- Laparoscopic ventral mesh rectopexy in male patients with internal or external rectal prolapse. [Journal Article]
- CDColorectal Dis 2016; 18(12):1189
- Resolution of Rectal Prolapse by Vaginal Reconstruction. [Journal Article]
- FPFemale Pelvic Med Reconstr Surg 2016 Nov 28
- CONCLUSIONS: Usually, the choice of surgical approach is tailored to each individual based on anatomy, age, comorbidity, and patient factors. Correcting both vaginal and rectal prolapse at the same time with a minimally invasive approach is an advantage to the patient. Restoring the apical, anterior, and posterior vaginal wall anatomy and an enterocele repair through the vaginal route caused resolution of the rectal prolapse. Further research is required as to whether rectal prolapse caused by anterior rectal compression needs an additional procedure or repair of the vaginal prolapse and enterocele alone will suffice.
- [Reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap]. [Journal Article]
- ZSZhonghua Shao Shang Za Zhi 2016 Nov 20; 32(11):644-648
- Objective: To investigate the method and timing of reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern f...
Objective: To investigate the method and timing of reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap. Methods: Ten patients who suffered anal stenosis induced by scar contracture after the first phase repair of defect of perineal region with paraumbilical flap were hospitalized from July 2009 to September 2015. Eight patients were with central type scar contracture of perineal region after healing of burn wound, and two patients were with lesion of perineal region which had been excised. In 6 to 8 weeks after the first phase surgery, two or three random pattern flaps were designed around the narrow anus in the survived paraumbilical flap. After thorough release of the narrow anus, the random pattern flaps were transferred to enlarge the anus. The tip of the lifted triangular flap was transferred to insert into the anal canal. The skin of anal canal or rectal mucosa was pulled out to be crossly-stitched with the flap. Results: All the patients' narrow anuses were released and enlarged with one operation, and the diameters of the narrow anuses were enlarged to 2.0 to 3.0 cm. During follow-up of 6 to 36 months, the anal stenosis was totally released, and the symptom of difficult defecation was significantly improved; 7 patients were excellent and 3 patients were good with evaluation of clinical criteria of anus function; no symptom of anal stenosis or rectal mucosal prolapse was observed any more. Conclusions: In 6 to 8 weeks post repair of defect in perineal region with paraumbilical flap, designing of random pattern flap in the survived paraumbilical flap to enlarge and reconstruct the narrow anus has good therapeutic effects on anatomical narrow and difficult defecation.
- Primary and repeated perineal stapled prolapse resection. [Journal Article]
- TCTech Coloproctol 2016 Nov 25
- CONCLUSIONS: PSPR is a rather new surgical procedure for external rectal prolapse. Immediate complications are few and not serious. Although recurrences can be treated with a second PSPR, the operation may only be the best option for old and fragile patients with comorbidities and a short life expectancy.
- Comparison of dynamic magnetic resonance defecography with rectal contrast and conventional defecography for posterior pelvic floor compartment prolapse. [Journal Article]
- CDColorectal Dis 2016 Nov 21
- CONCLUSIONS: The diagnostic accuracy of D-MRI for diagnosing rectocele and enterocele is less than conventional defecography. D-MRI, however, appears superior to CD in identifying intussusception. D-MRI and CD are complementary imaging techniques in the evaluation of patients with symptoms of prolapse of the posterior compartment. This article is protected by copyright. All rights reserved.
- Expression of a hepatitis B virus pre-S2 deletion mutant in the liver results in hepatomegaly and hepatocellular carcinoma in mice. [Journal Article]
- JPJ Pathol 2016 Nov 21
- Hepatocellular carcinoma (HCC) is the most common form of liver cancer and has a poor prognosis and a low survival rate; its incidence is on the rise. Hepatitis B virus (HBV) infection is one of the ...
Hepatocellular carcinoma (HCC) is the most common form of liver cancer and has a poor prognosis and a low survival rate; its incidence is on the rise. Hepatitis B virus (HBV) infection is one of the main causes of HCC. A high prevalence of pre-S deletions of HBV surface antigen, which encompass T-cell and/or B-cell epitopes, is found in HBV carriers; antiviral therapy and viral immune escape may cause and select for these HBV mutants. In particular, the presence of pre-S2 deletion mutants is an important risk factor associated with cirrhosis and HCC. We generated Alb-pre∆S2 transgenic mice that express a naturally occurring pre-S2 mutant protein containing a 33-nucleotide deletion (pre∆S2); the aim was to investigate its effect on hepatocarcinogenesis. After 30 months of follow-up, the liver pathology of the mice fell into four groups; G1, chronic inflammation solely; G2, chronic inflammation and fibrosis; G3, inflammation, fibrosis and hepatomegaly accompanied by rectal prolapse (4%-12%); and G4, hepatomegaly and spontaneous HCC (12%-15%). Striking degeneration of the endoplasmic reticulum (ER) was present in the mouse livers at an early stage (4-month old). At 8 months, overt ER stress and the Atf6 pathway of the unfolded protein response (UPR) were induced; at the same time metabolic pathways associated with mevalonate and cholesterol biogenesis, involving the peroxisomes and the ER, were disturbed. At 20 months and older, the protein kinase RNA-like endoplasmic reticulum kinase (PERK) pathway of the UPR was induced and the Hippo transducer Yap was activated. Together, these ultrastructural aberrations and metabolic disturbance all seem to contribute to the molecular pathogenesis and hepatocarcinogenesis present in the Alb-pre∆S2 mice. These findings may inform the development of therapies for the liver disorders and HCC associated with pre-S2 deletion mutations among HBV carriers.
- Outcomes of laparoscopic sacropexy in women over 70: A comparative study. [Journal Article]
- EJEur J Obstet Gynecol Reprod Biol 2016 Nov 11; 207:178-183
- CONCLUSIONS: Our findings suggest that laparoscopic sacropexy is a valid option in elderly women presenting with genital prolapse.
- Internal rectal prolapse: Definition, assessment and management in 2016. [Journal Article]
- JVJ Visc Surg 2016 Nov 16
- Internal rectal prolapse (IRP) is a well-recognized pelvic floor disorder mainly seen during defecatory straining. The symptomatic expression of IRP is complex, encompassing fecal continence (56%) an...
Internal rectal prolapse (IRP) is a well-recognized pelvic floor disorder mainly seen during defecatory straining. The symptomatic expression of IRP is complex, encompassing fecal continence (56%) and/or evacuation disorders (85%). IRP cannot be characterized easily by clinical examination alone and the emergence of dynamic defecography (especially MRI) has allowed a better comprehension of its pathophysiology and led to the proposition of a severity score (Oxford score) that can guide management. Decision for surgical management should be multidisciplinary, discussed after a complete work-up, and only after medical treatment has failed. Information should be provided to the patient, outlining the goals of treatment, the potential complications and results. Stapled trans-anal rectal resection (STARR) has been considered as the gold standard for IRP treatment. However, inconsistent results (failure observed in up to 20% of cases, and fecal incontinence occurring in up to 25% of patients at one year) have led to a decrease in its indications. Laparoscopic ventral mesh rectopexy has substantial advantages in solving the functional problems due to IRP (efficacy on evacuation and resolution of continence symptoms in 65-92%, and 73-97% of patients, respectively) and is currently considered as the gold standard therapy for IRP once the decision to operate has been made.
- Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool. [Journal Article]
- ACAnn Coloproctol 2016; 32(5):195-198
- Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they c...
Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they can be associated with severe complications. We describe the case of a 59-year-old woman who underwent STARR for ODS and developed a postoperative pelvic hemorrhage. A computed tomography (CT) scan revealed a vast pelvic, retroperitoneal hematoma and free gas in the abdomen. Laparoscopy ruled out any bowel lesions, but identified a hematoma of the pelvis. Flexible sigmoidoscopy showed a small leakage of the rectal suture. The patient was treated conservatively and recovered completely. Surgeons performing STARR and SH must be aware of the risk of this rare, but severe, complication. If the patient is not progressing after a STARR or SH, a CT scan can be indicated to rule out intra-abdominal and pelvic hemorrhage. Laparoscopy is a diagnostic tool and should be associated with intraluminal exploration with flexible sigmoidoscopy.
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- Perineal stapled prolapse resection (PSPR) for external rectal prolapse in high morbidity patients. [Journal Article]
- AIAnn Ital Chir 2016; 87:476-480
- CONCLUSIONS: PSPR can be considered among perineal approaches for the treatment of full-thickness rectal prolapse. The reported rate of minor complications is low. No major complications have been described. Functional outcome is good, with marked improvement in both continence and constipation.These results are better than those reported for other perineal procedures, although no randomized trials have yet been published. A multicenter study is needed to better evaluate the indications for and the outcome AFTER PSP.