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PubMed1988

Absorbable mesh in the treatment of rectal prolapse.

Transabdominal rectopexy is a widely used method with excellent results in the treatment of rectal prolapse; a variety of absorbable and non-absorbable materials has been described in the literature. In the Department of Surgery in the University of Munster we have been using absorbable mesh (Vicryl/Dexon) routinely to perform rectopexy. These materials are practically identical in their mode of degradation. Both are absorbed completely, releasing glycolic acid which is believed to be bacteriostatic. In this series of 62 cases absorbable mesh was used to fix the mobilised rectum to the sacrum. The operations were performed using one-dose antibiotic prophylaxis. There were no deaths. Two recurrences developed within two weeks of operation, one complete and one incomplete. Both cases, however, had been operated upon by inexperienced surgeons. Two further recurrences occurred after 36 and 45 months; thus the overall rate of recurrence was 6.4%. In no case was there abdominal or pelvic infection. We believe that absorbable mesh is a suitable material for performing rectopexy, reducing the rate of abdominal and particularly pelvic infection without increasing recurrence rate.

Adolescent↗
PubMed2006

How accurate are published recurrence rates after rectal prolapse surgery? A meta-analysis of individual patient data.

BACKGROUND: The literature shows wide variations of recurrence rates (RRs) after abdominal surgery for rectal prolapse. The aim of this meta-analysis was to evaluate the accuracy of published RRs. METHODS: An electronic search was performed with no restrictions. Inclusion criterion was abdominal surgery in at least 10 adults with follow-up evaluation of any length of time. Two reviewers screened 1669 references. A total of 190 investigators were asked to provide individual patient data that should be the same used at the time their reports were written. The RR was estimated by actuarial analysis. Investigators were asked for comments on results. RESULTS: Individual patient data from 6 reports published with 273 patients (186 women, 87 men) with a median age of 54 years (range, 18-88 y) were available. Abdominal surgery included mobilization with pexy (88%), with additional resection (7%), or mobilization only (5%). There were 16 recurrences at a median follow-up period of 3.94 years (range, .05-15.11 y). The effect of age (hazard ratio [HR], 2.010; P = .3443), sex (HR, 2.070; P = .4260), surgical technique (HR, .743; P = .7669), and publication (HR, 1.014; P = .8747) on RR was not significant. Two publications reported a RR of 0. In another report, the published and estimated RRs of 15% did not differ. Published RRs differed from estimated RRs in 3 reports (2.5% vs 4%; 7% vs 54%; and 9.6% vs 36%). The pooled odds ratios of 6 reports revealed a borderline significant difference between the published and estimated RRs (P = .066). CONCLUSIONS: Published RRs differed by as much as 47% from the RRs estimated by actuarial analysis depending on event definition and how the data were censored.

Actuarial Analysis↗
PubMed1996

Paediatric rectal prolapse in Rwanda.

During the 1994 crisis in Rwanda, a high incidence of full-thickness rectal prolapse was noted among the refugee children in the south-west of the country. The prolapses arose as a result of acute diarrhoeal illness superimposed on malnutrition and worm infestation. We used a modification of the Thiersch wire technique in 40 of these cases during two months working in a refugee camp. A catgut pursestring was tied around the anal margin under local, regional or general anaesthesia. This was effective in achieving short-term control of full-thickness prolapse until the underlying illness was corrected. Under the circumstances, no formal follow-up could be arranged; however, no complications were reported and only one patient presented with recurrence.

Anal Canal↗
PubMed1987

Perineal progressive myonecrosis following Thiersch's operation for rectal prolapse.

An extremely rare case of progressive perineal clostridial myonecrosis secondary to Thiersch's operation for rectal prolapse illustrates the need for early recognition of the initial clinical findings to maximize the chances for survival. Management of these infections include prompt administration of shock therapy, a broad spectrum of antibiotics, and thorough surgical debridement of all involved tissue. Prophylactic systemic antibiotic therapy must be considered, especially in high risk patients.

Aged↗
PubMed1989

Rectal prolapse: rational therapy without foreign material.

A number of operations are available for the correction of rectal prolapse. Rational judgement is required for the selection of the most appropriate procedure for each patient. Perineal rectosigmoidectomy offers a reasonable alternative to an abdominal procedure in patients who are elderly and debilitated. Simple suture rectopexy is our procedure of choice for an abdominal prolapse repair. We believe that simple rectopexy offers comparable results with less risk than procedures utilizing resection or foreign material. Colon resection should be reserved for those patients who require surveillance for colon polyps or have a history of diverticulitis.

Adult↗
PubMed1995

Laparoscopic-assisted perineal rectosigmoidectomy for rectal prolapse.

One of the important surgical principles in perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse is to ensure the complete resection of the redundant rectosigmoid colon to avoid recurrence of the prolapse. We present a new technique of laparoscopic assistance during this procedure, which helps achieve maximal mobilization and resection of the prolapsed portion.

Anastomosis, Surgical↗
PubMed1992

Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram.

Twenty-two patients with full-thickness rectal prolapse underwent ambulatory fine wire electromyography of the internal and sphincter (IAS), external and sphincter and puborectalis, together with anorectal manometry, using a computerized system. Examinations were performed both before and 3 to 4 months after rectopexy. The median (interquartile range (i.q.r.)) preoperative IAS electromyogram (EMG) frequency was 0.18 (0.05-0.31) Hz and the median (i.q.r.) preoperative resting anal pressure was 28 (15-64) cmH2O. An improvement in the IAS EMG frequency, median (i.q.r.) 0.29 (0.19-0.38) Hz (P less than 0.03), and resting anal pressure, median (i.q.r.) 41 (20-72) cmH2O (P less than 0.05), was recorded after operation, but these variables remained significantly lower than those found in normal controls: median (i.q.r.) IAS EMG frequency 0.44 (0.36-0.48) Hz and median (i.q.r.) resting anal pressure 92 (74-98) cmH2O. We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent rectoanal inhibition.

Adult↗
PubMed1983

An unusual hamartomatous malformation of the rectosigmoid presenting as an irreducible rectal prolapse and necessitating rectosigmoid resection in a 14-week-old infant.

A 14-week-old female infant presented with an irreducible rectal prolapse and a large polypoid tumor at the tip of the prolapsed mucosa. The tumor and prolapsed rectum were resected. Four weeks after the operation, profuse rectal bleeding occurred and a second similar tumor was diagnosed by endoscopy in the sigmoid colon. Laparotomy, rectosigmoid resection, and endorectal pull-through were performed. At operation, the serosal surface showed ragged polypoid lesions and an abnormal angiomatous vascularization. The postoperative course was uneventful. The histology suggested a congenital mucosal malformation. This pathology is unique in our experience and we have been unable to find anything resembling it in the literature. At age two years a Sertoli cell tumor developed in the girl with pubertas precox and a recurrent colonic polyp of the Peutz-Jeghers type.

Colon, Sigmoid↗
PubMed1987

[Total rectal prolapse in children. Modified Lockhart-Mummery operation].

A variant of the Lockhart Mummery operation for complete rectal prolapse in children is described. The modification consists of inserting a polyglactin mesh in the retrorectal presacral space. Nine children have been operated upon and followed up, some of them for more than 2 years. The immediate and long-term post-operative course has been satisfactory in all cases.

Child↗
PubMed1989

[Treatment of rectal prolapse. Perineal rectosigmoidectomy using a suture machine].

More than 50 operations designed for the treatment of complete rectal prolapse have been reported. Perineal rectosigmoidectomy using autosuture devices was first described by Vermeulen et al in 1983. During the last two years we have used this technique at Gjøvik County Hospital. We believe it to be a good alternative in patients where a transabdominal approach is unsuitable. The method is described in detail and illustrated by figures.

Colon, Sigmoid↗
PubMed1996

[Surgical therapy of rectal prolapse].

A review of literature and own clinical studies confirm that best postoperative functional results in complete rectal prolapse may be reached with rectopexy in combination with partial resection of the colon. Incontinence may be improved in 38% to 93%, depending on the author. Constipation may be reduced in 41% to 83% of the cases. In comparison, rectopexy without resection resulted in a reduction of constipation of only 11% to 28%, with even a change to the worse in 60% of the patients. Improved operative and anesthesiological conditions cause an acceptable perioperative morbidity (7-13%) and mortality (0-2%) after rectopexy with partial resection of the colon.

Colon↗
PubMed1997

Incarcerated rectal prolapse--rupture and ileal evisceration after failed reduction: report of a case.

We report a case of incarcerated rectal prolapse that could not be reduced after using the previously described application of ordinary table sugar. Gentle pressure caused the prolapsed rectum to perforate, and the small bowel herniated through the tear. This is only the second case reported in the literature of an ileal herniation through a perforated rectum after an attempted reduction of an incarcerated prolapse. It is the only reported case occurring after sugar application and the 42nd case of ileal herniation through the rectum from all causes.

Administration, Rectal↗
PubMed1976

[Combined method of rectopexy in rectal prolapse with the use of skin autoimplants].

During 1964-1973 twenty six patients were operated upon for grave rectal prolapse (6 patients after 1-2 unsuccessful operations elsewhere). The combined method of rectopexy by means of skin autoimplants after the technic suggested by B.A. Barkov was employed. All patients recovered and were completely rehabilitated, the follow-up being from 2 to 10 years. No recurrences were noted.

Adolescent↗
PubMed1993

[Rectal prolapse. Experiences with rectopexy and Delorme's operation].

During the period 1982-91, 52 patients were treated for rectal prolapse. We present the results for 25 treated with Delorme's operation and 14 with rectopexy, all of whom were observed for more than 12 months after operation. Four patients who had internal prolapse were treated with rectopexy. Eight (15%) of 52 patients had postoperative complications, including six in the Delorme group and two in the rectopexy group. A 75 year-old woman operated with rectopexy died from peritonitis. Eight patients (32%) developed recurrent prolapse after Delorme's operation. Five of these were successfully reoperated. No patients in the rectopexy group had a recurrent prolapse. Incontinence and bleeding were reduced in both groups. Despite a relatively high rate of recurrence, we consider Delorme's operation to be a good alternative, also for old debilitated patients, and to involve a minimal risk of serious complications. If recurrence occurs, reoperation can be carried out with good results.

Adult↗