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Rectal Prolapse [keywords]
- Lessons from an aggressive angiomyxoma unrecognized and treated as rectal prolapse. [JOURNAL ARTICLE]
- Int J Colorectal Dis 2014 Dec 12.
- Comparison of outcomes between laparoscopy-assisted and posterior sagittal anorectoplasties for male imperforate anus with recto-bulbar fistula. [Journal Article]
- J Pediatr Surg 2014 Dec; 49(12):1815-7.
All reports comparing laparoscopy-assisted anorectoplasty (LAARP) with posterior sagittal anorectoplasty (PSARP) in male high-type imperforate anus include a mix of recto-vesical, recto-prostatic, recto-bulbar, and absent fistula cases without focusing on recto-bulbar fistula (RBF), the most challenging type to treat laparoscopically. We compared LAARP with PSARP for treating only RBF.We used our fecal continence evaluation questionnaire (FCE; maximum score=10), scoring of magnetic resonance imaging (MRI) findings (MRI scores), and the angle between the rectum and the anal canal (RAA) to assess 20 RBF cases (LAARP=12, PSARP=8) treated from 2000 to 2013 prospectively.Mean ages at surgery, MRI scores, mean RAA, and duration of raised C-reactive protein (6.6 vs. 6.7days; p=NS) were similar. In all cases, postoperative MRI showed no residual fistula and normal urination. LAARP had consistently higher FCE (7.9 vs. 7.8 at 3years; 8.6 vs. 8.3 at 5years; 8.9 vs 8.6 at 7years; p=NS, respectively), less wound infections (0 vs. 37.5%; p<0.05), higher incidence of rectal mucosal prolapse (50.0 vs. 0%; p<0.05), and required less analgesia (p<0.05).Although LAARP and PSARP are comparable for treating RBF, LAARP is associated with less wound infections and higher incidence of rectal mucosal prolapse.
- Residual Prolapse in Patients with III-IV Degree Haemorrhoids Undergoing Stapled Haemorrhoidopexy with CPH34 HV: Results of an Italian Multicentric Clinical Study. [Journal Article]
- Surg Res Pract 2014.:710128.
CPH34 HV, a high volume stapler, was tested in order to assess its safety and efficacy in reducing residual/recurrent haemorrhoids. The clinical charts of 430 patients with third- to fourth-degree haemorrhoids undergoing SH in 2012-2013 were consecutively reviewed, excluding those with obstructed defecation (rectocele >2 cm; Wexner's score >15). Follow-up was scheduled at six and 12 months. Rectal prolapse exceeding more than half of CAD was reported in 341 patients (79.3%); one technical failure was reported (0.2%) without any serious untoward effect; and 1.3 stitch/patient (SD, 1.7) was required to achieve complete haemostasis. Doughnuts volume was higher (13.8 mL; SD, 1.5) in patients with a large rectal prolapse than with smaller one (8.9 mL; SD, 0.7) (P value <0.05). Residual and recurrent haemorrhoids occurred in 8 of 430 patients (1.8%) and 5 of 254 patients (1.9%), respectively. A high index of patient satisfaction (visual analogue scale = 8.9; SD, 0.9) coupled with a persistent reduction of constipation scores (CSS = 5.0, SD, 2.2) was observed. The wider prolapse resection well correlated with a clear-cut reduction of haemorrhoidal relapse, a high index of patient satisfaction, and clinically relevant reduction of constipations scores coupled with satisfactory haemostatic properties of CPH34 HV.
- Single-incision laparoscopic-assisted anorectoplasty using conventional instruments for children with anorectal malformations and rectourethral or rectovesical fistula. [Journal Article]
- J Pediatr Surg 2014 Nov; 49(11):1689-94.
This study aims to evaluate the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for children with anorectal malformations (ARM) and rectourethral or rectovesical fistula.Children with ARMs and rectourethral or rectovesical fistula who underwent SILAARP between May 2011 and December 2012 were reviewed. The operative time, early postoperative and follow-up results were analyzed.Thirty-one patients (ARM with rectovesical vs. rectoprostatic fistula vs. rectobulbar fistula: 9/6/16) successfully underwent SILAARPs without conversions. Mean ages at operation were similar in 2 groups (ARM with rectovesical or rectoprostatic fistula vs. ARM with rectobulbar fistula: 4.94months vs. 5.67months, p=0.46). Average operative time in ARM children with rectobulbar fistula was 1.94hours, which did not differ from 1.78hours in ARM children with rectovestical or rectoprostatic fistula (p=0.39). All patients resumed feeding on postoperative day 1. The median follow-up period was 20months. No injuries of vessels, urethral or vas deferens occurred in operations. No mortality or morbidities of wound infection, rectal retraction, recurrent fistula, urethral diverticulum, anal stenosis, or rectal prolapse was encountered.SILAARP is safe, feasible and effective for ARM with rectourethral or rectovesical fistula. One-stage SILAARP may offer a viable alternative treatment for ARM children with rectourethral or rectovesical fistula.
- The role of synthetic and biologic materials in the treatment of pelvic organ prolapse. [Journal Article, Review]
- Clin Colon Rectal Surg 2014 Dec; 27(4):182-90.
Pelvic organ prolapse is a significant medical problem that poses a diagnostic and management dilemma. These diseases cause serious morbidity in those affected and treatment is sought for relief of pelvic pain, rectal bleeding, chronic constipation, obstructed defecation, and fecal incontinence. Numerous procedures have been proposed to treat these conditions; however, the search continues as colorectal surgeons attempt to find the procedure that would optimally treat these conditions. The use of prosthetics in the repair of pelvic organ prolapse has become prevalent as the benefits of their use are realized. While advances in biologic mesh and new surgical techniques promise improved functional outcomes with decreased complication rates without de novo symptoms, the debate concerning the best prosthetic material, synthetic or biologic, remains controversial. Furthermore, laparoscopic ventral mesh rectopexy has emerged as a procedure that could potentially fill this role and is rapidly becoming the procedure of choice for the surgical treatment of pelvic organ prolapse.
- Sacral neuromodulation for faecal incontinence: is the outcome compromised in patients with high-grade internal rectal prolapse? [JOURNAL ARTICLE]
- Int J Colorectal Dis 2014 Nov 30.
High-grade internal rectal prolapse appears to be one of the contributing factors in the multifactorial origin of faecal incontinence. Whether it affects the outcome of sacral neuromodulation is unknown. We compared the functional results of sacral neuromodulation for faecal incontinence in patients with and without a high-grade internal rectal prolapse.One hundred six consecutive patients suffering from faecal incontinence, who were eligible for sacral neuromodulation between 2009 and 2012, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and ultrasound. Symptoms were assessed preoperatively and at 12 months after operation using a standardized questionnaire incorporating the Faecal Incontinence Severity Index (FISI range = 0-61) and the Gastrointestinal Quality of Life Index (GIQLI). Success was defined as a decrease in the FISI score of 50 % or more.High-grade internal rectal prolapse (HIRP) was found in 36 patients (34 %). The patient characteristics were similar in both groups. Temporary test stimulation was successful in 60 patients without HIRP (86 %) and in 25 patients with HIRP (69 %) (p = 0.03). A permanent pulse generator was then implanted on these patients. After 1-year follow-up, the median FISI was reduced in patients without HIRP from 37 to 23 (p < 0.01). No significant change in FISI score was observed in patients with a HIRP (FISI, 38 to 34; p = 0.16). Quality of life (GIQLI) was only improved in patients without HIRP. A successful outcome per protocol was achieved in 31 patients without HIRP (52 %) versus 4 patients with HIRP (16 %) (p < 0.01).The presence of a high-grade internal rectal prolapse has a detrimental effect on sacral neuromodulation for faecal incontinence.
- Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien-Dindo classification. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2014 Nov 28.
To systematically review surgical complications of vaginal native tissue prolapse repair using Clavien-Dindo classification and to show whether concomitant surgery leads to increased complication rates.Retrospective analysis of complications in 438 consecutive vaginal native tissue prolapse repairs and subgroup analysis was performed for concomitant hysterectomy or sacrospinous fixation for level I defects using Fisher´s exact tests.Anterior and posterior colporrhaphia was performed in all 438 patients and sacrospinous fixation (SSF) for level I defects in 269 patients. Prolapse repair was combined with hysterectomy in 255 cases. One intra-operative bladder lesion (0.23 %) and one rectal lesion (0.23 %) occurred. Postoperative urinary tract infection requiring antibiotics was noted in 34 cases (7.8 %). Post-void residual volume was medically treated in 24 cases (5.5 %). Four patients (0.9 %) underwent postoperative suprapubic catheter insertion. Asymptomatic gluteal hematomas were noted in 11 cases (2.5 %). Four patients (0.9 %) underwent re-operations for postoperative hemorrhage. Mean hospital stay was 5.6 days. Minor complications were classified as CD grade I in 2.5 %, as CD grade II in 13.2 %, complications requiring surgical intervention as grade IIIa in 0.9 % and as grade IIIb in 0.9 % of patients. No CD grade IV or V complications occurred. Apart from gluteal hematomas classified as CD grade I occurring in the SSF group (p = 0.019), no other differences of complication rates were found in the hysterectomy subgroup or in the SSF subgroup.Surgery was associated with low rate of CD grade III complications. Re-operation rate was 0.9 %. The authors suggest introduction of CD classification for comparability of prolapse surgery.
- Direct current electrotherapy for internal haemorrhoids: experience in a tertiary health institution. [Journal Article]
- Pan Afr Med J 2014.:145.
Haemorrhoids disease is one of the most frequently occurring disabling conditions of the anorectum. We re-present the method, advantages and results of using direct current electrotherapy in the treatment of haemorrhoids.Symptomatic grades 1, 2 or 3 internal and mixed haemorroids were treated. Exposure and evaluation was with an operative proctoscope which visualized one-eighth of the anal canal at a time. All diseased segments were treated per visit, indicators of successful treatment were, darkening of the treated segment, immediate shrinking of the haemorrhoid and ceasation of popping sound of gas release at the probe tip. Patients were followed up for two weeks. No bowel preparations, medications, anesthesia nor admission was required.Four hundred and fifty six segments were exposed, 252(55.3%) were diseased. eight patients with either grades 2 or 3 diseases required two treatment visits. The most common symptom was rectal bleeding (94.7%), followed by prolapsed but manually reduced hemorrhoids (68%). Prolapse of tuft of haemorrhoidal tissue with spontaneous return was seen in 59.6%, anal pain in 29.8%, and itching in 3.5%. the median number treated segments per patient was 4. No complication was encountered. All patients treated remained symptom free at a mean duration of follow up of 16 months.Direct current electrotherapy is an effective, painless and safe out-patient treatment method for grades 1 to 3 internal and mixed hemorrhoid disease.
- Laparoscopic Ventral Rectopexy for Faecal Incontinence: Equivalent Benefit is seen in Internal and External Rectal Prolapse. [JOURNAL ARTICLE]
- J Gastrointest Surg 2014 Nov 21.
An external rectal prolapse (ERP) is often associated with faecal incontinence, and surgery is the recommended therapy. It has been suggested that correction of a high grade internal rectal prolapse (HIRP) is also worthwhile for patients with faecal incontinence. The aim of the present study is to compare the results of laparoscopic ventral rectopexy (LVR) in patients with faecal incontinence associated with either an ERP or a HIRP.Consecutive patients suffering from faecal incontinence, who underwent a LVR between June 2010 and October 2012, were identified from a prospective database. All patients underwent preoperative defaecating proctography, anorectal manometry and ultrasound. Symptoms were assessed preoperatively and at 1 year after operation using a standardized questionnaire incorporating the Faecal Incontinence Severity Index (FISI; range 0-61) and the Gastrointestinal Quality of Life Index (GIQLI).LVR was performed in 50 incontinent patients with a HIRP, and in 41 patients with an ERP. Preoperatively, the FISI was higher in patients with HIRP (HIRP 42 versus ERP 30, P < 0.01). The recurrence rate at 1 year was similar in both groups (HIRP 6 % versus ERP 2 %, P = 0.156). The FISI scores were significantly reduced in both groups (HIRP 48 % versus ERP 50 %, both P < 0.01). GIQLI was equally improved in both groups (HIRP 17 % versus ERP 18 %, both P < 0.01).Laparoscopic ventral rectopexy for the treatment of faecal incontinence achieves equivalent outcomes in both patients with an external rectal prolapse or high grade internal rectal prolapse.
- Long-term Outcome of Stapled Transanal Rectal Resection (STARR) versus Stapled Hemorrhoidopexys (STH) for Grade III-IV Hemorrhoids: Preliminary Results. [JOURNAL ARTICLE]
- In Vivo 2014 11-12; 28(6):1171-1174.
Circular stapled transanal hemorrhoidopexy (STH) was first introduced by A. Longo for the correction of internal mucosal prolapse and obstructed defecation and in 1998, was proposed as alternative to conventional excisional hemorrhoidectomy. More recently, stapled transanal rectal resection (STARR) has gradually gained popularity, as the Longo procedure, in the treatment of hemorrhoids. The aim of our study was to evaluate the usefulness of STARR as alternative to STH in patients with grade III (n=218, 68.1%) and IV (n=102, 31.9%) hemorrhoids. A group of 320 consecutive patients (median age=51 years; range=16-85) underwent STH (n=281) or STARR (n=39) procedure. The rate of postoperative bleeding (53.8% vs. 74.4%, p<0.01) was significantly reduced in patients who underwent STARR procedure, which required a longer (45±22 vs. 26±11 min, p<0.01) operative time. There were no differences between groups with regard to use of painkillers, postoperative pain intensity, short- (three months) and long-term (one and three years) residual pain, soiling, incontinence and urgency. Patients treated with the STARR procedure had lower recurrence rate of hemorrhoids and a lower incidence of prolapse, both at one year (none vs. 1.4%, p=0.593 and 2.6% vs. 5.3%, p=0.396, respectively) and at two years (none vs. 6.8%, p=0.078 and none vs. 13.2%, p=0.012, respectively). The one-year (9.0±1.8 vs. 9.4±0.7, p=0.171) and two-year (9.6±0.8 vs. 9.1±1.7, p=0.072) general satisfaction was similar but higher in STARR patients than in the STH group. In conclusion, according to our preliminary results, the STARR procedure leads to a lower incidence of complications and recurrences and should be considered for patients with grade III or IV hemorrhoids previously selected for stapled hemorrhoidectomy, as a promising alternative to STH.