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Results for “RECTAL PROLAPSE”

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PubMed2005

[Modified procedure for prolapse and hemorrhoids to prevent and treat postoperative complications].

OBJECTIVE: To investigate the complications of procedure for prolapse and hemorrhoids (PPH) and their management. METHOD: The clinical data of 147 cases of severe hemorrhoids treated by modified PPH were analyzed in view of the operation method and postoperative complications. RESULT: All the prolapsed hemorrhoids recovered immediately after the operation. The main complications on the first postoperative day were abdominal distention caused by dysuria, pain, and constant sense of defecation urgency, which lasted for 1 to 16 days. Thirty-six cases had intermittent hemafecia 1 to 12 days after operation, improved with expectant treatment. No stoma stenosis, copracrasia or relapse of prolapse occurred during the follow-up for 1 to 37 months. CONCLUSION: All postoperative complications can be prevented, alleviated and cured with modified PPH.

Digestive System Surgical Procedures↗

PubMed2000

Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial.

BACKGROUND: Haemorrhoidectomy is commonly an inpatient procedure because it is frequently associated with postoperative pain. Day case haemorrhoidectomy is a similar operation to that used on inpatients but with different strategies for managing postoperative pain. Circumferential mucosectomy (stapled haemorrhoidectomy) may be associated with less postoperative pain than conventional haemorrhoidectomy. We compared stapled haemorrhoidectomy with conventional haemorrhoidectomy in patients with third degree haemorrhoids. METHODS: We randomly assigned 22 patients to conventional haemorrhoidectomy by the diathermy dissection or to stapled haemorrhoidectomy with the use of an intraluminal stapling device. Patients were discharged when free of pain, took co-codamol as required, completed visual analogue charts each day, and were assessed at 1 and 6 weeks postoperatively for symptom control. FINDINGS: All patients received the assigned treatment. Mean inpatient stay was lower in the group assigned to stapled as opposed to conventional haemorrhoidectomy (1.09 [0.3] vs 2.82 [0.09] nights, p<0.001), experienced less pain overall (p=0.003), and returned to normal activities sooner (8.1 [1.53] vs 16.9 [2.33] days, p<0.005). Stapled haemorrhoidectomy controlled symptoms of prolapse, discharge and bleeding in all patients. INTERPRETATION: Stapled haemorrhoidectomy is an effective treatment for third degree haemorrhoids with significant advantages for patients compared with conventional haemorrhoidectomy.

Electrocoagulation↗

PubMed2003

Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial.

BACKGROUND AND AIMS: The notable success of stapled prolapsectomy in recent years led us to compare this technique with Milligan-Morgan hemorrhoidectomy in terms of the results obtained both in the immediate postoperative period and in the long term. PATIENTS AND METHODS: We performed conventional hemorrhoidectomy on 50 randomly selected patients and operated on a further 50 using the stapler technique. The patients were monitored over the immediate postoperative period (e.g., type of anesthesia, mean duration of operation, mean hospitalization time, analgesic administration, time before returning to work) and over a long-term follow-up period of 48 months (later complications such as prolapse relapse, bleeding, stenosis, incontinence). RESULTS: The stapled group experienced significantly less pain (mean number of analgesic tablets 2.60 vs. 15.9) and returned to normal activity sooner (8.04 vs. 16.9 days), as reported by other authors. In the long-term follow-up at 48 months, stapled hemorrhoidectomy was found to control prolapse, discharge, and bleeding, with no stenosis or significant incontinence, in 94% of cases. CONCLUSION: Our conclusions confirm the excellent advantages of stapled hemorrhoidectomy which allows the rapid recovery of patients and also promises the complete resolution of hemorrhoidal prolapse in the long term.

Activities of Daily Living↗

PubMed1982

Retrorectal levatorplasty with colporrhaphy.

There is an uncommon type of genital prolapse characterized by descent of the anus and rectum and sagging of the normally horizontal levator plate. When this is associated with long-standing severe constipation and marked decrease in the diameter of the stool while straining, retrorectal levatorplasty with colporrhaphy may be curative.

Female↗

PubMed1978

Modified Buie amputation for extensive hemorrhoidal disease.

Radical anal surgery of the type described for complicated hemorrhoidal and mucosal prolapse has good to excellent anatomic and functional results in 90 per cent of patients. This has been demonstrated in a group of 100 consecutive patients followed for an average of more than two years.

Adult↗

PubMed1991

Sugar in the reduction of incarcerated prolapsed bowel. Report of two cases.

Incarcerated, prolapsed rectum, colostomies, and ileostomies, when viable, may be reduced using ordinary table sugar. The placing of sugar granules on the incarcerated bowel results in a decrease in tissue edema and spontaneous bowel reduction. The technique, case reports, and a review of the literature are herein reported.

Administration, Rectal↗

PubMed1997

Dynamic MR colpocystorectography assessing pelvic-floor descent.

Magnetic resonance colpocystorectography (MR-CCRG) is presented in the evaluation of patients with pelvic-floor disorders. Five healthy volunteers and 44 female patients with isolated or combined visceral descent underwent dynamic MRI and dynamic fluoroscopy (DF). MR-CCRG was performed with the patient in a supine position using a True FISP sequence (1 image/1.2 s; in-plane resolution 1.02 mm) during pelvic floor contraction, relaxation, and straining maneuvers. Relevant organs, such as urethra, bladder, vagina, and rectum, were opacified by using a saline solution, Magnevist (Schering AG, Berlin, Germany), and sonography gel, respectively. The clinical evaluation and the intraoperative results (30 cases) were used as reference. MR-CCRG and DF were non-diagnostic in 3 cases each. Most patients had a combined type of visceral prolapse, the most frequent combination being a vaginal vault prolapse and a cystocele. The points of reference were sufficiently outlined by DF and MR-CCRG. In comparison with the clinical and intraoperative results, MR-CCRG proved to be especially beneficial in the diagnosis of different types of enteroceles including a uterovaginal prolapse. MR-CCRG showed an equal or higher sensitivity and specificity for all individual sites when compared with DF. Also, predominant herniation obscuring other concomitant prolapse could be verified in 8 cases. MR-CCRG is superior to DF and accurately depicts pelvic-floor descent and prolapse in women. The possibility of dynamic presentation (see enclosed CD-ROM) allows for a better understanding of the organ movements within a given topographic reference setting.

Contrast Media↗

PubMed2002

Pig bite of prolapsed rectum in a child.

A case of pig bite to the prolapsed rectum in a 2(1/2) year old boy is reported because of its rarity and successful management in spite of delayed presentation.

Age Factors↗

PubMed1992

The importance of the endopelvic fascia repair during vaginal hysterectomy.

During 1985 to 1989, 177 vaginal hysterectomies were performed in the Department of Gynecology, Kaplan Hospital, Rehovot, Israel, using the Porges technique with some modifications. Ninety patients had some degree of loss of the pelvic support--anterior or posterior wall relaxation, enterocele or uterine prolapse in various degrees. The patients were allocated to two groups, in which two different techniques were compared: group 1, with repair of the pubocervical and pararectal fascia and group 2 without the repair. The repair of the pubocervical and pararectal fascia after vaginal hysterectomy prevented vaginal vault prolapse (zero versus 15 percent, p < 0.01) and reduced the incidence of recurrent rectocele (23 versus 55 percent, p < 0.05) and recurrent cystocele (14 versus 45 percent, p < 0.005). Recurrent genuine stress incontinence was found in 9 percent of patients in group 1 and 18 percent of patients in group 2 (not statistically significant; p = 0.163). Optimal management of relaxation of the vaginal wall during vaginal hysterectomy requires clinical suspicion and precise preoperative diagnosis and therapeutic plan. In the present study, the need for careful repair of the pubocervical and pararectal fascia during vaginal hysterectomy to prevent vaginal vault prolapse is emphasized. This procedure does not prolong the operation significantly (92 +/- 15 versus 84 +/- 17 minutes) and has no deleterious postoperative complications.

Aged↗

PubMedDate not supplied

[Surgical treatment of rectoceles].

Rectocele is a posterior colpocele inhabited by an expansion of the anterior wall of the rectum. Its physiopathology is similar to that of other vaginal prolapse and is essentially dependent on the opening of the vulva secondary to a damage of the pelvi-perineal musculature. Its specific symptomatology is poor except for dyschesis. A colpocystogram may be helpful when there is a need to differentiate between rectocele and elytrocele. The surgical treatment of rectocele requires, most of the time, a vaginal approach with posterior colpo-perineomyorraphy. More rarely, when the rectocele is isolated, small and associated with another anorectal pathology, the endo ano-rectal approach may be used to perform the rectorraphy.

Female↗

PubMed1977

The results of treatment for complete prolapse of the rectum in the adult patient.

A method of anterior fixation of the bowel in complete prolapse of the rectum is described. The treatment is based on the concept that abdominal pressure should be directed on the bowel against the pubis rather than directly onto the perineum. The results have been universally successful, without mortality and with excellent functional results.

Adult↗

PubMed1984

The foreskin anoplasty.

The role of anal sensation in fecal control is well established. A new operative method of creating a skin-lined anal canal using the patient's foreskin, as a secondary procedure, in patients with anal (colonic) prolapse following surgery for high anorectal anomalies, is described. The results in five patients treated between 1967 and 1979 are presented. A sixth patient, treated in 1983, is not included due to the short follow-up period.

Anal Canal↗

PubMed1991

Surgery for pelvic floor disorders.

By careful observation of the physical findings in the patient complaining of one of the disorders of genital prolapse, it should be possible to discern the origin of the symptoms and therefore to devise an appropriate treatment that would remedy by reconstruction all of the signs of anatomic weakness. The goals of reconstructive surgery are three: to relieve the symptoms, to restore the anatomy to normal, and to restore the function to normal. When any element of weakness in the pelvic floor is found to be sufficient to produce symptoms that warrant repair, it is the responsibility of the surgeon to identify all the sites of weakness, so that all may be repaired at the same time, sparing the patient the expense, pain, and inconvenience of future readmission for further surgery. These weaknesses all relate to deficiencies of the six major organ systems that are involved in the support of the female pelvis, which may be damaged singly or in any combination. There are various types of cystocele, each of which must be carefully excised if an appropriate surgical treatment is to be given. This may involve correction of cystocele, enterocele, rectocele, prolapse of the uterus, and posthysterectomy prolapse of the vaginal vault. With enterocele, it is possible to correlate the four common types of enterocele with their location, which in turn correlates directly with their treatment. The prevention of complications is emphasized along with the treatment of certain mechanical complications easily recognized at the time of surgery.

Female↗

PubMed1997

Preventing wading pool suction-drain injuries.

Wading pools with displaced drain covers and single drain outlets can lead to life-threatening injuries. This is a case of a Maryland child who sustained transanal suction which resulted in prolapse and avulsion of the small intestine from its blood supply. Because the injury would likely have been prevented if at least one of three safety precautions had been followed, standards for pool operation and pool design are reviewed.

Child, Preschool↗

PubMed2003

Short-term and long-term results of combined sclerotherapy and rubber band ligation of hemorrhoids and mucosal prolapse.

PURPOSE: Rubber band ligation is a common office procedure for symptomatic hemorrhoids. The aim of the study was to assess our short-term and long-term results of combined sclerotherapy and rubber band ligation in the management of hemorrhoids and incomplete mucosal prolapse. METHODS: Data on 6,739 patients who had previous combined sclerotherapy and rubber band ligation by the senior authors (GLN and PRD) were retrieved from the database dating between January 1976 and June 2000. These patients either had hemorrhoids or incomplete mucosal prolapse. Furthermore, questionnaires were sent to a random sample of 2,400 patients. Telephone interviews were performed for 600 of the nonrespondents. RESULTS: Of 6,739 patients (3,683 males; mean age, 46.7 years) in the database, 4,686 (70 percent) received the procedure once, and 2,053 (30 percent) received the procedure more than once. There were 5,689 patients (84 percent) who had their procedures performed consecutively within a planned period, and only 1,050 patients (16 percent) had repeat procedures after a period of more than 12 months from their last treatments. Thus, the recurrence rate was 16 percent. The overall complication rate was 3.1 percent, with minor bleeding being the major complaint. With regard to the questionnaire, 44 percent responded. The mean follow-up period was 6.5 (range, 1-11) years. There were patients who had residual symptoms of bleeding (19 percent), itch (21 percent), and lump (20 percent). However, 58 percent of patients who replied were asymptomatic. With satisfaction scores ranging from +3 to -3 (+3 indicating complete satisfaction and -3 indicating complete dissatisfaction), 90 percent scored >/=1, 9 percent scored 0 or less, and 1 percent did not specify a score. Hemorrhoidectomy was required in 7.7 percent of the responders. Of 600 phone interviews with the nonrespondents, 152 responded to the questionnaires. Although there was less satisfaction from the phone respondents, which may have accounted for the initial nonresponse, no statistical difference was detected in residual symptoms. CONCLUSIONS: Combined triple sclerotherapy and rubber band ligation is an effective treatment for early hemorrhoids and incomplete mucosal prolapse, with low rates of recurrence, complications, and hemorrhoidectomy, and it can be repeated easily.

Adolescent↗

PubMed1975

Conservative management of haemorrhoids. Part I: injection, freezing and ligation.

Of 111 consecutive patients treated by partial internal sphincterotomy for a haemorrhoidal disease in the course of a prospective study, 101 could be re-examined between 24 and 36 months after operation. There were no major complications but 11 patients had some significant complaints at some time after operation. There were six recurrences, five of which could be attributed to inadequate sphincterotomy. One patient had an excessive sphincterotomy which led to difficulties with continence of fluid stools. One patient developed a peri-anal abscess two years after partial sphincterotomy and four patients with marked soiling will require surgical correction of the posterior gutter. The gutter is due to secondary epithelialisation after open sphincterotomy in the posterior midline. The recommended technique entails the division of the internal sphincter up to a few millimeters above the dentate line and reconstruction of the anal mucosa with a continuous absorbable suture. 'Landscaping' by partial resections of the prolapsed haemorrhoids is recommended to avoid sclerotic tags. Submucosal sphincterotomy should be considered by the very experienced only and then provided that the anal mucosa shows little scarring.

Aged↗

PubMed1989

[Surgical techniques and long-term results for hemorrhoids from the clinical viewpoint].

The decongestion of the hemorrhoidal cushion is the main principle in treating piles. This is achieved with a diet high in roughage. Although severe hemorrhoids are not cured by buld-forming agents, they are of central importance to prevent recurrences. Hemorrhoidectomy should be performed mainly in cases of hemorrhoidal prolapse. Results of the three most often used techniques (Milligan-Morgan, Parks, Ferguson) are more or less comparable, although the presentation of the details in the literature is contradictionary. Each surgeon should use the technique that suits him best. We prefer the closed operation described by Ferguson.

Follow-Up Studies↗

PubMed1986

Transsphincteric approach to the rectum.

During a transsphincteric operation the patient is prone with the legs sliahtly abducted and the hip and knee joints flexed at right angles. The pelvic floor is opened by means of a left parasacral incision and, if necessary, the sphincters are divided providing an excellent exposure of the caudal rectum and anal canal. At the end of the procedure the pelvic floor and the sphincters are repaired anatomically so that normal defecation and continence are preserved. 106 surgical interventions on the rectum were performed by the sphincter splitting parasacral approach from January 1974 to June 1985. Very good results were obtained by this technique when applied to benign tumours, fistulas and traumatic lesions. Radical resection of certain very low malignant tumours restricted to the bowel wall as well as lymph node staging are possible by this technique. In the case of recto-sigmoid prolapse, resection of the protruding bowel segment and tightening of a lax pelvic floor are achieved by the parasacral transsphincteric operation. The transsphincteric approach is also a highly suitable technique in the treatment of high fistulae and traumatic lesions. Severe complications are rare assuming accurate preliminaries and surgical skill.

Adult↗