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Rectal Prolapse [keywords]
- Temporary Protective Loop Ileostomy in Open Low Rectal Resection - An Alternative Technique. [JOURNAL ARTICLE]
- Chirurgia (Bucur) 2014 Mar-Apr; 109(2):238-242.
The paper presents a simplified method for performing atemporary protective loop ileostomy as a result of ourexperience in 33 cases of low rectal resections for cancer.The particularities of this technique are: the skin incision issmaller than the muscle one, the seromuscular layer of the loopis fixed at the skin level only by marking a small portion of theantimesenteric wall, with no mucosal eversion. No supportingrod is used. The reversal requires resection of the thickened freemargins and enterorrhaphy. It involves a direct approach andavoids median laparotomy and segmental bowel resection.There was no case of peristomal abscess, bleeding, prolapse,retraction of the loop after the stoma was formed. Four patients(12.12%) had peristomal dermatitis. Five patients (15.62%) hadhigh output fluid losses with electrolyte disorders, one of them(3.12%) with acute renal failure. Closure was performed after 6weeks on average for the colorectal anastomoses and 10 weeksfor the coloanal ones. We recorded a case (3.12%) of enterocutaneousfistula that was managed conservatively and 4 cases(12.12%) of incisional hernia, all of them surgically treated. Nomortality was attributed to either creation or closure of thetemporary loop ileostomy. It is a simple and fast technique inaccordance with the temporary character of its indication.
- Anorectal conditions: rectal prolapse. [Journal Article]
- FP Essent 2014 Apr.:28-34.
Rectal prolapse, the protrusion of the layers of the rectal wall through the anal canal, may be partial (mucosal) or complete (full thickness). Although prolapse is most common among older women, it affects individuals of all ages, including children. Associated fecal incontinence and constipation are typical. Urinary incontinence and uterovaginal/bladder prolapse also may coexist. Some patients may have rectal ulcers. Diagnosis is predominantly clinical; visualization of the prolapse may require the patient to strain while sitting or squatting. Imaging studies, including fluoroscopic or dynamic magnetic resonance defecography, can confirm the prolapse if the diagnosis is uncertain, and endoscopy can aid in detecting other colonic/extracolonic pathology. Nonsurgical management (eg, increased fiber intake, fiber supplements, biofeedback) often is therapeutic in minor (first- or second-degree) mucosal prolapse and can help alleviate constipation and incontinence before and after surgery for patients with full-thickness prolapse. However, for full-thickness prolapse, transabdominal procedures are the most effective management and are favored for healthy patients, irrespective of age. Perineal procedures (eg, rubber band ligation, mucosal excision) can be used for patients with full-thickness prolapse who are not candidates for transabdominal surgery and for those with second- and third-degree mucosal prolapse.
- Diagnostic Effectiveness of Dynamic Colpocystoproctography in Women Planning for Combined Surgery with Urinary Incontinence and Pelvic Organ Prolapse. [JOURNAL ARTICLE]
- Gynecol Obstet Invest 2014 Apr 8.
Objective: To evaluate the advantage of performing the dynamic cystoproctography (DCP) in patients planning for combined surgery due to urinary incontinence and pelvic organ prolapse (POP). Materials and Methods: We performed DCP on a total of 113 consecutive women with POP and compared the findings of the physical examination with POP quantification against those of DCP including squeezing, straining and evacuation phases, and analyzed the changes to the rates of surgical planning. For statistical analysis, sensitivity, specificity, and positive predictive value of each test were performed. Results: DCP identified an additional 10 cases of cystocele, 32 cases of rectocele, 2 cases of enterocele, 4 cases of sigmoidocele, and 8 cases of rectal intussusception compared to those cases who were only included for a physical examination. The initial surgical plan was changed in a total of 24 cases (22.1%). The prevalence of bowel symptoms in the group in which the surgical plan changed was higher than in the group with no changes to the surgical plan (p = 0.023). Conclusions: DCP may be a more sensitive test for diagnosing POP compared to physical examination alone, and it is useful to patients with bowel symptoms by making surgical planning for combined surgery with stress urinary incontinence and POP. © 2014 S. Karger AG, Basel.
- Long-term outcomes of stapled hemorrhoidopexy. [Journal Article]
- Wideochir Inne Tech Malo Inwazyjne 2014 Mar; 9(1):18-23.
Hemorrhoidal disease is one of the commonest anorectal disorders worldwide. Stapled hemorrhoidopexy (SH) is a treatment modality associated with low postoperative pain and early mobilization.To assess long-term outcomes after SH.All 326 patients who underwent SH in 1999-2003 were invited by mail to participate. For each patient we analyzed their medical records, and conducted a questionnaire survey and a digital rectal examination.Only 91 patients attended the final examination and the mean ± SD follow-up time was 8.7 ±1.2 years. Recurrences were diagnosed in one third of the 91 subjects. There were correlations between recurrences and: the duration of disease (p = 0.047); female gender (p = 0.037); and childbirth (vaginal delivery) (p = 0.026). Sixty-seven patients (73.6%) were satisfied with the outcomes. In the group of dissatisfied patients symptoms such as pain (p = 0.0001), burning (p = 0.0002) and itching (p = 0.014) were most common. Long-term outcomes were good with 75% and 88% reductions in pain sensation and severe and moderate hemorrhoidal bleeding. Pruritus, burning and discomfort resolved in more than 50% of patients. Flatus incontinence, fecal incontinence, or soiling occurred in 21%, 11%, and 32% of patients.Long-term results of stapled hemorrhoidopexy are satisfactory in most patients. The 36% recurrence rate correlates with the degree of hemorrhoidal prolapse before the operation, duration of the disease, female gender, and previous vaginal delivery.
- Long term outcomes of laparoscopic-assisted anorectoplasty: A comparison study with posterior sagittal anorectoplasty. [Journal Article]
- J Pediatr Surg 2014 Apr; 49(4):560-3.
The aim of this study is to compare the long term outcomes between laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) for children with rectobladderneck and rectoprostatic fistula anorectal malformations (ARM).Thirty-two ARM children with rectobladderneck and rectoprostatic fistula who underwent LAARP between October 2001 and March 2012 were reviewed. The outcomes were compared with those of 34 ARM children who underwent PSARP between August 1992 and September 2001. The sacral ratio (SR), age at operation, operative time, postoperative hospital stay and complications were evaluated. Bowel functions were assessed using the Krickenbeck classification.The mean operative time of the LAARP was significantly shorter than that of PSARP group (1.62±0.40 vs 2.13±0.30h). The postoperative hospital stay was significantly shorter in the LAARP group (5.8±0.65 vs 8.4±0.67h). The wound infections (11.8% vs 0%) and recurrent fistula (11.8% vs 0%) were more common in PSARP patients. The overall morbidity rate of PSARP group was significantly higher than that of the LAARP group (35.3% vs 12.5%, p<0.05). However, 7.5% of the LAARP patients developed rectal prolapse. Twenty-four of 32 patients were followed up for more than 3years in LAARP group. The median follow up period was 7.5years (range 4-11) in LAARP patients and 15.5years (range 11-20) in PSARP patients. The rates of voluntary bowel movement, soiling (grade 1, 2 & 3) were similar in both groups. More patients from PSARP group developed grade 2 or 3 constipation (22.5% vs 0%, P<0.01).Compared to PSARP, LAARP is a less invasive procedure. The long term functional outcomes after LAARP were equivalent if not better than those of PSARP.
- Transrectal bladder prolapse secondary to pelvic fracture in two dogs. [JOURNAL ARTICLE]
- J Small Anim Pract 2014 Apr 3.
This report describes the exteriorisation of the urinary bladder in two dogs as a result of a laceration of the rectum from a traumatic pelvic fracture. Clinical examination and contrast radiography of the bladder were used as diagnostic tools. Both patients were treated with exploratory laparotomy, where traction of the bladder was utilised to pull the bladder through the traumatic rectal laceration allowing the organ to return to its normal anatomical position. This procedure was followed by surgical reconstruction of the rectum, resulting in effective resolution of each case.
- Laparoscopic ventral rectopexy is effective for solitary rectal ulcer syndrome when associated with rectal prolapse. [Journal Article]
- Colorectal Dis 2014 Mar; 16(3):O112-6.
Solitary rectal ulcer syndrome (SRUS) is uncommon and its management is controversial. The aim of this study was to evaluate the outcome of patients with SRUS who underwent laparoscopic ventral rectopexy (LVR).A review was performed of a prospective database at the Oxford Pelvic Floor Centre to identify patients between 2004 and 2012 with a histological diagnosis of SRUS. All were initially treated conservatively and surgical treatment was indicated only for patients with significant symptoms after failed conservative management. The primary end-point was healing of the ulcer. Secondary end-points included changes in the Wexner Constipation Score and Faecal Incontinence Severity Index (FISI).Thirty-six patients with SRUS were identified (31 women), with a median age of 44 (15–81) years. The commonest symptoms were rectal bleeding (75%) and obstructed defaecation (64%). The underlying anatomical diagnosis was internal rectal prolapse (n = 20), external rectal prolapse (n = 14) or anismus (n = 2). Twenty-nine patients underwent LVR and one a stapled transanal rectal resection (STARR) procedure. Nine (30%) required a further operation, six required posterior STARR for persistent SRUS and two a per-anal stricturoplasty for a narrowing at the healed SRUS site. Healing of the SRU was seen in 27 (90%) of the 30 patients and was associated with significant improvements in Wexner and FISI scores at a 3-year follow-up.Almost all cases of SRUS in the present series were associated with rectal prolapse. LVR resulted in successful healing of the SRUS with good function in almost all patients, but a significant number will require further surgery such as STARR for persistent obstructed defaecation.
- Shiga toxin-associated hemolytic uremic syndrome complicated by intestinal perforation in a child with typical hemolytic uremic syndrome. [Journal Article]
- Korean J Pediatr 2014 Feb; 57(2):96-9.
Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in childhood and is primarily diagnosed in up to 4.5% of children who undergo chronic renal replacement therapy. Escherichia coli serotype O157:H7 is the predominant bacterial strain identified in patients with HUS; more than 100 types of Shiga toxin-producing enterohemorrhagic E. coli (EHEC) subtypes have also been isolated. The typical HUS manifestations are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. In typical HUS cases, more serious EHEC manifestations include severe hemorrhagic colitis, bowel necrosis and perforation, rectal prolapse, peritonitis, and intussusceptions. Colonic perforation, which has an incidence of 1%-2%, can be a fatal complication. In this study, we report a typical Shiga toxin-associated HUS case complicated by small intestinal perforation with refractory peritonitis that was possibly because of ischemic enteritis. Although the degree of renal damage is the main concern in HUS, extrarenal complications should also be considered in severe cases, as presented in our case.
- Ligaments of the rectum: anatomical and surgical considerations. [Journal Article]
- Am Surg 2014 Mar; 80(3):275-83.
The ligaments of the rectum have been the subject of controversy for decades. Not only have their contents and components been a source of contention, but also the very existence of these ligaments has been called into question. This article explores the anatomical features of these ligaments with implications for surgical treatment of rectal prolapse, rectal cancer, and resection of the rectum and mesorectum. A theory about the evolution of the lateral rectal ligaments and the mesorectum in humans and higher mammals is also presented.
- Transanal endoscopic microsurgery: a review. [REVIEW]
- Can J Surg 2014 Apr; 57(2):127-138.
Rectal adenomas and cancers occur frequently. Small adenomas can be removed colonoscopically, whereas larger polyps are removed via conventional transanal excision. Owing to technical difficulties, adenomas of the mid- and upper rectum require radical resection. Transanal endoscopic microsurgery (TEM) was first designed as an alternative treatment for these lesions. However, since its development TEM has been also used for a variety of rectal lesions, including carcinoids, rectal prolapse and diverticula, early stage carcinomas and palliative resection of rectal cancers. The objective of this review is to describe the current status of TEM in the treatment of rectal lesions. Since the 1980s, TEM has advanced substantially. With low recurrence rates, it is the method of choice for resection of endoscopically unresectable adenomas. Some studies have shown benefits to its use in treating early T1 rectal cancers compared with radical surgery in select patients. However, for more advanced rectal cancers TEM should be considered palliative or experimental. This technique has also been shown to be safe for the treatment of other uncommon rectal tumours, such as carcinoids. Transanal endoscopic microsurgery may allow for new strategies in the treatment of rectal pathology where technical limitations of transanal techniques have limited endoluminal surgical innovations.