Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Rectal Prolapse [keywords]
- Laparoscopic repair of recurrent lateral enterocele and rectocele. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Sep 16.
It is difficult to determine what types of procedures should be attempted in patients who have recurrent prolapse. We present a case of recurrent lateral enterocele and rectocele after the patient had undergone multiple surgeries for pelvic organ prolapse (POP), including a vaginal hysterectomy, bladder-neck suspension, anterior colporrhaphy, site-specific rectocele repair, apical mesh implant, iliococcygeus vault suspension, and transobturator suburethral sling procedure. With recurrence, the patient underwent robot-assisted laparoscopic sacral colpopexy, tension-free vaginal tape transobturator sling insertion, rectocele repair, and perineorrhaphy with cystoscopy. She then presented with defecatory outlet obstruction and constipation and subsequently was treated with a stapled transanal rectal resection. The patient returned with continued defecatory dysfunction and a recurrent lateral enterocele and rectocele. The recurrence was treated laparoscopically using a lightweight polypropylene mesh. The postoperative period was uneventful. Two years later, the patient reported decreased defecatory symptoms and no further symptomatic prolapse.
- Altemeier operation for gangrenous rectal prolapse. [Journal Article]
- S Afr J Surg 2014 Aug; 52(3):86-7.
A stranguled rectal prolapse is a rare cause of intestinal occlusion. It requires emergency surgery. A patient who underwent emergency perineal proctectomy, the Altemeier operation, combined with diverting loop sigmoid colostomy is described. The postoperative course was uneventful, with an excellent final result after colostomy closure. The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual scenario of bowel incarceration.
- Thd(®) doppler for haemorrhoids: results from a multicenter trial. [JOURNAL ARTICLE]
- Colorectal Dis 2014 Sep 12.
This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of a Doppler guided THD (THD(®) Doppler) in the treatment of symptomatic haemorrhoids and to identify predictive failure factors for an effective mid-term outcome.803 patients affected by grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD(®) Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni- and multivariate analysis of the potential predictive factors of failure was performed.The morbidity rate was 18.0%, and it was represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in 7 patients (0.9%). No serious or life-threatening complication occurred. After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%), 5 (0.6%) patients, respectively. Sixteen out of 47 re-operated patients underwent a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (p<0.0001). At multivariate analysis the absence of morbidity and performing a distal Doppler-guided dearterialization were associated to a better outcome.THD(®) Doppler is a safe and effective therapy of haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms. This article is protected by copyright. All rights reserved.
- Perioperative complications in abdominal sacrocolpopexy, sacrospinous ligament fixation and prolift procedures. [Journal Article]
- Balkan Med J 2014 Jun; 31(2):158-63.
Pelvic organ prolapse is an important problem for women. To overcome this issue, different operational technics are in use, such as abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure.This study assessed perioperative complications in abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure.Retrospective comparative study.Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures, 60 patients underwent sacrospinous fixation, and 43 patients underwent the total Prolift procedure.In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the sacrospinous group, one rectal injury and one postoperative vault infection occurred. In the Prolift group, one bladder injury and one hemorrhage occurred. Minor complications were more frequent in the abdominal group than the others. The operating time and hospital stay of the abdominal group were significantly longer than the others. The Pro-lift procedure had less operating time and hospital stay than other procedures.The total Prolift may be a novel alternative for apical prolapse with low perioperative morbidities and complications.
- Ventral Colporectopexy For Overt Rectal Prolapse And Obstructed Defaecation Syndrome: A Systematic Review. [JOURNAL ARTICLE]
- Colorectal Dis 2014 Sep 4.
Laparoscopic ventral rectopexy (VR) with the use of prosthesis has been advocated for both overt rectal prolapse (ORP) and obstructed defaecation syndrome (ODS). The present study reviews the short-term and functional results of laparoscopic VR.A MEDLINE, Embase, Ovid, and Cochrane database search was performed on all studies reporting on VR for ORP, ODS and other pelvic floor anatomical abnormalities from 2004 until February 2013. No language restrictions were made. All studies on VR were reviewed systematically. The main outcomes were intraoperative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, ORP recurrence, anatomical disorder recurrence, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers.Twenty three studies including 1,460 patients were eligible for analysis. The conversion rate ranged from 0 to 14.3%. No mortality was reported. The immediate postoperative morbidity rate was 8.6%. Length of stay ranged from 1 to 7 days. A significant improvement in constipation and incontinence symptoms was observed in the postoperative period for both ORP and ODS (chi-square test, p<0.0001).Laparoscopic VR is a safe and effective procedure for ORP and ODS. Longer follow-up is required and studies comparing VR to standard rectopexy and STARR are not yet available. This article is protected by copyright. All rights reserved.
- Review of the Diagnosis, Management and Treatment of Fecal Incontinence. [JOURNAL ARTICLE]
- Female Pelvic Med Reconstr Surg 2014 Sep 2.
Fecal incontinence is a common problem affecting women but is underreported because of patients' reluctance to discuss their symptoms and an inconsistent use of screening tools by physicians. Obstetric injury from vaginal delivery is the principal cause of fecal incontinence among young women. Prevalence rates are highest in the elderly, especially those with declining cognitive function. There are multiple diagnostic tests including anal manometry, endosonography, defecography, and pudendal nerve latency testing to assist physicians in the workup of patients and aid in the selection of appropriate treatment options. After patient identification and workup, most patients can be offered conservative measures including dietary measures and biofeedback. Surgery is indicated for specific abnormalities such as rectal prolapse, fistula, and recent obstetrical sphincter injury repair. Management of refractory cases may include sacral nerve stimulation and percutaneous tibial nerve stimulation. Fecal diversion or an artificial bowel sphincter may be considered when all else has failed.Primary care physicians, gynecologists, and specialists in female pelvic medicine should screen women for fecal incontinence. Initial conservative therapy may be directed by the primary health provider, and those resistant to this approach should be referred to specialist care.
- Laparoscopic ventral mesh rectopexy (LVMR) in male patients with internal or external rectal prolapse. [JOURNAL ARTICLE]
- Colorectal Dis 2014 Sep 1.
Laparoscopic ventral mesh rectopexy (LVMR) has been used to treat rectal prolapse, obstructive defaecation (OD), faecal incontinence (FI) and multi-compartment pelvic floor dysfunction. Its value in treating males has been questioned. The aim of the present study was to assess the results in these patients.A password protected electronic database was examined of all LVMRs carried out between 2002-13. In addition to the clinical outcome, quality of life (QoL), Cleveland Clinic Incontinence Score (CCIS), Obstructive Defecation Syndrome (ODS) score, visual analogue score (VAS) for the severity of bowel and urinary symptoms, Numerical Rating Scale (NRS) for pain and patient-reported outcome measures (PROMs) were evaluated RESULTS: 68 males of median age 35 years and BMI 26 kg/m(2) underwent LVMR for external rectal prolapse (18) or grade III-V rectal intussusception (50) presenting with OD, FI and pelvic pain. 10% had been labelled "chronic idiopathic pelvic pain" and 60% had undergone previous haemorrhoidal surgery. Complications were minor and included urinary retention (10%). 80% of patients had an uncomplicated recovery with 24% performed as day cases. There was no cases of impotence or retrograde ejaculation. Median FU was 42 (IQR 26-61) months. CCIS improved from 4 (IQR 0-8) to 0 (IQR 0-0) [p < 0.001] and the ODS score from 18.5 (IQR 16-22) to 6 (IQR 5-8) [p<0.001]. Patients reported significant improvement in NRS for pain and QoL (BBSQ-22) at three months (p=0.000). The QoL and the VAS for bowel symptoms were maintained at 4 years. At the last follow up 56 (82%) of patients were asymptomatic and 6 (8.8%) had persisting symptoms. There was no case of recurrent ERP.LVMR is an effective treatment of external and symptomatic internal rectal prolapse in males leading to significant improvement in QoL and function. This article is protected by copyright. All rights reserved.
- Rectal Prolapse and Cystic Fibrosis. [JOURNAL ARTICLE]
- J Pediatr Gastroenterol Nutr 2014 Aug 25.
Screening for cystic fibrosis (CF) is suggested in patients with rectal prolapse. Little is known about this association in the era of newborn screening (NBS) for CF. Our retrospective review showed that 3.6% of patients with rectal prolapse had CF, and 3.5% of CF patients had rectal prolapse. No demographic or clinical factors appear to predict the likelihood of rectal prolapse in patients with CF. Sweat chloride testing for patients with rectal prolapse has a very low yield in the era of NBS but may still need to be considered in children with rectal prolapsed to avoid missing the rare child with CF.
- Robot-assisted or conventional laparoscoic rectopexy for rectal prolapse? Systematic review and meta-analysis. [JOURNAL ARTICLE]
- Int J Surg 2014 Aug 22.
Aim: The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However the role of robotic assistance in laparoscopic rectopexy is still not demonstrated. Methods: A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library, and Google Scholar up to 30th June 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the data currently available regarding the incidence of recurrence rate of rectal prolapse, conversion rate, operative time, intra-operative blood loss, post-operative complications, re-operation rate and hospital stay in robot-assisted rectopexy (RC) compared to conventional laparoscopic rectopexy (LR). Results: Six studies were included resulting in 340 patients. The meta-analysis showed that the RR does not influence the recurrence rate of rectal prolapse, the conversion rate and the re-operation rate, whereas it decreases the intra-operative blood loss, the post-operative complications and the hospital stay. Yet, the RR resulted to be longer than the LR. Post-operative ano-rectal and the sexual functionality and procedural costs could not meta-analyzed because the data from included studies about these issues were heterogeneous and incomplete. Conclusion: The meta-analysis showed that the RR may ensure limited improvements in post-operative outcomes if compared to the LR. However, RCTs are needed to compare RR to LR in terms of short-term and long-term outcomes, specially investigating the functional outcomes that may confirm the cost-effectiveness of the robotic assisted rectopexy.
- Recurrence after perineal rectosigmoidectomy: when and why? [JOURNAL ARTICLE]
- Colorectal Dis 2014 Aug 23.
Reported recurrence rates after perineal rectosigmoidectomy (Altmeier's procedure) in patients with full-thickness rectal prolapse vary from 0-60%. The object of this study was to analyze risk factors for recurrence after this procedure.From May 2004 to December 2012, 63 consecutive patients suffering from full-thickness rectal prolapse undergoing perineal rectosigmoidectomy were included. Of these 46 were female and the median age of the whole group was 79 (30-90) years. The median follow-up was 53 (3-99) months. Patient characteristics and operative parameters were compared between patients with and without recurrence.One patient died and another patient needed reoperation. Eight full-thickness recurrences occurred in eight patients after a median of 18 (6-48) months. Stapled compared with handsewn anastomosis (hazard ratio 7.96, 95% confidence interval 1.90-33.47; p = 0.001) and shorter specimen length (hazard ratio 4.06, 95% confidence interval 0.97-16.99; p = 0.03) increased the risk of recurrence in Cox regression analysis.Operative technique including stapled anastomosis and length of the resected specimen seem to be associated with a high recurrence rate after perineal rectosigmoidectomy. This article is protected by copyright. All rights reserved.