recurrence, one hematoma and infection, and one bladder injury had occurred. Conclusion: According to our study, ICF is a safe, durable and surgically feasible procedure that can be done concomitantly with other procedures. Thus, we strongly advocate this procedure until the ideal mesh is found since it avoids many serious complications of SSLF.

Recurrence Rates and Risk Factors in the Altemeier Procedure for Rectal Prolapse: A Multicenter Study.

Perineal proctosigmoidectomy (Altemeier) is a surgical procedure that is commonly used for the treatment of rectal prolapse. However, there is a diverse range of recurrence rates after Altemeier procedure repair that has been reported in the literature. To identify primary and subsequent recurrence rates after perineal proctosigmoidectomy and to define potential risk factors for recurrence. Cohort study. Conducted at 6 hospitals affiliated with the Cleveland Clinic. The study included patients who were older than 18 years and were treated with the Altemeier procedure for rectal prolapse between 2007 and 2022. Primary outcomes were rates of primary and subsequent recurrences. Secondary outcomes included potential risk factors for recurrence previously mentioned in the literature. We identified 182 patients, of whom 95.1% were women, with a mean age of 79 years (SD 11.4). Overall, procedures were elective in 92.1% of patients, and 14.3% had previously undergone prolapse repairs (Delorme, Thiersch, abdominal suture rectopexy, and abdominal mesh rectopexy). At a mean follow-up period of 27.5 months (SD 45.7), 37.9% of patients experienced recurrence, with 16.5% of patients having multiple recurrences. A subsequent Altemeier procedure was performed in 72.5% of instances. Other treatments included Delorme, abdominal suture rectopexy, abdominal mesh rectopexy, or conservative management. This study identified connective tissue disorders and time since surgery as significant risk factors for recurrence. Retrospective design and varying follow-up periods. Perineal proctosigmoidectomy is associated with a significant risk of recurrence. The risk of recurrence increased with the presence of a connective tissue disorder and in proportion to the elapsed time since surgery. These discoveries assist health care professionals in counseling and managing patients who undergo perineal proctosigmoidectomy for rectal prolapse. See Video Abstract . ANTECEDENTES:La proctosigmoidectomía perineal (Altemeier) es un procedimiento quirúrgico que se utiliza comúnmente para el tratamiento del prolapso rectal. Sin embargo, existe una amplia gama de tasas de recurrencia después de la reparación con el procedimiento de Altemeier que se han informado en la literatura.OBJETIVO:Nuestro objetivo fue identificar las tasas de recurrencia primaria y posterior después de la proctosigmoidectomía perineal, así como definir los posibles factores de riesgo de recurrencia.DISEÑO:Estudio de cohorte.AJUSTES:Realizado en 6 hospitales afiliados a la Clínica Cleveland.PACIENTES:Se incluyeron pacientes mayores de 18 años que fueron tratados con procedimiento de Altemeier por prolapso rectal entre 2007 y 2022.PRINCIPALES MEDIDAS DE VALORACIÓN:Los resultados primarios fueron las tasas de recurrencias primarias y posteriores. Los resultados secundarios incluyeron factores de riesgo potenciales de recurrencia mencionados anteriormente en la literatura.RESULTADOS:Se identificaron 182 pacientes, de los cuales el 95,1% eran mujeres con una edad media de 79 años (DE 11,4). En general, el 92,1% fueron electivos y el 14,3% se habían sometido previamente a reparaciones de prolapso (Delorme, Thiersch, rectopexia con sutura abdominal y rectopexia con malla abdominal). En un período de seguimiento medio de 27,5 meses (DE 45,7), el 37,9% de los pacientes experimentó recurrencia, y el 16,5% de los pacientes tuvo recurrencias múltiples. En el 72,5% de los casos se realizó un procedimiento de Altemeier posterior. Otros tratamientos incluyeron Delorme, rectopexia con sutura abdominal, rectopexia con malla abdominal o manejo conservador. Este estudio identificó los trastornos del tejido conectivo y el tiempo transcurrido desde la cirugía como factores de riesgo importantes de recurrencia.LIMITACIONES:Diseño retrospectivo y períodos de seguimiento variables.CONCLUSIÓN:La proctosigmoidectomía perineal se asocia con un riesgo significativo de recurrencia. El riesgo de recurrencia aumentó con la presencia de un trastorno del tejido conectivo y en proporción al tiempo transcurrido desde la cirugía. Estos descubrimientos ayudan a los profesionales de la salud a asesorar y tratar a los pacientes que se someten a proctosigmoidectomía perineal por prolapso rectal. (Traducción-Dr. Ingrid Melo ).

Evaluating the Efficacy and Safety of Perirectal Sclerotherapy with 50% Dextrose Injection as a Primary Surgical Procedure for Rectal Prolapse in Pediatric Patients: A Clinical Trial

Background: Rectal prolapse is a condition where the rectum protrudes through the anus. This study aimed to evaluate the effectiveness of perirectal sclerotherapy using a 50% dextrose injection as a primary surgical procedure for rectal prolapse in children under 14 years of age. Objectives: The purpose of the study was to evaluate the efficacy, safety, and advantages of perirectal sclerotherapy using a 50% dextrose injection as a primary surgical procedure for rectal prolapse in pediatric patients. Methods: This clinical trial involved 40 patients diagnosed with rectal prolapse, who were treated with perirectal sclerosant (dextrose 50%) injection. All patients had grade III or grade IV rectal prolapse. Three injections of 50% dextrose were administered into the area around the anus and the submucosa, 2 - 3 cm above the dentate line, while the patient was in the lithotomy position. Injections were given at the 3, 6, and 9 o'clock positions around the anus (1 cc/kg at the 6 o'clock position and 0.5 cc/kg at the 3 and 9 o'clock positions). The patients were followed up for recurrence and complications at three-month and six-month intervals, respectively. Results: The patients had an average age of 5.62 years, with the majority being male (77.5%). The average time between symptom onset and sclerotherapy administration was 6.60 ± 1.73 months. Five patients experienced edema around the anus and injection site on the first day of observation. At the second examination (one week later), only one patient had cellulitis. At the three-month visit, eight patients exhibited symptoms of rectal mucus discharge, which were considered mid-term complications. In the final examination at six months, four patients experienced prolapse recurrences. Conclusions: Based on the findings, it can be concluded that perirectal sclerotherapy using a 50% dextrose injection is an effective primary surgical procedure for rectal prolapse in children under 14 years of age. The treatment is simple, inexpensive, and associated with minimal risk of complications and short recovery times compared to open surgery.

Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model.

High-grade hemorrhoids are usually recommended to receive operational treatments. However, these traditional surgeries are associated with severe postoperative pain. A procedure for prolapse and hemorrhoids (PPH), a circular staple device, has been developed to improve short-term outcomes, including reducing the severity of postoperative pain. PPH, compared to conventional surgery, has been associated with the incidence of anatomical anal stenosis. The causes of stenosis after PPH are not yet clear. We first analyzed the complications of our patients with PPH, and then developed a rat model to verify the tension force of PPH using Hematoxylin-eosin, Masson's trichrome, immunohistochemistry, and immunofluorescence staining. Our clinical data showed that PPH significantly improved postoperative pain, but that it resulted in higher incidences of complications, including anal stenosis, than hemorrhoidectomy. We simulated the status of PPH and developed a rat model to verify PPH's tension force, including the scarring area and the deposition of proinflammatory factors, angiogenic factors, and fibrotic factors. The tension wound histological data showed more extensive granulation tissue and inflammatory cell infiltration and a thicker epidermis than the control group on day 12 post-operation and tension treatment. In addition to IL-1β and IL-10 cytokines on day 3 and IL-1β, IL-6, and IL-10 cytokines on day 12 post-operation in the tension group, two angiogenic factors, CD31 and VEGF-A, were found to have a more significant expression on day 7 post-operation in the tension group. The mean scar area was larger and the distribution of fibrotic proteins (collagen 1, α-SMA, CTGF, and MMP2) in the tension group was significantly broader than in the control on day 12 post-operation and tension treatment. Based on the findings of our animal model, the development of a lesser tensile force for PPH to decrease the deposition of proinflammatory factors, angiogenic factors, and fibrotic factors is urgently required.

Sigmoido-rectal intussusception anastomosis in the Altemeier procedure for complete rectal prolapse: preliminary results of a new technique.

Our research introduces an innovative surgical approach, combining the Altemeier Procedure with Sigmoido-rectal Intussusception Anastomosis, effectively reducing recurrence, minimizing complications, and improving postoperative anal function in rectal prolapse patients. This retrospective study, conducted at tertiary referral hospitals including Shandong University of Traditional Chinese Medicine's Affiliated Hospital, Linyi People's Hospital, and Pingyi People's Hospital, examined data from patients undergoing conventional Altemeier surgery or Altemeier combined with Sigmoido-rectal Intussusception Anastomosis. Analyzing hospitalization and follow-up data from January 2009 to December 2022, the study focused on prolapse recurrence, complications, and anal function as primary outcome indicators across these three study centers. In the study, both groups had an average follow-up of (12.5 ± 2.41) months, and only two traditional group patients experienced mortality. Recurrence rates significantly differed, with 26.47% in the traditional group and 1.54% in the modified group (P < 0.001). The modified group showed no perioperative anastomotic dehiscence, contrasting with a 13.24% occurrence in the conventional group (P = 0.003). Primary complications in the modified group included anastomotic hemorrhage, with rates of 17.65% and 6.15% in the traditional and modified groups, respectively (P = 0.077). At 12 months postoperatively, both groups improved in anal manometry parameters and the Wexner anal incontinence score. Resting pressure was significantly lower in the traditional group (32.50 ± 1.76 mmHg) than the modified group (33.24 ± 2.06 mmHg) (P = 0.027), while the extrusion pressure was higher in the modified group (64.78 ± 1.55 mmHg) than the traditional group (62.85 ± 2.30 mmHg) (P < 0.001). The Wexner anal incontinence score was significantly lower in the modified group (2.69 ± 1.65) than the traditional group (3.69 ± 1.58, P = 0.001). This retrospective study affirms that adding Sigmoido-rectal Intussusception Anastomosis to the Altemeier procedure reduces recurrence and complications. While both approaches enhance postoperative anal function in complete rectal prolapse patients, the combined method, particularly with Sigmoido-rectal Intussusception Anastomosis, proves more effective.

Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes

PurposeRecurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure.MethodsWe queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier’s perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy.ResultsTen women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m2 (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred.ConclusionMesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.

Clinical efficacy of ultrasound doppler-guided hemorrhoidal artery ligation combined with procedure for prolapse and hemorrhoids in treatment of severe hemorrhoids.

Hemorrhoids are a prevalent anorectal condition that affects a wide range of adult populations. The severity of this condition was graded using a validated hemorrhoidal grading system, specifically focusing on grade III and IV cases. This retrospective study aimed to compare the clinical efficacy of a standard Procedure for Prolapse and Hemorrhoids (PPH) with a combined Doppler-guided Hemorrhoidal Artery Ligation (DG-HAL) and a PPH approach in patients with severe hemorrhoids. Conducted from May 2021 to January 2023, the study included patients aged 18-65 with confirmed diagnosis of Grade III or Grade IV hemorrhoids. Patients with a history of anorectal surgery and significant comorbidities were excluded. The control group underwent standard PPH, whereas the observation group received DG-HAL followed by PPH. Clinical outcomes were measured using variables such as the operative duration, intraoperative blood loss, postoperative wound healing time, and length of hospital stay. Efficacy was evaluated using a hierarchical scale and a visual analog scale (VAS) for postoperative pain. The complication rates were also assessed. baseline characteristics were homogeneous between the 2 groups. The observation group demonstrated significantly faster postoperative wound healing and shorter hospital stay (P < .01). The overall therapeutic efficacy in the observation group was 90.0%, which was higher than that of the control group (75.0%; P = .025). The VAS pain scores were also significantly lower in the observation group (P = .002). A marked decrease in complication rates was observed in the observation group (3.3%) compared with that in the control group (17.9%) (P < .05). The combined DG-HAL and PPH surgical approach exhibited superior clinical efficacy in treating severe hemorrhoids. This technique offers high effectiveness, reduced postoperative VAS pain scores, and lower complication rates. The long-term efficacy requires further observation.

Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

BackgroundCauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression.Case presentationA 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset.ConclusionThis case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required.

Retracted: Value of Defecography in the Diagnostic and Therapeutic Management of the Modified Wells Procedure for Rectal Prolapse.

[This retracts the article DOI: 10.1155/2022/2219330.].

Comparison of the efficacy and safety of different surgical procedures for patients with hemorrhoids: a network meta-analysis.

This study used a network meta-analysis to evaluate the efficacy and safety of different surgical approaches in patients with hemorrhoids. PubMed, Embase, Web of science, and Cochrane Library were searched for randomized controlled trials on patients with hemorrhoids treated by different surgical procedures. The search was conducted until January15, 2023. Two investigators independently screened the resulting literature, extracted information, evaluated the risk of bias of the included studies, and performed a network meta-analysis. A total of 23 randomized controlled studies were included and involved 3573 patients and 10 interventions, namely L(Ligasure), M-M(Milligan-Morgan), F(Ferguson), H(Harmonic), OH(open Harmonic), CH(closed Harmonic), PPH(procedure for prolapse and hemorrhoids), TST(tissue selecting technique), T-S(TST STARE+; tissue selection therapy stapled transanal rectal resection plus), and STARR (stapled transanal rectal resection). Network meta-analysis results showed that L has the shortest mean operating time and STARR has the longest mean operating time, F and H have the longest length of hospitalization and T-S has the shortest length of hospitalization, PPH has the most intraoperative blood loss and L has the least intraoperative blood loss, TST has the shortest time to first defecation and M-M has the longest time to first defecation, STARR had the least recurrence and PPH had the most recurrence, PPH had the least anal stenosis and L had the most anal stenosis, and F had the least postoperative pain after 24h and PPH had the most postoperative pain after 24h. Current evidence suggests that L is best at reducing mean operative time and intraoperative bleeding, T-S is best at reducing mean length of stay, TST has the shortest time to first defecation, STARR is best at reducing recurrence rates, PPH is best at reducing postoperative anal stricture, and F is best at reducing postoperative pain after 24h.

Altemeier's Procedure for Full-Thickness Rectal Prolapse.

Altemeier's Procedure for Full-Thickness Rectal Prolapse.

Prevention and Treatment of Anastomotic Strictures After Procedure for Prolapse and Hemorrhoids.

Procedure for Prolapse and Hemorrhoids (PPH), also known as circular stapled hemorrhoidectomy, is a common method of treating hemorrhoids due to its low risk of complications and minimal postoperative pain. Several complications have appeared alongside the rise of treated cases, however, and this has led to a progressive slowing of the clinical use of PPH in recent years. Anastomotic stenosis is one of the most common complications of PPH, but the greater amount of tissue removed and the speed with which it can heal make it the best choice for patients with severe prolapsed annular hemorrhoids or rectal mucosal prolapse. Therefore, academics continue to comprehensively study PPH to take advantage of annular resection and reduce complications. In this paper, we analyzed the causes, intraoperative warnings, and postoperative therapy of anastomotic stenosis induced by PPH, with an eye toward scientific application in the anorectal field, based on the experience of clinical applications.

Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids.

This study aimed to establish a clinical model to predict the risk of hemorrhoid recurrence after procedure for prolapse and hemorrhoids. The clinical data of patients who underwent stapler hemorrhoidal mucosal circumcision in Shanxi Bethune Hospital from April 2014 to June 2017 were collected retrospectively and followed up regularly after the operation. Finally, 415 patients were included, which were divided into training group (n = 290) and verification group (n = 125). Logistic regression method was used to select meaningful predictors. The prediction model was constructed with nomographs, and the model was evaluated with correction curve, receiver operating characteristic curve and C index. The decision analysis curve was used to determine the clinical utility of the nomogram. Birth history, muscle attachment, postoperative anal urgency, anal resting pressure, postoperative nutritional index, body mass index, Wexner score, and hemorrhoid grading were included in the nomogram. The area under the curve of the prediction model was 0.813 and 0.679, respectively, in the training and verification groups, and 0.839 and 0.746, respectively, for the 5-year recurrence rate. The C index (0.737) and clinical decision curve showed that the model had high clinical practical value. The prediction model of hemorrhoid recurrence risk after hemorrhoidectomy based on multiple clinical indicators can be used for individualized prediction of hemorrhoid recurrence in patients after hemorrhoidectomy, and early intervention measures can be given to individuals with a high recurrence risk to reduce the risk of recurrence.

Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial

PurposeThe purpose of this study was to explore the effect of electroacupuncture (EA) at Baliao point on short-term complications, such as anal pain and swelling, after procedure for prolapse and hemorrhoids (PPH) in patients with mixed hemorrhoids.MethodsA total of 124 eligible patients undergoing PPH surgery were included in this study and randomly divided into a control group (n = 67) and an EA group (n = 57), with patients in the control group receiving only PPH surgery and patients in the EA group receiving PPH surgery and EA at Baliao point.ResultsThe visual analogue scale (VAS) scores of EA group at 8, 24, 48, and 72 h after operation were significantly lower than those of control group. The anal distension scores at 8, 48, and 72 h after operation were also significantly lower than those of control group. The number of postoperative analgesic drug administration per patient was also significantly lower in the EA group. The incidence of urinary retention and tenesmus in EA group was significantly lower than that in control group within the first day after surgery.ConclusionEA treatment at the Baliao point can alleviate short-term anal pain and anal swelling after the procedure for prolapse and hemorrhoids, reduce the incidence of urinary retention, and decrease the use of postoperative analgesic drugs.Trial registrationThis study was approved and registered by the Chinese Clinical Trial Center, Registration number: ChiCTR2100043519, Registration time: February 21, 2021 (https://www.chictr.org.cn/).

Bandwagons in colorectal surgery.

Surgery, like other fields of medicine, has not been spared by a number of unfortunate phenomena. Although our perception may point at recent times, some trends can actually be traced back to 1979. Cohen and Rothschild stated that even when medical progress is extraordinary, the path has too often been driven by overwhelming acceptance of popular albeit unproven ideas. These are referred to as bandwagons. Some of such ideas were eventually proven as valid, but more often were abandoned and/or replaced by new bandwagons. In the specific case of colorectal surgery, there are at least five currently ongoing bandwagons: 1) laparoscopic lavage of perforated colon; 2) laparoscopic ventral rectopexy; 3) stapled hemorrhoidopexy, also known as procedure for prolapse and hemorrhoids (PPH); 4) watch and wait; 5) transanal total mesorectal excision (taTME). Preventing bandwagons from taking off requires efforts at different levels: 1) innovators must constrain their self-interest of fame and rather recognize the need for establishing evidence to support their ideas; 2) new treatment modalities must be carefully weighed by sufficiently powered clinical trials prior to been implemented on patients; 3) the media should not mislead patients into the "best" treatment without reliable evidence; 4) physicians should keep in mind that the process of innovation in medicine is slow and disregard the temptation to accept at face value perhaps plausible, yet unproven ideas.

Laparoscopic Nerve-Sparing Sacropexy: Tips and Tricks for a Safe and Anatomical Surgical Procedure

Study Objective to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. Design A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Setting Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients or Participants Patients with POP-Q Stage III and IV/prolapse of uterine Interventions Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. Measurements and Main Results LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. Conclusion A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps. to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients with POP-Q Stage III and IV/prolapse of uterine Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps.

Hemi-circumferential mucosal resection and anastomosis procedure for rectal prolapse following anorectoplasty for anorectal malformations.

Rectal prolapse after radical surgery for anorectal malformations (ARMs) is a common postoperative complication that causes bleeding and stenosis, and sometimes requires surgical treatment. Different surgical techniques have been reported, but most are associated with high recurrence rates and a long postoperative stay. We performed the hemi-circumferential mucosal resection and anastomosis procedure (HCMR) to preserve anal muscle and anal function. Here, we report the success of our minimally invasive surgical approach to correct rectal prolapse in patients with ARMs. The subjects of this retrospective review were patients who underwent HCMR for rectal prolapse after radical surgery for ARMs between January, 2014 and August, 2021. HCMR involves rectal mucosal resection without muscle plication. A collective 15 HCMR procedures were performed in 10 patients. The median age at repair was 1.8years (range, 10months-18years). The median operation time and postoperative length of stay were 46min (range, 17-85min) and 3days (range, 1-7days), respectively. The median postoperative observation period was 3years 4months (range, 8months-7years 10months) and no complications or recurrences were observed. HCMR is a safe and effective surgical treatment for rectal prolapse after radical operation for ARMs, which is minimally invasive and preserves rectal muscle and function.

The Clinical Effect and Mechanism of Prostant on Urinary Retention and Anal Pain.

Anal pain and urinary retention are the two most outstanding complications of the procedure for prolapse and hemorrhoids (PPH) surgery. This study intended to assess the clinical effect and mechanism of Prostant on urinary retention and anal pain after the PPH. Here, 30 patients received PPH surgery. The role and mechanism of Prostant in patients and mice with urinary retention and anal pain were evaluated. ANOVA tests were executed and differences between groups were regarded as statistically significant when p < 0.05. Prostant effectively improved the urination status, lower abdomen symptoms, time to urinate and score of VAS, and the reduction of TNF-α and IL-6. Similarly, Prostant can ameliorate the outcome of urodynamics in urinary retention mice. Mechanically, Prostant reversed the urinary retention-elevated the serum level of hs-CRP and TNF-α, reduction of IL-2, imbalance of Treg/Th17, and level of JAK2 and phosphorylated STAT3. Besides, Prostant ameliorated the pain as shown by the reduction of writhing response, and the elevation of threshold of pain and degree of swelling. Moreover, Prostant antagonized the pain-induced dysregulation of Treg/Th17. Therefore, Prostant can treat patients and mice with anal pain and urinary retention by modulating the balance of Th17/Treg to regulate the secretion and production of inflammatory factors. We hope our results can establish a scientific treatment approach for solving anal pain and urinary retention after PPH surgery of mixed hemorrhoids.

Delorme's Procedure for Rectal Prolapse.

Cerdán Santacruz, Carlos M.D., Ph.D.1; Gancedo Quintana, Álvaro M.D.1; Cerdán Miguel, Javier M.D., Ph.D.2 Author Information