- Laparoscopic-assisted abdominoperineal proctosigmoidectomy for rectal prolapse : A new technique. [Journal Article]
- SESurg Endosc 1997; 11(2):150-151
- The inability to completely mobilize the redundant colon in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse is a main contributor to the recurrence rate associa...
The inability to completely mobilize the redundant colon in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse is a main contributor to the recurrence rate associated with the procedure. However, the presence of a redundant sigmoid after the Ripstein procedure or other rectal sling operations is the main cause of the high rate of postoperative constipation and stool impaction. Low anterior resection as the definitive treatment is associated with the higher morbidity of laparotomy and the risk of anastomotic leak. We describe a laparoscopic-assisted surgical approach which combines the benefits of completely resecting the redundant sigmoid colon as well as the performance of extraperitoneal anastomosis at the level of the anus.
- Indications and Complications Associated with the Removal of 506 Pieces of Vaginal Mesh Used in Pelvic Floor Reconstruction: A Multicenter Study. [Journal Article]
- STSurg Technol Int 2016 Oct 26; XXIX:185-189
- CONCLUSIONS: In our study, the most common indication for mesh removal was pain with or without intercourse. The most common mesh procedure resulting in removal was the TOT sling. Use of a vaginal approach only for sling removal had the lowest incidence of intraoperative complications. Laparoscopic RPS removal had the highest incidence of required blood transfusions, anterior TVM had the highest incidence of ureteral injury, and posterior TVM had the highest incidence of rectal injury. Overall, sling, TVM, and sacrocolpopexy mesh removal are safe procedures when performed by experienced surgeons.
- Incidence and risk factors for pelvic pain following mesh implant surgery for the treatment of pelvic floor disorders. [Journal Article]
- JMJ Minim Invasive Gynecol 2016 Oct 20
- CONCLUSIONS: One in six women reported de novo pelvic pain after pelvic mesh implant surgery, with decreased sexual function. Risk factors included younger age, fibromyalgia, early post-operative pain, poorer physical health, and somatization. Understanding risk factors for pelvic pain after mesh implantation may improve patient selection.
- A novel technique for correction of total rectal prolapse: Endoscopic-assisted percutaneous rectopexy with the aid of the EndoLifter. [Journal Article]
- RGRev Gastroenterol Mex 2016 Oct - Dec; 81(4):202-207
- CONCLUSIONS: Endoscopic-assisted percutaneous rectopexy is a safe and feasible endoluminal procedure for fixation of the rectum to the anterior abdominal wall in experimental animals.
- Rectal prolapse in Winnie mice with spontaneous chronic colitis: changes in intrinsic and extrinsic innervation of the rectum. [Journal Article]
- CTCell Tissue Res 2016; 366(2):285-299
- Rectal prolapse is associated with diminished anal sensitivity and rectal motor activity. Both sensory and motor functions are controlled by the extrinsic and intrinsic (enteric nervous system) inner...
Rectal prolapse is associated with diminished anal sensitivity and rectal motor activity. Both sensory and motor functions are controlled by the extrinsic and intrinsic (enteric nervous system) innervation of the gastrointestinal tract. Studies of changes in intestinal innervation in humans and in animal models with rectal prolapse are extremely scarce. The Winnie mouse model of spontaneous chronic colitis closely represents human inflammatory bowel disease and is prone to develop rectal prolapse. We have investigated changes in the myenteric and inhibitory motor neurons and evaluated changes in the density of sensory afferent, sympathetic, and parasympathetic fibers in the rectal colon of Winnie mice with and without rectal prolapse. Our results demonstrate that rectal prolapse in Winnie mice with chronic colitis is correlated with enhanced levels of inflammation, gross morphological damage, and muscular hypertrophy of the rectum. Animals with prolapse have more severe damage to the rectal innervation compared with Winnie mice without prolapse. This includes more severe neuronal loss in the myenteric plexus, involving a decrease in nNOS-immunoreactive neurons (not observed in Winnie mice without prolapse) and a more pronounced loss of VAChT-immunoreactive fibers. Both Winnie mice with and without prolapse have comparable levels of noradrenergic and sensory fiber loss in the rectum. This is the first study providing evidence that the damage and death of enteric neurons, including nitrergic neurons in myenteric ganglia and the loss of cholinergic nerve fibers, are important factors in structural changes in the rectum of mice with rectal prolapse.
- Laparoscopic Protack rectopexy for the management of full thickness rectal prolapse- a video vignette. [Letter]
- CDColorectal Dis 2016 Oct 18
- Full thickness rectal prolapse (FTRP) treatment options are surgical, either abdominal or perineal procedures. Laparoscopic ventral rectopexy has been suggested as safe option in the elderly cohort o...
Full thickness rectal prolapse (FTRP) treatment options are surgical, either abdominal or perineal procedures. Laparoscopic ventral rectopexy has been suggested as safe option in the elderly cohort of patients; however, there is growing concern about mesh complications, in particular rectal mesh fistulation. (1-3) "Laparoscopic Protack rectopexy (LPR)" for FTRP is becoming an established alternative intra-abdominal approach for the treatment of rectal prolapse(4) with the benefit of absence of a mesh. This article is protected by copyright. All rights reserved.
- [Transtar™ operation for rectocele and obstructed defecation syndrome]. [Review]
- CChirurg 2016 Oct 14
- The Contour® Transtar™ operation represents a further methodological development of conventional transanal stapled rectal resection (STARR) for the treatment of obstructed defecation syndrome (ODS) a...
The Contour® Transtar™ operation represents a further methodological development of conventional transanal stapled rectal resection (STARR) for the treatment of obstructed defecation syndrome (ODS) and/or full thickness rectal prolapse. In contrast to the conventional STARR technique a specially designed single curved stapler is used with which the rectal wall is incised in a circular fashion and anastomosed. This results in a monoblock resection with almost unlimited extent of resection. In multicenter studies the procedure has generally been shown to be effective for treatment of ODS with intussusception and rectocele. In comparison to conventional STARR the resected tissue samples are larger and the functional effectiveness is comparable. Furthermore, data from prospective randomized trials revealed higher effectiveness in long-term follow-up. With reference to full thickness rectal prolapse, feasibility studies have been performed which showed low morbidity but long-term follow-up studies suggest a high recurrence rate of >40 %.
- Rectal bleeding and prolapse… not always benign diseases rather anal cancer. The importance of a correct decision making since primary care. [Journal Article]
- GCG Chir 2016 May-Jun; 37(3):133-135
- Rectal bleeding is very common in general population with a prevalence of 10-20 %. Primary care physicians have to stratify patients basing on urgency and on the colo-rectal cancer risk and to conduc...
Rectal bleeding is very common in general population with a prevalence of 10-20 %. Primary care physicians have to stratify patients basing on urgency and on the colo-rectal cancer risk and to conduct a decision making for the correct management. We report a case of a 61-years-old woman, complaining rectal bleeding and an anal mass attended to their family doctor who does a visit but without a digital rectal examination and diagnosed a hemorrhoidal prolapse suggesting medical therapy. For the persistence of symptoms she comes to our service from emergency attention. Inspection and digital rectal examination revealed an anal mass. CT scan was performed showing a large anal mass involving half anal circumference. Histologic samples showed an epithelial proliferation compatible with a squamous carcinoma. Oncological consult was requested and a chemo-radiotherapy treatment was proposed. This case report highlights the difficulty when physicians assess patients with anorectal complaints in differentiating anal cancer from benign disease, presumably because symptoms are similar. Primary care physicians must maintain a high index of suspicion of cancer in high-risk population. Sensitization of these colleagues is required since digital rectal examination is of inestimable value to verify the presence of a rectal or an anal mass.
- An Unusual Cause of Rectal Stenosis. [Journal Article]
- CRCase Rep Gastroenterol 2016 May-Aug; 10(2):406-409
- Solitary rectal ulcer syndrome (SRUS) is a benign disease that is often misdiagnosed. It is characterized by a combination of symptoms, endoscopic findings and histology. Patients present with consti...
Solitary rectal ulcer syndrome (SRUS) is a benign disease that is often misdiagnosed. It is characterized by a combination of symptoms, endoscopic findings and histology. Patients present with constipation, rectal bleeding, mucous discharge, pain and a sensation of incomplete defecation. There are many different manifestations of this disease, with or without rectal prolapse. We report an unusual presentation of SRUS as a circular stenosis in a middle-aged male.
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- High-resolution Rectoanal Manometry for Identifying Defecatory Disorders and Rectal Structural Abnormalities in Women. [Journal Article]
- CGClin Gastroenterol Hepatol 2016 Oct 5
- CONCLUSIONS: In a retrospective analysis of patients assessed by HRM, measurements of rectal evacuation by anorectal HRM, BET, and MRI were correlated. HRM alone, and together with anorectal descent during evacuation, may identify rectal prolapse and large rectoceles, respectively, and also identify unique phenotypes of rectal prolapse.