TITLE

Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty

AUTHOR(S)
Chun, S. W.; Pikarsky, A. J.; You, S. Y.; Gervaz, P.; Efron, J.; Weiss, E.; Nogueras, J. J.; Wexner, S. D.
PUB. DATE
March 2004
SOURCE
Techniques in Coloproctology;Mar2004, Vol. 8 Issue 1, p3
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The management of full thickness rectal prolapse remains controversial. Although abdominal approaches have a lower recurrence rate than do perineal operations, they are associated with a higher morbidity. The aim of this study was to compare the outcomes of perineal rectosigmoidectomy with and without levatorplasty. Between 1989 and 1999, a total of 109 consecutive patients (10 men) underwent 120 perineal procedures. These patients were retrospectively evaluated in two groups on the basis of the type of surgery received: perineal rectosigmoidectomy (PRS) or perineal rectosigmoidectomy with levatorplasty (PRSL). Subsequent functional outcome and physiological parameters were assessed. The patients had a mean age of 75.7 years (range, 23.0–94.8 years) and they were followed for an overall mean (in both groups combined) of 28.0 months (range, 0.4–126.4 months) after surgery. Mean duration of surgery was 78.1 min (SD=25.9) and 97.6 min (SD=32.3) in PRS and PRSL, respectively (p=0.002, unpaired t test). There was no significant difference between the two groups in terms of hospital stay, morbidity or mortality. Recurrence rates and mean time interval to recurrence were, respectively, 20.6% and 45.5 months in PRS compared to 7.7% and 13.3 months in PRSL (p=0.049, chi-square test; p=0.001, unpaired t test). Both groups had significant improvements in postoperative incontinence score (p<0.0001, Wilcoxon's matched-pairs signed-ranks test), however, there were no significant changes in anorectal manometric findings and pudendal nerve terminal motor latency assessment. Perineal rectosigmoidectomy with levatorplasty is associated with a lower recurrence rate and a longer time to recurrence than perineal rectosigmoidectomy alone. Levatorplasty should be offered to patients when a perineal approach for rectal prolapse is selected.
ACCESSION #
13565627

 

Related Articles

  • Complications and reoperations in stapled anopexy: learning by doing. Jongen, Johannes; Bock, Jens-Uwe; Peleikis, Hans-Günter; Eberstein, Anne; Pfister, Karin // International Journal of Colorectal Disease;Mar2006, Vol. 21 Issue 2, p166 

    Although stapled anopexy for second and third degree hemorrhoids has been widely used since 1998, there are limited long-term data available. We performed an analysis of a prospectively accrued data set of all patients undergoing stapled anopexy in our practice from 1998 through August 2003....

  • Study of the role of the transverse perineal muscles during rectal filling. Shafik, Ahmed; Shafik, Ali A.; Shafik, Ismail; El-Sibai, Olfat // International Journal of Colorectal Disease;Nov2006, Vol. 21 Issue 7, p698 

    The function of perineal muscles at defecation is poorly addressed in the literature. We investigated the hypothesis that rectal distension effects reflex contraction of four perineal muscles. After rectal balloon distension with carbon dioxide in increments of 20 ml, the responses of...

  • Pouch perineal rectosigmoidectomy: a case report. Baig, Mirza K.; Galliano, Domingo; Larach, Jorge A.; Weiss, Eric G.; Wexner, Steven D.; Nogueras, Juan J. // Surgical Innovation;Dec2005, Vol. 12 Issue 4, p373 

    Many surgical methods have been described for the treatment of full-thickness rectal prolapse. Rarely, unusually large lengths of colon must be excised, thus resulting in a significant loss of the absorptive function of the remaining colon. We present an unusual case in which an extraordinary...

  • Clinical and functional outcome of laparoscopic posterior rectopexy (Wells) for full-thickness rectal prolapse. A prospective study. Dulucq, Jean-Louis; Wintringer, Pascal; Mahajna, Ahmad // Surgical Endoscopy;Dec2007, Vol. 21 Issue 12, p2226 

    Background: Laparoscopic rectopexy offers the advantages of the open transabdominal approach while decreasing the surgical comorbidity. The aim of this prospective study was to assess the clinical and functional outcome of laparoscopic Wells procedure for full-thickness rectal...

  • Solitary rectal ulcer syndrome: physiology and treatment options. Swatton, Anna // British Journal of Nursing;11/26/2009, Vol. 18 Issue 21, p1312 

    Solitary rectal ulcer syndrome (SRUS) is a rare condition that can lead to pain, rectal bleeding and mucus. It is associated with chronic straining and abnormal defaecatory behaviour, including digitating and several unsuccessful visits to the toilet daily. Other symptoms can include tenesmus,...

  • Sacral neuromodulation for faecal incontinence: is the outcome compromised in patients with high-grade internal rectal prolapse? Prapasrivorakul, Siriluck; Gosselink, Martijn; Gorissen, Kim; Fourie, Simona; Hompes, Roel; Jones, Oliver; Cunningham, Chris; Lindsey, Ian // International Journal of Colorectal Disease;Feb2015, Vol. 30 Issue 2, p229 

    Background: High-grade internal rectal prolapse appears to be one of the contributing factors in the multifactorial origin of faecal incontinence. Whether it affects the outcome of sacral neuromodulation is unknown. We compared the functional results of sacral neuromodulation for faecal...

  • Diagnostic Evaluation of Patients with Faecal Incontinence at a Specialist Institution. T. Mimura; M. Kaminishi; M.A. Kamm // Digestive Surgery;2004, Vol. 21 Issue 3, p235 

    Background: Evaluation of the anorectal function, clinically, structurally, and functionally, in patients with faecal incontinence should ensure appropriate and individual treatment. Methods: Two hundred and twenty-six patients with faecal incontinence were reviewed regarding disease history and...

  • Self-Reported Rectal Bleeding in a United States Community: Prevalence, Risk Factors, and Health Care Seeking. Talley, Nicholas J.; Jones, Michael // American Journal of Gastroenterology;Nov1998, Vol. 93 Issue 11, p2179 

    Objective: Little data on rectal bleeding in the U.S. population are available. We therefore sought to assess the prevalence of different types of rectal bleeding, their association with potential risk factors including other colonic symptoms, and predictors of health care seeking in a U.S....

  • Short Papers and Trials in Treatment of Pelvic Floor Disorders.  // Gut;2015 Supplement1, Vol. 64, pA41 

    The article presents abstracts on medical topics which include results of surgery for rectal prolapse, anorectal excitatory reflex's significance in faecal incontinence patients and effects of gynaecological surgery on symptom resolution following laparoscopic ventral mesh rectopexy.

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics