Laparoscopic Rectopexy for Rectal Prolapse: Will it be the Gold Standard?

A review of the current literature is presented regarding the surgical management of full thickness rectal prolapse, comparing laparoscopic rectopexy with open abdominal operations and perineal procedures. Outcome measures include length of stay, short- and long-term outcomes and financial burdens. Current evidence suggests that laparoscopic rectopexy as treatment for full thickness rectal prolapse is a safe alternative to the other options

Minilaparotomias para tratamento de doenças do cólon

OBJETIVO: Estudar as possibilidades técnicas e resultados obtidos com pequenas incisões para tratar doenças do cólon. MÉTODO: Vinte e seis pacientes, 12 do sexo masculino e 14 do feminino foram submetidos a laparotomias com incisões menores que 10cm. As minilaparotomias variaram entre 3,6 e 10cm (média - 7,11cm), paramedianas e realizadas sobre a área tumoral localizada por palpação ou colonoscopia. Várias operações foram realizadas: hemicolectomias direitas, sigmoidectomias, colectomias segmentares e colotomias. As doenças tratadas foram: adenocarcinoma (20), lipoma (1), pólipo adenomatoso (1), carcinóide (1), Crohn íleo-cecal (1), adenoma viloso (1) e mucocele (1). RESULTADOS: Vinte e cinco enfermos evoluíram sem complicações. Uma paciente de 90 anos, com câncer de cólon ocluído e disseminado faleceu com broncopneumonia e com função intestinal normal. As funções intestinais retornaram cedo: emissão de gases no 2º e 3º dias, evacuações no 3º e 4º dias. CONCLUSÕES: Tumores menores que 8cm puderam ser facilmente operados através de minilaparotomias. Tumores maiores ou fixos não devem ser operados por pequenas incisões. Princípios oncológicos foram respeitados como na cirurgia convencional. A recuperação dos doentes foi confortável e sem queixa de dor significativa. O efeito cosmético foi excelente

Complete Rectal Prolapse in Adults: Clinical and Functional Results of Delorme Procedure Combined with Postanal Repair

This study has been performed at the Department of General Surgery, Zagazig University Hospital and King Saud Hospital, Oniza, KSAduring the period from November 1998 to September 2008.Twentyadult patients (6 males and 14 females with a mean age of 55 years) with complete rectal prolapse were eligible for the study, Where Delorme’s procedure and postanal repairwere combined. All patients presented with complete rectal prolapse at least 5 cm in length. The associated disorders included constipation (4 patients, 20%), variable degrees of incontinence (15 patients, 75%). Only one patient had no associated functional problems. The median follow up period was 65 months. There was no mortality and immediate postoperative complications developed in 4 patients (20%). Recurrence of the prolapse occurred in two patient. Eleven patients (73.3%) (11/17) with faecal incontinence showed postoperative improvement and 4 patients failed to improve. The 4 patients presented with constipation were all improved postoperatively. We conclude that the combination of Delorme’s procedure and postanal repair in the treatment of complete rectal prolapse in adults is a safe procedure that corrects the anatomical defects and improves the functional outcome. We recommend use of this method in the treatment of complete rectal prolapse especially in the elderly who are complaining of faecal incontinence

Abdominal rectopexy for complete rectal prolapse: Preliminary results of a new technique

Purpose: Although the technique for the surgical repair of rectal prolapse has advanced over the years, no ideal procedure has been found. We aim to test a new surgical procedure for abdominal rectopexy that uses the greater omentum to support the rectum below the rectopexy, to reconstruct the anorectal angle and dispense with the need for synthetic mesh, thus reducing the risk of infection. Methods: A series of ten patients, all young and medically fit, underwent repair surgery for rectal prolapse with the new rectopexy technique. Some patients had concomitant sigmoidectomy. Preoperative and postoperative assessment included a clinical examination, anal manometry and defecography. Results: Follow-up lasted a mean of 56.4 months. None of the patients had recurrent rectal prolapse or infection. Postoperative assessment at 24 months disclosed significant improvements in all the bowel and sphincter variables assessed. The 8 patients who had severe incontinence preoperatively had notably improved and 4 were fully continent, 3 moderately incontinent, and only 1 patient had persistently high levels of incontinence. In only 1 patient who initially had severe incontinence, continence completely regressed and severe constipation developed. Maximal basal pressure values increased significantly after surgery (p=0.0025), although they increased slightly less evidently in patients in whom marked incontinence persisted at postoperative follow-up. Maximal voluntary contraction pressure also increased significantly after surgery (p=0.0054), although the values changed less than those for basal pressure. During rest, squeeze and straining, and in all the patients who regained continence, even those who recovered it only partly, surgery substantially reduced the anorectal angle. The reduction during rest was statistically significant (p=0.0062). Conclusions: The rectopexy technique we tested in patients with rectal prolapse avoids the need for synthetic mesh, and provides good results in terms of bowel and sphincter function, without infection or recurrence. © Springer-Verlag 2004