Recurrent Rectal Prolapse Research Articles

Ninety-day morbidity of robot-assisted redo surgery for recurrent rectal prolapse, mesh erosion and pelvic pain: lessons learned from 9years' experience in a tertiary referral centre.

AimWith increasing follow‐up of patients treated with minimally invasive ventral mesh rectopexy (VMR) more redo surgery can be expected for recurrent rectal prolapse, mesh erosion and pelvic pain. The aim of this study is to evaluate the 90‐day morbidity of robot‐assisted redo interventions.MethodAll robot‐assisted redo interventions after primary transabdominal repair of rectal prolapse between 2011 and 2019 were retrospectively analysed and compared with the results for patients after primary robot‐assisted VMR during the same period. The redo interventions were divided into groups based on the indication for surgery (recurrent prolapse, mesh erosion, pelvic pain). Intraoperative complications and 90‐day postoperative morbidity were evaluated.ResultsThree hundred and fifty nine patients were treated with primary VMR, with 73 for recurrent rectal prolapse, 12 for mesh erosion and 14 for pelvic pain. Complications of recurrent prolapse surgeries were comparable to those of primary VMR (p > 0.05). More intraoperative complications, minor and major complications were seen in redo surgery for erosion compared with primary VMR (23% vs. 3%, p = 0.01; 31% vs. 11%, p = 0.055; and 38% vs. 1%, p < 0.01 respectively). The frequency of intraoperative complications after redo surgery for pelvic pain was 7% with minor and major morbidity rates of 14% and 7% (p > 0.05). Half of the patients with pelvic pain experienced relief of their symptoms.ConclusionRedo surgery for management of recurrent rectal prolapse is safe. Redo surgery for mesh erosion is associated with high morbidity rates. Redo surgery for pelvic pain can have major complications and is only effective in half of the cases.

Robotic-Assisted Laparoscopic Rectal Prolapse Repair in a Patient with Indiana Pouch.

Study Objective To highlight the surgical techniques for ventral rectopexy with sacrocolpopexy in the face of extensive abdomino-pelvic adhesions and to present the use of strattice reconstructive tissue matrix as a viable option in a patient with significant previous abdominal surgeries and decreased peritoneum available for mesh coverage. Design Surgical video presentation. Setting Academic tertiary care center. Patients or Participants We present a 26-yo nulliparous patient with recurrent rectal prolapse. She had failed a previous rectopexy repair 4 years prior. Her medical history is significant for Ehlers Danlos Syndrome, chronic pelvic pain and interstitial cystitis refractory to medical management. This prompted surgical interventions in the form of hysterectomy with bilateral salpingectomy, cystectomy and creation of an Indiana Pouch. Interventions Evaluation with a dynamic MRI proctogram showed pelvic floor laxity with a moderate anterior rectocele and large enterocele. At laparoscopy there was significant adhesions of omentum and bowel to the anterior abdominal wall, extending into the pelvis. Careful lysis of adhesions was started laparoscopically in order to create safe entry points for the robotic trocars and to delineate the anatomical landmarks for the rectopexy and sacrcolpopexy. Prolene mesh was secured to the exposed levator ani muscles, attached to the rectal wall and then extended to the sacral promontory. Strattice mesh was then fashioned and extended from the back of the pubic symphysis to the sacral promontory. Measurements and Main Results The patient was discharged on post op day 1 and at her postoperative review she was recovering well with no bowel dysfunction or rectal prolapse symptoms. Her Indiana Pouch remained functional. Conclusion The safety and feasibility of a robotic-assisted laparoscopic rectopexy was demonstrated in this surgical video even with extensive pelvic adhesive disease. Strattice matrix can safely be used to separate Prolene mesh from the intra-abdominal contents therefore, minimizing postoperative morbidity and increasing the chances of good functional outcomes. To highlight the surgical techniques for ventral rectopexy with sacrocolpopexy in the face of extensive abdomino-pelvic adhesions and to present the use of strattice reconstructive tissue matrix as a viable option in a patient with significant previous abdominal surgeries and decreased peritoneum available for mesh coverage. Surgical video presentation. Academic tertiary care center. We present a 26-yo nulliparous patient with recurrent rectal prolapse. She had failed a previous rectopexy repair 4 years prior. Her medical history is significant for Ehlers Danlos Syndrome, chronic pelvic pain and interstitial cystitis refractory to medical management. This prompted surgical interventions in the form of hysterectomy with bilateral salpingectomy, cystectomy and creation of an Indiana Pouch. Evaluation with a dynamic MRI proctogram showed pelvic floor laxity with a moderate anterior rectocele and large enterocele. At laparoscopy there was significant adhesions of omentum and bowel to the anterior abdominal wall, extending into the pelvis. Careful lysis of adhesions was started laparoscopically in order to create safe entry points for the robotic trocars and to delineate the anatomical landmarks for the rectopexy and sacrcolpopexy. Prolene mesh was secured to the exposed levator ani muscles, attached to the rectal wall and then extended to the sacral promontory. Strattice mesh was then fashioned and extended from the back of the pubic symphysis to the sacral promontory. The patient was discharged on post op day 1 and at her postoperative review she was recovering well with no bowel dysfunction or rectal prolapse symptoms. Her Indiana Pouch remained functional. The safety and feasibility of a robotic-assisted laparoscopic rectopexy was demonstrated in this surgical video even with extensive pelvic adhesive disease. Strattice matrix can safely be used to separate Prolene mesh from the intra-abdominal contents therefore, minimizing postoperative morbidity and increasing the chances of good functional outcomes.

A Case of Recurrent Rectal Prolapse with Perforation of the Rectum with Prolapse of the Small Intestine from the Anus

A Case of Recurrent Rectal Prolapse with Perforation of the Rectum with Prolapse of the Small Intestine from the Anus

Evaluation of Laparoscopic Ventral Mesh Rectopexy in Complete Rectal Prolapse

Abstract Background: Complete rectal prolapse is a condition that greatly impairs the quality of life. Treatment in adults is essentially surgical but the optimum method is still a chal-lenging clinical problem in colorectal surgery. The literature offers abundant publications and there have been turns and twists in the evolution of surgical techniques for treatment of this condition. Aim of Study: To evaluate the outcome of laparoscopic ventral mesh rectopexy as a procedure for repair of complete rectal prolapse in terms of recurrence rate and post-operative improvement of faecal incontinence and constipation. Periop-erative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively. Patients and Methods: This was a retrospective cohort study conducted on 20 patients with complete rectal prolapse underwent laparoscopic ventral mesh rectopexy admitted from colo-rectal unit clinic of Ain Shams University hospital in the period from January 2017 to December 2018, were eval-uated in the present study. Results: Twenty patients 13 females (65%) and 7 males (35%) with median age of 47.7. Wexner constipation score improved significantly from the preoperative value of median (IQR) 6.5 (range, 2-19) to 6 (range, 2-12) (p-value <0.001). In patients presenting with faecal incontinence (FI), significant improvement in post-operative wexner (Cleveland clinic incontinence score) (CCIS) from median (IQR) 14.5 (range 0-20) to 0 (range, 0-16) (p-value <0.001). Three cases (15%) of complete rectal prolapse recurrence were reported within 18 months follow-up. Conclusion: Despite a multitude of existing operative techniques for correction of rectal prolapse, we believe that laparoscopic ventral mesh rectopexy has obtained good results in terms of functional outcome of the abdominal procedures with low recurrence rate and significant improvement in constipation and faecal incontinence, offering the advantages of anterolateral mobilization, mesh repair and of a laparoscopic approach compared to an open one.

Adult residual rectourethral fistula and diverticulum presenting decades after imperforate anus repair: a\xa0case report

BackgroundThis report describes a rare surgical case of an intraabdominal mass in a middle-aged patient 40 years after imperforate anus repair.Case presentationA 44-year-old Latino male with history of repaired anorectal malformation presented with recurrent urinary tract infections and rectal prolapse with bothersome bleeding and fecal incontinence. During his preoperative evaluation, he was initially diagnosed with a prostatic utricle cyst on the basis of magnetic resonance imaging findings, which demonstrated a cystic, thick-walled mass with low signal contents that extended inferiorly to insert into the distal prostatic urethra. However, at the time of surgical resection, the thick-walled structure contained an old, firm fecaloma. The final pathology report described findings consistent with colonic tissue, suggesting a retained remnant of the original fistula and diverticulum.ConclusionsAlthough rare, persistent rectourethral fistula tracts and rectal diverticula after imperforate anus repair can cause symptoms decades later, requiring surgical intervention. This is an important diagnostic consideration for any adult patient with history of imperforate anus.

Longer prolapsed rectum length increases recurrence risk after Delorme's procedure.

Purpose Risk factors for recurrence of rectal prolapse after surgery remain unclear. Delorme’s procedure is often selected for relatively small-sized rectal prolapse, but there are few reports discussing the association between prolapsed rectum length and prolapse recurrence after Delorme’s procedure. We hypothesized that patients with longer rectal prolapses are at a higher risk of recurrence after Delorme’s procedure.Methods The study population comprised patients with rectal prolapse who underwent Delorme’s procedure between January 2014 and December 2019 at Tokyo Yamate Medical Center. We extracted data on patient age, sex, body mass index, previous history of anal surgery, previous history of surgery for rectal prolapse, and length of prolapse, to identify risk factors for prolapse recurrence.Results Altogether, 96 patients were eligible for analysis. The median length of the prolapsed rectum was 3.0 cm (range, 1.0–6.6 cm). Twenty-four patients (25.0%) experienced recurrence after Delorme’s procedure after a median of 7.5 months (interquartile range, 3.2–20.9 months). Multivariate analysis revealed that longer prolapsed rectum length increased the risk of recurrence after Delorme’s procedure (hazard ratio, 6.28; 95% confidence interval, 1.83–21.50; P<0.001).Conclusion The length of the prolapsed rectum should be measured before Delorme’s procedure for rectal prolapse, because length is associated with a risk of recurrence after the surgery.

Success of Aetoxiscerolin the Treatment of Medically Refractory Rectal Mucous Prolapse among Children at the Hospital Aristide Le Dantec in Dakar, Senegal

Background: Rectal prolapse (RP) is a protrusion of the rectum through the anus. In the literature. Sclerotherapy is the best second line minimally invasive method. The purpose of this work is to review the effectiveness of this technique in a context where surgical procedures still seem to be very used. Method: This was a prospective cross-sectional study over 04 years concerning 20 patients who had recurrent RP and had a lauromacrogol 400 (Aetoxisclerol 2%) submucosal perirectal sclerotherapy. Results: After an average follow-up of 28 months, complete healing was achieved in 100% of cases. A single injection was required for 19 patients (95%). No complications were reported.&#x0D; Conclusion: Sclerotherapy is an effective and simple method that every team must give itself the means to put in place for the management of recurrent RP.

Laparoscopic approach to recurrence following multiple surgeries for external rectal prolapse: a case report

IntroductionThe optimal procedure for recurrent external rectal prolapse remains unclear, particularly in laparoscopic approach. In addition, pelvic organ prolapse (POP) is sometimes concomitant with rectal prolapse. We present a case who underwent laparoscopic procedure for the recurrence of full-thickness external rectal prolapse coexisting POP.Case presentationAn 81-year-old parous female had a 10-cm full-thickness external rectal prolapse following the two operations: the first was perineal recto-sigmoidectomy and the second was laparoscopic posterior mesh rectopexy. Imaging study revealed that the recurrent rectal prolapse was concomitant with both cystocele and exposed vagina, what we call POP. We planned and successfully performed laparoscopic ventral mesh rectopexy (LVMR) with laparoscopic sacrocolpopexy (LSC) using self-cut meshes without any perioperative complication.ConclusionThis is the first report of LVMR and LSC for recurrent rectal prolapse with POP following the perineal recto-sigmoidectomy and laparoscopic posterior mesh rectopexy. Even for recurrent rectal prolapse with POP, our experience suggests that LVMR and LSC could be utilized.

What is the recommended procedure for recurrent rectal prolapse? A retrospective cohort study in a single Japanese institution

PurposeThe choice of surgical procedure for rectal prolapse (RP) is challenging because of the high recurrence and morbidity rates. We aimed to clarify whether laparoscopic suture rectopexy (lap-rectopexy) is suitable for Japanese patients with recurrent RP.MethodsWe retrospectively evaluated 77 recurrent RP patients who had been treated on average 1.5 times between June 2008 and April 2016. Forty-one patients underwent lap-rectopexy and 36 underwent perineal procedures. We compared surgical outcomes and recurrence rate following surgery between the two groups. The multivariable logistic regression analysis was performed to determine risk factors of recurrent RP.ResultsIn patients’ characteristics, significant differences were observed in the type of anesthesia (p < 0.01) and length of recurrent RP (p = 0.030). The mean operative time was significantly longer in the lap-rectopexy group (p < 0.001). Blood loss, length of hospitalization, and postoperative complications were similar. The recurrence rate was significantly lower in the lap-rectopexy group (17.1% vs. 38.9%, p = 0.032). Multivariate analysis showed that only the laparoscopic approach was significantly associated with a low recurrence following surgery (odds ratio 0.273, 95% CI − 2.568 to − 0.032).ConclusionLap-rectopexy is recommended for recurrent RP because its low recurrence rate and safety profile are similar to those of perineal procedures.

A Case of Rectal Perforation with Transanal Small Bowel Evisceration After Recurrent Rectal Prolapse

A Case of Rectal Perforation with Transanal Small Bowel Evisceration After Recurrent Rectal Prolapse

Rectal Prolapse Repair with Abdominal Fixation Under Sedation and Local or Epidural Anesthesia: Prospective Pilot Study in 10 Elderly Subjects.

Background: Rectal prolapse (RP) is primarily a disease of the elderly, where treatment may be associated with significant postoperative morbidity including that related to anesthesia. Objective: The aim of this study was to evaluate the safety and feasibility of a novel abdominal approach to RP repair under sedation and local anesthesia and to assess short- and long-term clinical outcomes in elderly patients (>70 years). Design Settings: This is a prospective pilot study with 10 patients using a novel RP repair. The anesthesia type was local or epidural with sedation. Follow-up was done at 30 days, 12, and 24 months. Patients: Patients were men and women >70 years of age with RP. Main Outcome Measures: (1) Feasibility: successful completion of RP repair using the novel abdominal approach with laparoscopic assistance. (2) Safety: safety was measured by the incidence of the intraoperative complications (bowel perforation, organ injury, and bleeding requiring blood transfusion). (3) Sedation and local anesthesia feasibility: surgery was safely completed without patient intubation. Results: Ten female patients >70 years of age underwent RP repair using the novel abdominal approach. General anesthesia was not required in any of the 10 patients. Two patients recurred within 6 months. One of the patients with recurrence of RP subsequently underwent laparoscopic rectopexy, and the other was minimal and required no further treatment. One mortality occurred at 3 months unrelated to the procedure. No other anesthetic or surgical intraoperative and postoperative complications were observed. Limitations: This is a single-institution pilot study. Conclusions: Abdominal RP repair under sedation and regional anesthesia appears feasible and safe in elderly patients and may, in the future, provide an effective alternative to current treatment options for RP, avoiding general anesthesia. ClinicalTrial.gov registration number: NCT01980043.

La diagnosi e la gestione del prolasso rettale

Rectal prolapse is an overall rare occurrence in children in the first 4 years of age. It typically tends to relapse. In the majority of cases it is not possible to highlight a single cause that determines prolapse, even if it is more frequent in children who suffer from constipation. In about 1 in 10 cases there is an underlying predisposing anatomical-neurological condition (in particular neurological: myelomenigocele, spina bifida occulta). A predisposing cause that must always be considered and excluded is cystic fibrosis, even in the age of newborn screening. Rectal prolapse management is conservative in most cases. Behavioural measures (correct toilet training, good hydration, diet rich in fibres) and the use of the macrogol laxative are fundamental. The prolapse that does not resolve spontaneously must be reduced manually by instructing the family on the technique to be used. In 90% of cases the natural history of rectal prolapse is favourable, with complete resolution within the first 4 years of age. After this age, it occurs more rarely. Surgery is rarely indicated. The current techniques that have a large consensus are sclerotherapy and laparoscopic rectopexy. The paper reports the management of recurrent rectal prolapse in a 3-year-old boy.

Rectal Tonsil as a Cause of Recurrent Rectal Prolapse.

A 9-year-old boy presenting with recurrent rectal bleeding and prolapse refractory to therapy for constipation was referred for colonoscopy. Initial work-up (magnesium, thyroid function, food allergies, celiac disease, and stool cultures) was negative. Five large rectal polyps were evidenced just above dental line. Due to the location of the lesions, a combined endoscopic/surgical submucosal resection of the lesions was performed (Fig. 1). Postoperative course was uneventful. The patient's symptoms resolved quickly. Histological examination after complete resection ruled out a malignant process, particularly extranodal marginal zone B-cell lymphoma (1–4), and confirmed the diagnosis of atypical mantle zone hyperplasia, also known as rectal tonsil (RT) (Fig. 2).FIGURE 1: Endoscopy showing polypoid lesions of lower rectum.FIGURE 2: Histology. (A) Rectal submucosal resection specimen showing nodular lymphoid proliferation in the mucosa and submucosa. Hematoxylin and eosin staining. (B) Positive CD20 immunohistochemical (IHC) staining, showing prominent B-lymphocyte proliferation. (C) Positive CD3 IHC staining demonstrating small T lymphocytes surrounding B-lymphoid nodules; (D) Bcl2 IHC staining showing negative-stained and disorganized germinal center (asterisk).RT corresponds to prominent and localized lymphoid tissue hyperplasia. The incidence seems to be more frequent in young children and adolescent. RT is associated with viral and bacterial infections (Giardia lamblia, Helicobacter pylori), food allergies, immune deficiency (IgA deficiency), and refractory constipation (5). RT can be asymptomatic or present with rectal bleeding, abdominal pain, or intestinal obstruction (3). Identification of predisposing factors and their treatment usually allows spontaneous resolution of the symptoms and sometimes regression of the lesions. Occasionally, resection is necessary to treat some complications as described in this unusual case (6–8).

Surgical approach, complications, and reoperation rates of combined rectal and pelvic organ prolapse surgery.

Our primary objective was to determine rectal prolapse (RP) and pelvic organ prolapse (POP) reoperation rates and postoperative < 30-day complications after combined RP and POP surgery at a single institution. This was an IRB-approved retrospective cohort study of all female patients who received combined RP and POP surgery at a single tertiary care center from 2008 to 2019. Recurrence was defined as the need for subsequent repeat RP or POP surgery at any point after the index surgery. Surgical complications were separated into Clavien-Dindo classes. Sixty-three patients were identified, and 18.3% (12/63) had < 30-day complications (55% Clavien-Dindo grade 1; 27% Clavien-Dindo grade 2; 18% Clavien-Dindo grade 4). Of patients undergoing combined abdominal RP and POP repair, no postoperative < 30-day complications were noted in the MIS group compared to 37.5% of those patients in the laparotomy group (p < 0.01). Overall, in those patients who underwent combined RP and POP surgery, the need for subsequent RP surgery for recurrent RP was 14% and the need for subsequent POP surgery for recurrent POP was 4.8% (p = 0.25). In this cohort of women undergoing combined RP and POP surgery, a higher proportion required subsequent RP surgery compared to those requiring subsequent POP surgery, although this was not statistically significant. Almost one-fifth of patients undergoing combined RP and POP surgery experienced a < 30-day surgical complication, regardless of whether the approach was perineal or abdominal. For those patients undergoing abdominal repair, < 30-day complications were more likely in those patients who had a laparotomy compared to those who had a minimally invasive surgery.

Same-Day Discharge and Quality of Life for Primary Laparoscopic Rectopexy for Rectal Prolapse in Children: A 10-Year Experience.

Introduction: Rectal prolapse (RP) in pediatric patients may require surgical intervention. Varying surgical approaches and heterogenous patient populations have resulted in difficulty defining surgical outcomes and superiority of technique. We sought to review our surgical and self-reported outcomes of patients who underwent laparoscopic rectopexy for idiopathic RP. Methods: Records of children <18 years who underwent primary laparoscopic rectopexy between March 2009 and March 2019 were retrospectively reviewed. Patients with redo rectopexy were excluded. Demographics, pre- and postoperative treatment, and outcome data were collected and reported using descriptive statistics. Qualitative analysis of a quality of life (QoL) questionnaire administered to patients and parents 2-10 years postoperatively was performed. Results: Fifteen patients were included. Median age at surgery was 5 years (interquartile range [IQR] 3, 12.5); 60% were male and median weight was 22 kg (IQR 16.4, 39.2). Median length of stay was 6 hours (IQR 4, 22) with 9 (60%) discharged the same day. Perioperatively, 73% were on laxative for constipation, whereas only 33% were on laxative therapy at 6 months postrectopexy. Median follow-up was 19 months (IQR 8, 39). Three patients (20%) suffered recurrent RP (2 required redo rectopexy), and 2 patients self-limited urinary retention. Respondents to the QoL questionnaire indicated improvement in symptoms after surgery. No patient reported fecal incontinence, smearing, or leakage of stool. Conclusion: Laparoscopic rectopexy is a safe minimally invasive approach for children with idiopathic RP that offers high patient satisfaction with same-day discharge, early recovery, and low recurrence.

MP05-18 DO PREOPERATIVE DEMOGRAPHICS OR SYMPTOMS PREDICT RECURRENCE IN PATIENTS FOLLOWING COMBINED SURGICAL REPAIR FOR PELVIC ORGAN PROLAPSE AND RECTAL PROLAPSE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-18 DO PREOPERATIVE DEMOGRAPHICS OR SYMPTOMS PREDICT RECURRENCE IN PATIENTS FOLLOWING COMBINED SURGICAL REPAIR FOR PELVIC ORGAN PROLAPSE AND RECTAL PROLAPSE? Raveen Syan, Shannon Wallace*, Brooke Gurland, and Ekene Enemchukwu Raveen SyanRaveen Syan More articles by this author , Shannon Wallace*Shannon Wallace* More articles by this author , Brooke GurlandBrooke Gurland More articles by this author , and Ekene EnemchukwuEkene Enemchukwu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Growing evidence suggests combined surgical repair for pelvic organ prolapse (POP) and rectal prolapse (RP) is safe and effective, however recurrence rates of POP and/or RP following combined surgery are poorly described. We sought to characterize demographics and presenting symptoms in patients undergoing combined repair and determine pre-operative predictors of recurrence. METHODS: We performed a retrospective review of women who underwent combined RP and POP surgery at a single tertiary center from 2008-2019. Patient demographic data and preoperative symptoms were collected. Patients with recurrent POP (Stage 2 anatomic prolapse) and/or RP on examination were identified. RESULTS: Sixty-three women with a mean follow up time of 1.1 years were evaluated. Five patients were lost to follow up. Mean age at the time of surgery was 65, and the majority patients were Caucasian (62%) and non-smokers (51%) (Figure 1A). The most commonly reported symptoms related to POP were overactive bladder (OAB) (73%) and vaginal bulge (79%), while the most commonly reported symptoms related to RP were obstructive defecation (51%) and fecal incontinence (FI) (68%) (Figure 1A). Postoperatively, 71% of patients with OAB and 87% of patients with vaginal bulge symptoms reported improvement in symptom. Similarly, 81% of patients with obstructive defecation and 79% of patients with FI reported improvement in symptoms. Of thirteen patients (22%) with recurrent POP and/or RP, 7 patients had recurrent POP and 10 had recurrent RP. Increasing age, pulmonary disease, obesity, obstructive urination and obstructive defecation were associated with recurrent POP and/or RP (Figure 1B). After adjusting for confounders, age (OR 1.10 [1.03-1.22]), obesity (OR 25.97 [2.56-623.14]), and obstructive defecation (OR 6.57 [1.03-69.57]) remained statistically significant (Figure 1B). CONCLUSIONS: Though majority of patients who undergo combined POP and RP surgery have improvement in symptoms related to RP and POP, our study suggests that older, obese, women with pre-operative obstructive defecation may have a higher risk of prolapse recurrence. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e48-e49 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raveen Syan More articles by this author Shannon Wallace* More articles by this author Brooke Gurland More articles by this author Ekene Enemchukwu More articles by this author Expand All Advertisement PDF downloadLoading ...

Rectal Prolapse in Children: An Update to Causes, Clinical Presentation, and Management.

Rectal prolapse is a protrusion of rectal mucosa through the anal sphincter. Although uncommon, it is seen more often in children, younger than 4 years of age. The last data analysis of rectal prolapse and its clinical characteristics in children was performed over 30 years ago. Since that time, many medical advances have occurred that may alter our workup and management of this disease in children. We performed a chart review to reassess the clinical characteristics of rectal prolapse and its management. This was a retrospective descriptive analysis study, assessing children less than 18 years of age that were diagnosed with rectal prolapse from 1999 to 2014 at a single tertiary care center. The onset of presentation, demographics, etiology, clinical characteristics, and management were analyzed. A total of 158 patients were diagnosed with rectal prolapse, with mean age of onset being 3 years. Constipation was the leading cause, with straining being the most common complaint. Stool consistencies with constipation varied. Many patients diagnosed with idiopathic recurrent rectal prolapse had either a social stressor or were described as having unusual behaviors associated with prolapse. Cystic fibrosis was only diagnosed in 4 patients. Thirty-four patients (22%) required surgical correction. Constipation remains the main cause of rectal prolapse. Cystic fibrosis is no longer a common etiology for rectal prolapse, because of the implementation of newborn screening. Patients with social stressors or atypical behavior may be at risk for recurrent rectal prolapse.

Rectal duplication in an adult cat: a novel transanal surgical approach

Case summaryA 3-year and 8-month-old male entire European domestic shorthair cat was presented with a history of recurrent rectal prolapse, straining and pain when defaecating. Previous non-surgical and surgical treatments had not provided a satisfactory result. Rectal prolapse had recurred within 2 weeks of treatment. Upon clinical examination, an intraluminal mass could be palpated rectally. A CT scan examination revealed the mass was of a cystic nature and the cyst was surgically excised via a transanal approach. On histological evaluation, the cyst walls consisted of three of the layers of normal rectum: mucosa, muscularis of the mucosa and submucosa. These findings led to the definite diagnosis of rectal duplication.Relevance and novel informationEnteric duplication is among the differential diagnoses for straining and rectal prolapse in cats. This condition has previously been discussed in the veterinary literature, with a single case report describing a rectal duplication in a cat. In that particular case, the authors described a perineal surgical approach. Here we present a novel approach whereby the duplicated material was excised transanally in order to limit intra- and postoperative morbidity. The clinical outcome was excellent in our case, with complete resolution of clinical signs and no recurrence 18 months after surgery.

Surgical Treatment of Rectal Prolapse: A 10-Year Experience at a Single Institution.

PurposeDespite the plethora of surgical options, there is no consensus regarding the best treatment for rectal prolapse. This study is aimed at evaluating our experience with its treatment and outcomes.MethodsWe retrospectively reviewed rectal prolapse patients’ characteristics, clinical presentation, surgical procedure, average length of hospital stay, morbidity, mortality, and recurrence over a 10 year period at our institution.ResultsA total of 46 patients underwent rectal prolapse repair at our institution over a 10 year period. Of the 39 patients with primary rectal prolapse, 18 patients had an abdominal procedure, while 21 patients underwent a perineal approach. Operative duration was significantly longer in abdominal procedures, of which 16 cases were performed laparoscopically. Length of hospital stay and recurrence were not statistically significant between the 2 groups. In patients with recurrent rectal prolapse, more than 80% of the initial surgeries were done using the perineal approach. An abdominal approach was utilized in the management of 75% of recurrences.ConclusionAn abdominal repair may be preferable in the treatment of recurrent rectal prolapse. Minimally invasive techniques may be feasible and can provide a safe alternative to perineal procedures in elderly patients.

Surgical Correction of Obstructed Defecation Syndrome

Video Objective Obstructed defecation syndrome (ODS) is a form of colonic constipation in which stool cannot effectively be evacuated from the rectum. ODS is usually caused by a combination of behavioral, functional, and anatomic factors. While many women with ODS can experience improvement with aggressive medical management, the anatomic contribution what we term a “posterior” enterocele to defecation obstruction can be significant. Setting We present a video description of anterior rectopexy at the time of sacrocolpopexy with obliteration of the rectovaginal space to address posterior compartment prolapse as a cause of outlet constipation. Interventions To date, we have completed 12 procedures with resolution of ODS in all subjects. With 6-12 months of post-operative follow up, there have been no operative complications and no recurrent posterior enterocele. One subject had recurrent rectal mucosal prolapse. Prospective data collection is still ongoing. Conclusion The modification to sacrocolpopexy presented in this video seeks to address ODS by obliterating the rectovaginal space. Traditional sacrocolpopexy does not effectively address this defect and small bowel continues to herniate behind the posterior vaginal mesh.