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Rectal Prolapse [keywords]
- 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.
- Laparoscopic rectopexy for external prolapse in children. [Journal Article]
- J Pediatr Surg 2014 Sep; 49(9):1413-5.
This study reports the results of laparoscopic rectopexy in children.Results were obtained from a prospective database for all laparoscopic rectopexy procedures performed for external prolapse in a tertiary referral centre from 2006 to 2013. Outcomes included recurrence of symptoms and/or visible prolapse as well as the need for further surgeryEighteen procedures including both suture and mesh rectopexy were performed in 11 patients. Six had solitary rectal ulcers. All patients had failed conservative management, including laxative therapy, and one patient had previously had a trial of injection of hypertonic saline. At a median follow up of 33months (6-75) complete resolution was seen in 7 cases and partial resolution, with some continuing symptoms, was seen in 1 patient. All suture rectopexy cases ultimately failed and required a redo rectopexy procedure. Three patients had persistent failure with recurrence of prolapse during the study period despite repeated procedures. There were no serious complications.Laparoscopic mesh rectopexy can be safely performed in children and can lead to complete resolution of external prolapse. There is a cohort for whom it fails to relieve the problem. In this series there was a trend towards less recurrence with mesh rectopexy.
- A Novel Percutaneous Technique for Treating Complete Rectal Prolapse in Adults. [JOURNAL ARTICLE]
- Surg Innov 2014 Aug 20.
Purpose. To evaluate a new technique for treating complete rectal prolapse in adults that combines injection sclerotherapy with anal encirclement. Methods. From 2008 to 2012, 20 patients were treated using combined perirectal injection sclerotherapy with anal encirclement. The primary outcome was recurrent full-thickness/mucosal rectal prolapse. Results. The mean age of the patients was 39 years. The mean operating time was 17 minutes. Patients had short hospital stays (range = 2-4 days) and rapid recovery with no serious postoperative complications. After a mean follow-up of 22 months, recurrence occurred in 9 patients, and was complete in 6 cases and mucosal in 3 patients. Recurrent mucosal prolapse was treated with a mucosectomy, while recurrent complete rectal prolapse was treated with an open rectopexy with mesh. Conclusion. The combination of perirectal sclerotherapy and anal encirclement for treating complete rectal prolapse in adults is a simple and safe procedure with reasonable outcome. These findings call for confirmatory trials in larger series.
- Giant colonic lipoma with prolapse through the rectum treated by external local excision: A case report. [JOURNAL ARTICLE]
- Oncol Lett 2014 Sep; 8(3):1377-1379.
Colonic lipomas are a rare type of gastrointestinal benign tumor. Those that are <2 cm are generally asymptomatic and do not require any treatment. However, those that are >2 cm may be symptomatic, resulting in abdominal pain, changes in bowel habits, intestinal obstruction and rectal bleeding. A 39-year-old male patient presented with a mass prolapse through the anal canal, which was causing anal pain and rectal bleeding. The patient was admitted to hospital via the emergency services and directed to the Department of General Surgery with the preliminary diagnosis of a rectal prolapse. A pedunculated polyp (size, 10×8×7.5 cm) was detected at the 35th cm of the anal canal. Due to the large size of the polyp, an endoscopic polypectomy could not be performed. Therefore, the prolapsed lipoma was excised externally and the patient was discharged on the first postoperative day on which no complications were experienced. A colonic lipoma must be considered during the differential diagnosis of anorectal diseases, such as hemorrhoids and rectal prolapses. Local excision, hemicolectomy, and segmental and external resection should be considered in addition to an endoscopic polypectomy for the diagnosis and treatment of colonic lipomas.
- The outcome of laparoscopic ventral mesh rectopexy (LVMR) for external Rectal prolapse. [JOURNAL ARTICLE]
- Colorectal Dis 2014 Aug 8.
The study assessed the efficacy of laparoscopic ventral mesh rectopexy (LVMR) for full thickness external rectal prolapse (ERP), including recurrent prolapse.A prospective database identified all patients undergoing LVMR for ERP over the 16yr period to December 2013. Clinical outcome, Cleveland Clinic Incontinence Score (CCIS), quality of life (QOL) and patient reported outcome (PROMS) were evaluated.190 LVMRs (87% female) were performed during the study period, with a median active follow-up (FU) of 29 (1-196) months; 120 had a FU >5 years and 16 >10 years. The median time from surgery was 73 (1-196) months. The 60 day mortality, recurrence and mesh-related complication rates were 1%, 3% of 3.6%. The mean improvement in CCIS was 8 (P<0.0001). Sixty two patients returned a complete sequence of QOL scores (BBUSQ-22), which had improved by 46% at year 1 and were sustained at a median of 4 years (P<0.001). Mean PROM for satisfaction at final review in 119 responders was 9.1/10. Thirty nine patients underwent LVMR for recurrent ERP following perineal repair. Of these, full thickness recurrence occurred in one and there were no mesh complications. The same sustained improvement in QOL was observed.LVMR for ERP is associated with low morbidity and recurrence and a long-term improvement in function and QoL. LVMR achieves the same benefits after a failed perineal procedure. This article is protected by copyright. All rights reserved.
- Mesh erosion after laparoscopic rectopexy: a benign complication? [LETTER]
- Colorectal Dis 2014 Aug 8.
Laparoscopic ventral rectopexy is an accepted treatment for total rectal prolapse , although can be complicated by mesh erosion. Two women aged 73-years and 32-years- presented with mesh erosion at 17 months and 27 months after laparoscopic ventral rectopexy for total rectal prolapse performed in our institution. They presented with per rectal mucus discharge but had no septic symptoms and no pain. Low intrarectal mesh migration was confirmed by rectal examination and rectoscopy. This article is protected by copyright. All rights reserved.
- High resolution anorectal manometry and dynamic pelvic magnetic resonance imaging are complementary technologies. [JOURNAL ARTICLE]
- J Gastroenterol Hepatol 2014 Aug 4.
Dynamic pelvic MRI (DP-MRI) offers a comprehensive evaluation of pelvic organ structure in addition to functional information regarding evacuation. Application of this technology can be limited due to regional availability. Ideally, clues from standard anorectal testing could predict abnormalities on DP-MRI leading to its efficient use. The aim of this study is to determine whether high resolution anorectal manometry (HR-ARM) correlates with findings on DP-MRI.This is a retrospective study of HR-ARM performed on patients with constipation who also underwent DP-MRI. Studies were reviewed for significant findings including: posterior pelvic organ prolapse, rectocele >3cm, rectal intussusception, and anorectal angle. Statistical analysis was performed using Pearson's correlation coefficient, student's t test, and Fisher's exact test.23 patients undergoing HR-ARM (age range 25-78) also underwent DP-MRI. All were female, 76% were Caucasian. 20 had significant structural findings: small pelvic prolapse (n=2), moderate pelvic prolapse (n=10), large pelvic prolapse (n=9), rectocele (n=8), and rectal intussusception (n=3). Only intrarectal pressure on HR-ARM weakly correlated with size of rectocele (R=0.46; p=0.03) and degree of pelvic organ prolapse (R=0.48; p=0.02). The remainder of the HR-ARM parameters did not significantly correlate with DP-MRI findings. Patients with dyssynergy were not more likely to have rectoceles >3cm (44.4% vs. 35.7% p=0.5) or large prolapses (44.4% vs. 50%, p=1.0) compared to those without dyssynergy on HR-ARM.We were unable to find a correlation between HR-ARM findings and structural pelvic defects on DP-MRI. Therefore, these two technologies provide complementary information in the evaluation of defecatory dysfunction.
- Vertebral discitis after laparoscopic resection rectopexy: a rare differential diagnosis. [Journal Article]
- J Surg Case Rep 2014; 2014(8)
Vertebral discitis usually arises from haematogenous spread of pathogens to the discs and bones. Vertebral discitis can rarely occur as a complication after laparoscopic operations with fixating sutures on the promontory. We report the case of an 81-year-old woman who underwent a laparoscopic resection rectopexy because of rectal prolapse. Weeks after the operation, the patient developed lower back pain with radiation to both legs not responding to symptomatic therapy. Two months later, a magnetic resonance imaging of the lumbar spine showed vertebral osteomyelitis and discitis. A fixation on the promontory may be sufficiently traumatic to the spine to pave the way for subsequent infection. A high index of suspicion should be raised in patients with persistent, severe back pain. Anamnesis, imageing and an adequate specimen from the affected area for microbiological analysis are crucial for timely diagnosis and appropriate management involving targeted and prolonged antimicrobial therapy.