Total Rectal Prolapse Research Articles

A COMPARATIVE STUDY ON LAPAROSCOPIC VERSUS OPEN MESH RECTOPEXY FOR FULL THICKNESS RECTAL PROLAPSE

To evaluate the efcacy and safety of laparoscopic versus open mesh rectopexy for total rectal prolapse. A retrospective review was conducted for 12 patients undergoing laparoscopic versus open mesh rectopexy for total rectal prolapse between November 2019 and November 2021. Laparoscopic rectopexy (n = 6) and open surgery (n = 6) were performed. Two groups were matched with regards to age, gender, body mass index (BMI) and American Society of Anesthesiologists (ASA) score. Mortality was zero in each group. There were insignicant inter-group differences in operative duration, postoperative complication, rate of long-term recurrence and improvement of incontinence and constipation. Perioperative blood loss and postoperative hospital stay were signicantly shorter in the laparoscopic rectopexy group. Laparoscopic mesh rectopexy is as safe and efcient as open rectopexy. And both are suitable for senile patients. Longterm outcomes are similar for two groups, but the laparoscopic group has better short-term outcomes.

Surgical treatment of total rectal prolapse using Delorme's procedure (with video).

Surgical treatment of total rectal prolapse using Delorme's procedure (with video).

Laparoscopic posterior rectopexy for complete prolapse of the rectum: Our experience

Background: Total rectal prolapse is a disorder that affects both sexes in all age groups causing debilitating symptoms along with constipation, incontinence or both and results in a poor quality of life (QoL).Aim: We present our experience of laparoscopic rectopexy for procidencia in terms of change in scores of these factors following surgery and the long term results.Materials and Methods: This is a retrospective study with prospectively collected data. Fifteen patients who underwent laparoscopic rectopexy for complete rectal prolapse in our unit from January 2013 to 2016 were included. Preoperative and postoperative constipation, incontinence and QoL scores have been followed up for a period of 18 months following surgery. Other outcomes measured were major and minor complications, length of hospital stay and recurrence.Results: Almost all patients suffered from pre-operative incontinence and had a poor QoL before surgery. Improvement in incontinence following surgery was seen in 86.7% and improvement in constipation was seen in 53% of the patients. There were no major complications. Retrograde ejaculation was seen in two patients in the 20–30 year age group. One patient recovered partially in 6 months and the other was lost to follow-up. There was no incidence of recurrence in the median follow-up period.Conclusions: Laparoscopic rectopexy for rectal prolapse is associated with good post-operative outcome as far as incontinence and constipation is concerned. There is a significant improvement in QoL and associated with a low risk of recurrence. There is a risk of sexual disorders following 'posterior rectopexy' among sexually active males and can be a major source of dissatisfaction.

Early experience with ambulatory robotic ventral rectopexy

Ventral rectopexy can be performed robotically with only limited trauma for the patient, making its performance in an ambulatory setting potentially interesting. The aim of this study is to report our preliminary experience with ambulatory robotic ventral rectopexy in consecutive patients. Ten consecutive patients underwent robotic ventral rectopexy for total rectal prolapse (n=8) or symptomatic enterocele (n=2) between February 2014 and April 2015. Patients were selected for outpatient treatment based on criteria of patient motivation, favorable social conditions, and satisfactory general condition. Patient characteristics, technical results and cost were reported. The mean operating time was 94minutes (range: 78-150). The average operating room occupancy time was 254minutes (222-339). There were no operative complications, conversion to laparotomy, or postoperative complication. The average duration of hospital stay was 11 (8-32) hours. Two patients required hospitalization: one for persistent pain and the other for urinary retention. The average maximum pain score recorded on postoperative day 1 was 2/10 on a visual analog scale (range: 0-5/10). Estimated average cost (excluding amortization of the purchase of the robot) was €9088 per procedure. Ambulatory management of robotic ventral rectopexy is feasible and safe.

A novel technique for correction of total rectal prolapse: Endoscopic-assisted percutaneous rectopexy with the aid of the EndoLifter

Introduction and aimsRectal prolapse is common in the elderly, having an incidence of 1% in patients over 65years of age. The aim of this study was to evaluate the safety and feasibility of a new endoluminal procedure for attaching the previously mobilized rectum to the anterior abdominal wall using an endoscopic fixation device. Materials and methodsThe study is a single-arm phasei experimental trial. Under general anesthesia, total rectal prolapse was surgically reproduced in five pigs. Transanal endoscopic reduction of the rectal prolapse was performed. The best site for transillumination of the abdominal wall, suitable for rectopexy, was identified. The EndoLifter was used to approximate the anterior wall of the proximal rectum to the anterior abdominal wall. Two percutaneous rectopexies were performed by puncture with the Loop FixtureII Gastropexy Kit® at the preset site of transillumination. After the percutaneous rectopexies, rectoscopy and exploratory laparotomy were performed. Finally, the animals were euthanized. ResultsThe mean procedure time was 16min (11-21) and the mean length of the mobilized specimen was 4.32cm (range 2.9-5.65cm). A total of 10 fixations were performed with a technical success rate of 100%. There was no evidence of postoperative rectal prolapse in any of the animals. The EndoLifter facilitated the process by allowing the mucosa to be held and manipulated during the repair. ConclusionsEndoscopic-assisted percutaneous rectopexy is a safe and feasible endoluminal procedure for fixation of the rectum to the anterior abdominal wall in experimental animals.

A novel technique for correction of total rectal prolapse: Endoscopic-assisted percutaneous rectopexy with the aid of the EndoLifter.

Rectal prolapse is common in the elderly, having an incidence of 1% in patients over 65years of age. The aim of this study was to evaluate the safety and feasibility of a new endoluminal procedure for attaching the previously mobilized rectum to the anterior abdominal wall using an endoscopic fixation device. The study is a single-arm phasei experimental trial. Under general anesthesia, total rectal prolapse was surgically reproduced in five pigs. Transanal endoscopic reduction of the rectal prolapse was performed. The best site for transillumination of the abdominal wall, suitable for rectopexy, was identified. The EndoLifter was used to approximate the anterior wall of the proximal rectum to the anterior abdominal wall. Two percutaneous rectopexies were performed by puncture with the Loop FixtureII Gastropexy Kit® at the preset site of transillumination. After the percutaneous rectopexies, rectoscopy and exploratory laparotomy were performed. Finally, the animals were euthanized. The mean procedure time was 16min (11-21) and the mean length of the mobilized specimen was 4.32cm (range 2.9-5.65cm). A total of 10 fixations were performed with a technical success rate of 100%. There was no evidence of postoperative rectal prolapse in any of the animals. The EndoLifter facilitated the process by allowing the mucosa to be held and manipulated during the repair. Endoscopic-assisted percutaneous rectopexy is a safe and feasible endoluminal procedure for fixation of the rectum to the anterior abdominal wall in experimental animals.

Evaluation of Laparoscopic Ventral Rectopexy for Treatment of Rectal Prolapse

Background: Total or complete rectal prolapse is the circumferential full-thickness protrusion of the rectal wall through the anus. Rectal prolapse is a major problem for both patients and surgeons. The aim of the treatment is to repair the prolapse and its complication (like incontinence) with minimal postoperative complication. Two approaches are generally possible to treat the patients; the perineal approach and abdominal approach, but both of them have many complications like obstructed defecation, fecal incontinence, and recurrence. Since its invention, laparoscopic ventral rectopexy has many benefits for the patient, it is safe, effective, durable and minimally invasive. In this study, we evaluated the effect of Laparoscopic ventral rectopexy on fecal continence and postoperative morbidity (including constipation). Aim of the study: Was to evaluate Laparoscopic ventral rectopexy for the treatment of rectal prolapse. Patients and methods: This was a prospective study carried out at Ain Shams University Hospitals in Egypt and Saudi German Hospital in Jeddah, in the period between May 2011 and January 2015. Laparoscopic ventral rectopexy was performed in 28 consecutive patients who required surgery for total rectal prolapse. Follow-up was done for early postoperative complication, hospital stay, recurrence, severity of fecal incontinence, which was assessed by Wexner's incontinence score and the presence of constipation (obstructed defecation and STC) and its treatment (including laxative and enema use) which was assessed by Adapted Rome II Criteria over the interval (3,6 and 12 months) postoperative. Results: There were 28 patients who underwent laparoscopic ventral rectopexy (24 female and 4 male) with mean age 55.6 ± 5.3 years. The average operating time range was 153±26 min. There was no postoperative death and postoperative complications were minimal (one urinary tract infections & two pelvic collections). The mean postoperative stay was 5.8 days. Two patients had recurred disease, and twelve of the 21 incontinent patients became fully continent; seven others experienced only a minor degree of incontinence. Before surgery, 13 patients with symptoms of constipation 9 of them improved after surgery. Conclusion: Laparoscopic ventral rectopexy is an effective, minimally invasive procedure for the correction of rectal prolapse with minimal complications and lower recurrence rate.

PWE-384 Comparison of functional outcomes after laparoscopic ventral mesh rectopexy and resection rectopexy

Introduction Laparoscopic ventral mesh rectopexy (LVMR) repairs rectal prolapse and rectocoele by an autonomic nerve-sparing rectal dissection, using mesh reinforcement. The aim of this retrospective series was to assess functional outcomes of laparoscopic VMR and compare with an historical control group having had open resection rectopexy. Method Between 2012 and 2015, 64 patients had LVMR for rectal prolapse, functional obstructed defaecation (FOD) caused by rectocoele and/or faecal incontinence (FI). 31 out of 64 patients underwent preoperative imaging by MRI defaecating proctogram. Biological mesh was used in 51 out of 64 (80%) patients. We reviewed electronic patient records for outcomes and telephoned patients for further review of symptoms after surgery. Follow-up ranged from 1–33 months, median 12 months. Outcomes were also analysed in 68 patients who had open resection rectopexy between 1999 and 2009 (range 5–14 years, median 8 years). Results The conversion rate to open VMR was 7 out of 64 (11%) patients, due to adhesions from previous surgery. In this series of laparoscopic VMR, a total of 4 out of 64 patients required re-intervention, 2 for complications and 2 for technical failure (ie. early recurrent rectal prolapse and rectocoele). At 5 months there were no infections, fistulae or pain complications. In all patients with FI (n = 32), there was improvement in symptoms at initial follow-up. FOD resolved in 43 out of 44 patients. Outcomes from open resection rectopexy include FI (11 patients), constipation (8), FOD due to rectocoele (7), adhesional small bowel obstruction (7, of which 3 required laparotomy), uterovaginal prolapse (6), recurrent rectal prolapse (4) and incisional hernia (1). Conclusion Laparoscopic VMR is an effective technique for repairing rectocoele, rectal prolapse, and tricompartmental pelvic floor decent. It has a low complication rate with high resolution of symptoms at early follow-up (median 12 months). The longer term follow-up for open resection rectopexy suggested a higher level of recurrent prolapse, FI and FOD. Longer follow-up data on laparoscopic VMR patients is underway. This series of laparoscopic VMR repair for rectal prolapse and/or rectocoele has demonstrated early improvement in functional outcome overall and when compared with historical open resection rectopexy operations. Disclosure of interest None Declared. References D9Hoore A, Penninckx F. Laparoscopic ventral recto (colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006;20:1919–1923 D9Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004;91:1500–1505

Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results.

To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse. MEDLINE, PubMed, EMBASE, and other relevant database were searched to identify studies. Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review. Twelve non-randomized case series studies with 574 patients were included in the review. No surgical mortality was described. Conversion was needed in 17 cases (2.9%), most often due to difficult adhesiolysis. Twenty eight patients (4.8%) presented with major complications. Seven (1.2%) mesh-related complications were reported. Most frequent complications were urinary tract infection and urinary retention. Mean recurrence rate was 4.7% with a median follow-up of 23 mo. Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%. Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages. Evaluation of functional score was disparate between studies. Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.

Laparoscopic versus open mesh rectopexy for total rectal prolapse

To evaluate the efficacy and safety of laparoscopic versus open mesh rectopexy for total rectal prolapse. A retrospective review was conducted for 34 patients undergoing laparoscopic versus open mesh rectopexy for total rectal prolapse between January 2006 and December 2013. Laparoscopic rectopexy (n = 15) and open surgery (n = 19) were performed. Two groups were matched with regards to age, gender, body mass index (BMI) and American Society of Anesthesiologists (ASA) score. Mortality was zero in each group. There were insignificant inter-group differences in operative duration, postoperative complication, rate of long-term recurrence and improvement of incontinence and constipation. Perioperative blood loss, time to first flatus and hospital stay were significantly shorter in laparoscopic rectopexy group. Laparoscopic mesh rectopexy is as safe and efficient as open rectopexy. And both are suitable for senile patients. Long-term outcomes are similar for two groups, but laparoscopic group has better short-term outcome.

Long-term Outcomes of Robot-assisted Laparoscopic Rectopexy for Rectal Prolapse

Robot-assisted laparoscopic rectopexy for total rectal prolapse is safe and feasible. Small series proved clinical and functional short-term results comparable with conventional laparoscopy. No long-term results have been reported yet. The primary objective of the study was to evaluate long-term functional and anatomic results of robot-assisted laparoscopic rectopexy. The secondary objective was to evaluate the learning curve of this procedure. Monocentric study data, both preoperative and perioperative, were collected prospectively, and follow-up data were assessed by a telephone questionnaire. The study was performed in an academic center by 3 different surgeons. We evaluated all of the consecutive patients who underwent a robot-assisted laparoscopic rectopexy between June 2002 and August 2010. Rectopexy was performed with 2 anterolateral meshes or with 1 ventral mesh, and in 9 patients a sigmoidectomy was associated with rectopexy. The actuarial recurrence rate was evaluated using the Kaplan-Meier method. During the study period, 77 patients underwent a robot-assisted laparoscopic rectopexy, and the mean age was 59.9 years (range, 23-90 y). Average operating time was 223 minutes (range, 100-390 min); the learning curve was completed after 18 patients were seen. Two patients died of causes unrelated to surgery at 5 and 24 months. There were 5 conversions (6%) to open procedure. Overall morbidity was low and concerned only 8 patients (10.4%). Mean follow-up time was 52.5 months (range, 12-115 mo). Recurrences have been observed in 9 patients (12.8%). Preoperatively, 24 (34%) of the patients had constipation. Postoperatively, constipation disappeared for 12 (50%) of 24 and constipation appeared for 11 (24%) of 46 patients. Fecal incontinence decreased after surgery from Wexner score 10.5 to 5.1 of 20. There was a lack of standardization of the surgical procedure. The study was monocentric. Seven patients (9%) were lost to follow-up. Long-term results of robot-assisted laparoscopic rectopexy are satisfying. Further studies comparing robot-assisted and conventional laparoscopy, including cost-effectiveness, are needed.

Rectal prolapse repair via vaginal route

Many elderly patients have concomitant anorectal, urological and gynecological symptoms involving multiple perineal structures, which require the surgeon to operate in different areas of his specialty in order to correct different dystopias in a single procedure. We de- scribe a technique for total rectal prolapse correction offering low surgical risk for patients presenting with this pathology along with pelvic floor defects. We used a simple, minimally invasive technique, which showed complete success in the postoperative follow-up. The patients showed no peri- and post-operative complications and were discharged briefly after the procedure. Although it was a small sample, there was no case of rectal prolapse recurrence with the technique described. With the procedure described here, the treatment of rectal prolapse is possible with concomitant pelvic reconstruction in a single procedure, which is an interesting approach for elderly patients commonly affected by both diseases, as these patients often have other comorbidities that increase the perioperative risk.

Lessons Learned after more than 400 Laparoscopic Ventral Rectopexies

Background : Laparoscopic ventral recto(colpo)pexy (LVR) is a minimally invasive, autonomic nerve-sparing technique to treat rectal prolapse syndromes. The position of the mesh on the anterior aspect of the rectum in the rectovaginal septum allows correction of concomitant rectocele and enterocele.Methods : Demographic, perioperative, and follow-up data of consecutive patients were analyzed in order to audit our 10-years’ experience with the technique.Results : From January 1999 to December 2008, 405 patients (93% female) underwent LVR for internal rectal prolapse (45.9%, n = 186), total rectal prolapse (43%, n = 174) and rectocele or enterocele (11.1%, n = 45). Mean age was 54.6 years (SD 15). The median hospital stay was 4 days (range 2–21). Conversion rate was 2%. There was no postoperative mortality. At a mean follow-up of 25.3 months, recurrence was observed in 4.6% (19 patients). Most often detachment of the mesh at the sacral promontory was found. Late complications occurred in 18% of patients. In five patients, LVR combined with perineotomy was complicated by mesh erosion into the vagina. Mesh erosion was not observed after LVR without perineotomy. Symptomatic improvement was observed in 85% of patients with total rectal prolapse and in 70% of patients with internal rectal prolapse (p < 0.050). The difference was mainly due to a lesser effect on obstructed defecation symptoms.Conclusions : LVR, with or without perineotomy, appears to be safe and feasible, with relatively low morbidity. Functional outcome data support its efficacy. The indication for LVR in patients with internal rectal prolapse could be optimised.

Laparoscopic Anterior Rectopexy to the Promontory for Full-Thickness Rectal Prolapse in 175 Consecutive Patients

There are multiple procedures to treat full-thickness rectal prolapse. No consensus exists as to the best surgical option. All procedures have a significant recurrence rate. The aim of this study was to report short- and long-term technical results following laparoscopic removal of the Douglas pouch peritoneum and anterior rectopexy in patients with total rectal prolapse. This study is a prospective evaluation of consecutive patients. This investigation was conducted at a single academic colorectal unit. Between May 1996 and June 2009, 175 consecutive patients (17 males) with a mean age of 58 years (range, 16-94) were operated on. The Douglas pouch peritoneum was excised, 2 synthetic meshes were fixated to the anterior part of the lower rectum with five 4-mm staples and to the promontory with 3 spiked chromium staples, and the peritoneum was closed over the meshes to isolate them from the abdominal cavity. Patients were reviewed at months 1, 6, 12, and then annually. Mortality, morbidity, and recurrence were analyzed. Median follow-up was 74 months (range, 24-181). Recurrence rate was calculated according to the Kaplan-Meier method. : There was no mortality. Morbidity (5.1%) consisted in temporary brachial plexus palsy in 2 cases, urinary infection in 3 cases, ureteral lesion in 1 patient having had a previous bone graft on the promontory for spondylolisthesis (JJ catheter), and perforation of the small bowel because of adhesions (laparoscopic suture) in 1 case. One patient presented with a rectal erosion at month 9 (transanal removal of the mesh). Two patients presented with a recurrence of the rectal prolapse at months 6 and 24 (recurrence rate of 3% at 5 years) that was treated with anal artificial sphincter in one and redo operation in the other. Laparoscopic removal of the Douglas pouch peritoneum and rectopexy to the promontory is a safe and efficient procedure to treat full-thickness rectal prolapse.

Total Rectal Prolapse Reduced via Ketamine Administration in the Emergency Department

Total Rectal Prolapse Reduced via Ketamine Administration in the Emergency Department

Traitement chirurgical de la rectocèle et du prolapsus du rectum

BackgroundPostoperative constipation is a common problem with most mesh suspension techniques used to correct rectal prolapse. Autonomic denervation of the rectum subsequent to its complete mobilization has been suggested as a contributory factor. The aim of this study was to assess the long-term outcome of patients who underwent a novel, autonomic nerve-sparing, laparoscopic technique for rectal prolapse.MethodsBetween 1995 and 1999, 42 patients had laparoscopic ventral rectopexy for total rectal prolapse. The longterm results after a median follow-up of 61 (range 29–98) months were analysed.ResultsThere were no major postoperative complications. Late recurrence occurred in two patients. In 28 of 31 patients with incontinence there was a significant improvement in continence. Symptoms of obstructed defaecation resolved in 16 of 19 patients. During follow-up, new onset of mild obstructed defaecation was noted in only two patients. Symptoms suggestive of slow-transit colonic obstipation were not induced.ConclusionLaparoscopic ventral rectopexy is an effective technique for the correction of rectal prolapse and appears to avoid severe postoperative constipation. The ventral position of the prosthesis may explain the beneficial effect on symptoms of obstructed defaecation.

Recto (colpo, perineo) sacropexia ventral en el tratamiento del prolapso rectal y rectogenital

Introduction Ventral sacral-rectopexy with mesh corrects rectal prolapse and minimises rectal dissection. Subsequent colpopexy corrects apical and posterior prolapses of the vagina. The combination of both procedures can lead to the simultaneous correction of pelvic organ prolapses (POP). Objective To present the results of a patient series with several types of POP treated using the same approach and operation. Material and method A total of 57 patients diagnosed with any type of POP were operated on between January 2005 and August 2008 using ventral rectal-colpo-sacropexy, who were grouped into three types: A, total rectal prolapse isolated or combined with a hysterocele or colpocele (11 patients); B, rectoenterocele with internal rectal invagination and/or descending perineum (4 patients); and C, middle and posterior genital compartment prolapse (42 patients). The laparoscopic approach was used in the 15 patients of groups A and B and 11 from group C. A biological mesh was used in 41 patients and a macroporous synthetic one in the rest. Results The mean age of the patients in the series was 66 (19–81) years, with 55 females and 2 males. The median follow up was 25 (4–48) months. There were no major post-surgical complications. A recurrence of prolapse was recorded in one patient in group A (1/11); the 7 patients who suffered from incontinence improved after the surgery, no case of de novo constipation being recorded and an improvement in 8 of the 9 patients from groups A and B with obstructive defaecation. There were 9 (21%) recurrences detected in group C, but only 4 (9%) required reintervention. In all the recurrences a biological mesh had been used. Conclusions Laparoscopic ventral rectal-colpo-pexy is an effective technique to correct POP. Although safe and innocuous, the results with biological meshes did not last as long.

A report of 112 cases of solitary rectal ulcer syndrome from Iran

Abstract Solitary rectal ulcer syndrome (SRUS) is a syndrome with symptoms such as rectal bleeding, obstructed defecation, straining at stool and incomplete evacuation, and rectal polyps. In the present study, the clinical features of SRUS among Iranian patients is reviewed. Records of 112 patients diagnosed with SRUS between 1997 and 2007 admitted to a special coloproctology clinic have been analyzed retrospectively. Of 112 patients with SRUS, 61 were male (54.4%) and 51 female (45.6%) with a mean age of 32.2 years (range, 16–64 years). The mean interval between onset of symptoms and final diagnosis of SRUS was 3.8 years (range, 1–14 years). Rectal bleeding (67%) was the most common symptom in both genders, while a feeling of fullness was the least common symptom, observed only in one woman (2%). Incontinence was observed in 4 women (7.8%) and 3 men (4.9%), comprising 6.25% of the total clinical presentations. There were 38 patients (33.9%) with mucosal prolapse and 2 patients (1.8%) with total rectal prolapse. In conclusion, rectal bleeding in the presence of constipation or diarrhea is the main sign for diagnosis of SRUS. This syndrome is usually misdiagnosed; it is frequently confused with inflammatory bowel disease (IBD) because the rectal macroscopic and microscopic lesions and true polyps of rectum are similar. We suggest that most of patients who are treating for IBD and true polyps without any response are suffering from SRUS. Regarding misdiagnosis between SRUS and IBD or rectal polyp, the exact prevalence of SRUS has been mistakenly underestimated.

Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse

IntroductionVentral sacral-rectopexy with mesh corrects rectal prolapse and minimises rectal dissection. Subsequent colpopexy corrects apical and posterior prolapses of the vagina. The combination of both procedures can lead to the simultaneous correction of pelvic organ prolapses (POP). ObjectiveTo present the results of a patient series with several types of POP treated using the same approach and operation. Material and methodA total of 57 patients diagnosed with any type of POP were operated on between January 2005 and August 2008 using ventral rectal-colpo-sacropexy, who were grouped into 3 types: A, total rectal prolapse isolated or combined with a hysterocele or colpocele (11 patients); B, rectoenterocele with internal rectal invagination and/or descending perineum (4 patients); and C, middle and posterior genital compartment prolapse (42 patients). The laparoscopic approach was used in the 15 patients of groups A and B and 11 from group C. A biological mesh was used in 41 patients and a macroporous synthetic one in the rest. ResultsThe mean age of the patients in the series was 66 (19–81) years, with 55 females and 2 males. The median follow up was 25 (4–48) months. There were no major post-surgical complications. A recurrence of prolapse was recorded in one patient in group A (1/11); the 7 patients who suffered from incontinence improved after the surgery, no case of de novo constipation being recorded and an improvement in 8 of the 9 patients from groups A and B with obstructive defecation. There were 9 (21%) recurrences detected in group C, but only 4 (9%) required reintervention. In all the recurrences a biological mesh had been used. ConclusionsLaparoscopic ventral rectal-colpo-pexy is an effective technique to correct POP. Although safe and innocuous, the results with biological meshes did not last as long.

Aluminum Potassium Sulfate and Tannic Acid Injection in the Treatment of Total Rectal Prolapse: Early Outcomes

No surgical method for repair of total rectal prolapse has been established as optimal. We describe a new technique that uses ALTA (aluminum potassium sulfate and tannic acid) injection as a simple perianal procedure for total rectal prolapse. Fourteen patients with total rectal prolapse were treated with sclerosing therapy by using ALTA injection. Via a perianal approach, 0.5 to 1 ml of ALTA solution was injected along a linear track into the submucosa at 30 to 80 different sites, totaling 20 to 60 ml. All 14 patients treated with injection sclerotherapy were cured, with no intraoperative or postoperative complications. One patient required a repeat injection after two months to be cured. No exacerbation of constipation has resulted, and no stenosis has been evident on rectal examination. In seven of ten patients presenting with fecal incontinence, this complaint resolved after therapy. ALTA sclerotherapy yielded satisfactory results in total rectal prolapse, causing no alteration in neurophysiology of bowel function. Injection sclerotherapy should be recommended as the first procedure for treatment of total rectal prolapse.