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PubMed1994

Rectal prolapse.

Marlex rectopexy is a popular and effective procedure for the repair of rectal prolapse. Heretofore, this operation has required a generous laparotomy. As videolaparoscopy provides superior pelvic exposure, performing a modified Ripstein procedure was a logical progression of minimally invasive surgery. Experience with the first sutured Marlex rectopexy suggested the need for a simple fixation device to secure the mesh to the sacrum. A commercially available orthopedic staple allows quick and secure fixation. Five cases of laparoscopic Marlex rectopexy provide our initial clinical experience. The LCR staple has reduced operating times by up to 1 h. Results in these cases show virtual complete repair of the prolapse, minimal postoperative analgesic requirements, and no postoperative incontinence. There was one postoperative complication requiring reoperation. There were no deaths. Laparoscopic stapled Marlex rectopexy is a promising modality for the treatment of procidentia.

Aged↗
PubMed1999

Rectal prolapse associated with urinary bladder neoplasia in a cat.

A case of feline rectal prolapse which appeared to be secondary to transitional cell carcinoma of the urinary bladder is described. The cat was reported to be incontinent and treatment was declined by the owners. Euthanasia was performed and necropsy revealed an extensive nodular thickening of the entire urinary bladder wall. A diagnosis of urinary bladder transitional cell carcinoma was made on histopathological examination.

Animals↗
PubMed1984

Complete rectal prolapse--the results of Ivalon sponge rectopexy.

Forty-two patients with complete rectal prolapse have been treated using the Ivalon sponge rectopexy. There was no operative mortality in this series and only one complete recurrence after an average follow-up of more than 4 years. Pelvic sepsis occurred in one patient and required removal of the sponge. The majority of the patients were satisfied with the results of surgery, despite some remaining incontinent.

Adult↗
PubMed1988

[Internal rectal prolapse].

Over a 2 1/2 year period a prospective study was undertaken to evaluate the occurrence and symptoms of rectal intussusception (internal procidentia). The condition was found in 28 female patients. 17 patients were operated on due to severe obstruction during defaecation, perineal pain, solitary rectal ulcer syndrome, and partial incontinence. The endopelvic findings were similar to those encountered in patients with complete, external rectal prolapse, and the operative procedure was identical (rectal mobilization, elevation, fixation, with rectosigmoid resection in most cases). Results were favorable. Conservative treatment seemed to be adequate in 7 of the 11 remaining patients.

Adult↗
PubMed2006

Laparoscopic suture rectopexy in the treatment of persisting rectal prolapse in children: a preliminary report.

BACKGROUND: The repair of choice for persistent rectal prolapse (PRP) in children is disputed. Laparoscopic suture rectopexy (LSRP) is effective in adults, but its usefulness in pediatric PRP is unknown. We compared LSRP with posterosagittal rectopexy (PSRP). METHODS: Sixteen children, with a median age of 6.5 years (range, 0.8-16.8) and duration of symptoms of 2.8 years (range, 0.5-10.2), underwent surgery for PRP. Eight (1991-2000) had PSRP, and eight (2002-2005) had LSRP. Three patients with LSRP were healthy; the others had mental retardation and epilepsy (n = 1), cerebral palsy (n = 1), Aspeger's syndrome (n = 1), meningomyelocele (n = 1), and bladder extrophy (n = 1). Preoperative cologram (n = 6), sigmoideoscopy (n = 3), and anorectal manometry (n = 2) were normal in patients with LSRP. In LSRP, the rectum was mobilized and sutured to the sacral periosteum. RESULTS: Median operation time for LSRP was 80 min (range, 62-90) and for PSRP 40 min (range, 25-70) (p < 0.05); median hospital time was 6 days (range, 3-8) for LSRP and 6 days (range, 3-9) for PSRP (not significant). Six patients with LSRP had a median follow-up of 13 months (range, 4-24). None have had recurrences, and two patients (33%) require laxatives. Of the patients with PSRP, two (25%) had recurrence and underwent abdominal rectopexy with sigmoid resection. CONCLUSION: Medium-term results indicate that LSPR is effective in pediatric PRP. Constipation is the only postoperative problem in a significant proportion of patients.

Adolescent↗
PubMed1997

Lymphoid hyperplasia causing recurrent rectal prolapse.

An 8-year-old girl had a 5-month history of recurrent rectal prolapse. On colonoscopy, two submucosal masses were noted in the distal rectum and diagnosed by biopsy as benign lymphoid hyperplasia. These were excised by limited dissection superficial to the submucosa, and the histologic diagnosis was confirmed. The child has done well after removal of the nodules, with no subsequent prolapse for more than 2 years.

Biopsy↗
PubMed1989

[Diagnostic measures in anal and rectal prolapse].

As incontinence and outlet obstruction are major problems for patients with anal and rectal prolapse, the following diagnostic procedures are used in addition to the usual examination to plan a more selective therapy and followup: measurement of anal pressure, EMG, anal reflex latency and proctogram.

Diagnosis, Differential↗
PubMedDate not supplied

[Complete rectal prolapse in a patient with Hirschsprung disease: a clinical case].

The disease of Mya-Hirschsprung (HD) it's rare and congenital, usually diagnosed in child age, but that it can also remain unknown until the adult age. It's associated to genetic mutations and it can involve other pathologies and malformations. The variability of the anatomopathological and clinical phenomena is correlated to the length of the aganglionic segment. The Authors describe the clinical case of one young female patient, who presented chronic constipation (less than 3 evacuations to week), tenesm, meteorism, abdominal pain. To the inspection of the anal region after the evacuation the presence of complete rectal prolapse (3) cylinders of the length of 30 cm was appraised, with presence of ulcerations of the mucosa. The patient came subordinate to diagnostic study that they demonstrated the presence of HD. The Authors operated the patient with the technique of Frykman and Goldberg. In the follow-up the patient had the complete remission of the symptomatology and resumption of the rectoanal inhibitory reflex, remarkable diminished in the preoperative manometric examination. The pathogenesis of the association of HD and rectal prolapse goes searched in the presence of ultrashort HD (aganglionic defect of a limited segment of rectum), pathological variety somewhat rare that can determine subocclusive phenomena and that it favors the prolapse of the rectum for the continuous evacuating strains.

Adolescent↗
PubMed1991

Clinical and functional results of abdominal rectopexy for complete rectal prolapse.

Between 1977 and 1987, 53 patients underwent polyvinyl alcohol sponge rectopexy for complete rectal prolapse. The mean follow-up period was 36.7 months. Full thickness prolapse recurred in two patients (3.8 per cent). Infection around the prosthesis and faecal impaction developed in two patients each. Continence improved significantly after operation, particularly in those under 70 years of age (P = 0.028, chi 2 test) and nulliparous women (P = 0.026, chi 2 test). Bowel function was generally unchanged after rectopexy; in particular only eight patients (15 per cent) had significant postoperative constipation.

Adolescent↗
PubMed1985

Rectal prolapse in childhood--the role of infections and infestations.

Seventy-eight cases of rectal prolapse in childhood treated during a 3-year period are reviewed retrospectively. A cause of prolapse which could be corrected surgically was found in 9 children (12%). Among the remaining 69, 25 children (36%) were infested with a variety of parasites, 4 (6%) had a specific dysentery, and 6 (9%) had a convincing clinical picture of gastro-enteritis. In 34 patients no precise diagnosis could be made; however, among children without a mechanical or neurological lesion, 90% responded rapidly to anthelmintics and symptomatic treatment.

Child↗
PubMedDate not supplied

[Occult rectal prolapse: functional results after rectopexy].

In the present work the Authors have studied 19 patients with occult rectal prolapse evaluating symptoms and functional results after posterior abdominal rectopexy. Symptoms of internal rectal procidentia appear as a definite syndrome. In our patients pain upon defecation, this being often localized to the perineal and sacral region, was observed in 14 on 19 cases, while fecal incontinence was present in 5 cases (29%) and rectal bleeding in 8 (44%). These compliances are relieved by the anatomical correction of the rectal intussusception, but the preexisting functional disorders in the mechanism of defecation appear to be unaffected by rectopexy. (Sensation of obstruction 11 cases (58%) preop. e 9 cases (53%) postop.).

Adult↗
PubMed1984

The long-term results of polyvinyl alcohol (Ivalon) sponge for rectal prolapse in young patients.

The long-term outcome of Ivalon sponge rectopexy for rectal prolapse in a group of young patients was reviewed. Thirty-two patients under the age of 40 underwent Ivalon sponge rectopexy between 1961 and 1975 with no mortality and one early complication. Twenty-five patients (9 men; 16 women) aged 13-39 years (median 28 years) at the time of operation were interviewed and examined in the Out-Patient Department between 5 and 20 years (median 10 years) after the operation. Five (20 per cent) had developed recurrence which occurred at 1, 1, 5, 6 and 9 years. There was no significant change in bowel habit postoperatively, with the exception of 3 patients with diarrhoea who reverted to normal. There was some disturbance in faecal continence pre-operatively in 20 patients, of whom 15 (75 per cent) were improved by rectopexy. All patients had normal urinary and sexual function, and there was no disturbance of menstruation in females following rectopexy. Three men who wished to have children were successful. Three of six women who attempted to conceive post-operatively had normal pregnancies and deliveries. The three women who failed to do so had already been investigated for infertility before the operation. No patient developed pelvic malignancy.

Adolescent↗
PubMed1996

Pudendal canal decompression for the treatment of fecal incontinence in complete rectal prolapse.

Our recent studies have attributed fecal incontinence (FI) when it is associated with complete rectal prolapse (CRP) to pudendal neuropathy caused by pudendal canal syndrome (PCS). Herein we present the results of pudendal canal decompression (PCD), performed for the treatment of FI in 21 patients whose CRP was corrected by Ivalon sponge rectopexy 5.2 years before presentation. Thirteen patients had partial and eight complete FI. Examination revealed perianal hypoesthesia, diminished rectal neck pressure, reduced electromyographic (EMG) activity of both the external anal sphincter (EAS) and levator ani (LA) muscle, as well as prolonged pudendal nerve terminal motor latency (PNTML). PCD was performed with a mean follow up of 14.8 months. Postoperatively, seven (53.8%) of the patients with partial FI showed full fecal control with normalization or improvement of the perianal hypoesthesia, rectal neck pressure, EMG of EAS and LA, as well as PNTML. The remaining six patients were failures. Five (62.5%) of the eight patients with complete FI showed full fecal control, two partial improvement, and one failure. The degree of response of FI to PCD seems to be related to the degree of pudendal nerve damage. Nonimprovement may be due to irreversible pudendal nerve damage or incomplete PCD. In conclusion, PCD is effective in the treatment of FI associated with CRP, provided it is performed before complete nerve damage occurs.

Adult↗
PubMed1986

Perineal proctectomy, posterior rectopexy, and postanal levator repair for the treatment of rectal prolapse.

This report describes a one-stage perineal operation for the treatment of complete rectal prolapse aimed at restoration of anal continence in addition to resection of the prolapsed segment of rectum. This procedure was performed on 25 patients, most of whom were elderly or debilitated, over the past three years without local or systemic complications. Significant improvement in continence was seen in 88 percent of the patients within four weeks of operation, and in the remainder of the patients, within three months postoperatively.

Aged↗
PubMed1980

Abdominoperineal levator ani repair for rectal prolapse: technique.

A review some twenty years ago of the then popular rectosigmoidectomy for complete rectal prolapse having shown an excessive recurrence rate and a high incidence of incontinence, it was felt essential to seek for a more satisfactory and reliable surgical procedure for its management. This was achieved in the form of an operation, carried out from above and below, approximating the levator ani anterior to the rectum. This has given very much more satisfactory results, and is described in detail in this paper.

Adult↗
PubMed1987

"Solitary" rectal ulcer syndrome. Are "solitary" rectal ulcer syndrome and "localized" colitis cystica profunda analogous syndromes caused by rectal prolapse?

The hypothesis that SRUS and localized CCP are analogous syndromes is supported by the similarities in clinical presentation and biopsy pathology of patients with these conditions. The theory that rectal mucosal prolapse causes SRUS and localized CCP is strengthened by the observation of like pathology in other clinical situations and various animal models in which mucosal prolapse occurs. However, rectal prolapse is not clinically demonstrable in all patients. Therefore, the definitive diagnosis of SRUS and localized CCP must depend upon the recognition of specific histopathologic features in rectal biopsy specimens from ulcer margins or otherwise abnormal mucosa. Conservative medical management is satisfactory for most patients, and surgical intervention should be reserved for highly selected patients.

Colitis↗
PubMed2003

Closed rectosacropexy for rectal prolapse in children.

This report describes a simple, effective, and permanent surgical solution for persistent rectal prolapse (RP). The technique simply involves passing multiple U-shaped sutures through the stab incisions made in the skin posterior to the anus, into the sacral fascia, then into the wall of rectum, down to the anal canal, and out through the stab incisions. The strands of the suture are tied subcutaneously through the stab incisions. This operation was successfully performed in 42 children (mean age, 3.5 years) who had suffered from recurrent RP for 3-5 months. None of the children experienced any further recurrence or specific complications during follow-up ranging from 1 to 3 years. Thus, I believe that closed rectosacropexy offers a simple, minimally invasive, and effective method of treating complete RP in children.

Child, Preschool↗