Outcome of Fecal Incontinence in Patients with Rectal Prolapse Undergoing the Altemeier Procedure with or without Posterior Levatorplasty

Abstract Objective To compare the fecal incontinence status of patients submitted to theAltemeier procedure with or without posterior levatorplasty. Materials and Methods Medical records of the patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered. In some cases, the operation was performed with posterior levatorplasty. Rectal prolapse due to collagen or connective tissue disorders, anal/sacral anomalies, immunodeficiency, history of rectal surgery, and pelvic radiotherapy were the exclusion criteria of the present study. In addition to the demographics (including age, gender, and body mass index), the fecal incontinence status of each case was determined through the Wexner scale preoperatively and 12 months after the surgery. The incontinence scores were then compared against the baseline values of the two groups of patients: those with and those without posterior levatorplasty. The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, US), software, version 21. Results In total, 53 patients (17 men and 36 women) with a mean age of 55.23 ± 18.24 years were analyzed. The comparison of the pre- and postoperative scores on the Wexner scale between the two groups revealed no statistically significant difference (p >0.05). Conclusion Posterior levatorplasty during the Altemeier procedure did not result in significant improvement of the fecal incontinence outcome of the patients.

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BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032015000400011 ◽

2015 ◽

Vol 52 (4) ◽

pp. 311-314

Author(s):

Seyed Mohsen DEHGHANI ◽

Hazhir JAVAHERIZADEH ◽

Mahmood HAGHIGHAT ◽

Mohammad-Hadi IMANIEH ◽

Saeed GHANBARI

Keyword(s):

Data Analysis ◽

Polyethylene Glycol ◽

Bowel Preparation ◽

Normal Saline ◽

Therapeutic Procedure ◽

Previous Surgery ◽

Exclusion Criteria ◽

Significant Difference ◽

History Of

Background - Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. Objectives - The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. Methods - This study included children with the range of ages (2-21) who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA) were used for data analysis. Results - In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%), 36 (94.73%), and 14 (82.35%) of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05). For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. Conclusion - There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.

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Surgical treatment of rectal prolapse: experience and late results with 51 patients

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812004000400003 ◽

2004 ◽

Vol 59 (4) ◽

pp. 168-171 ◽

Cited By ~ 4

Author(s):

Carlos Walter Sobrado ◽

Desidério Roberto Kiss ◽

Sérgio C. Nahas ◽

Sérgio E. A. Araújo ◽

Victor E. Seid ◽

...

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Rectal Prolapse ◽

Late Results ◽

Long Term Results ◽

Complete Rectal Prolapse ◽

Presacral Space ◽

Perineal Rectosigmoidectomy ◽

Study Results ◽

Low Incidence

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

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Laparoscopic Suture versus Mesh Rectopexy for the Treatment of Persistent Complete Rectal Prolapse in Children: A Comparative Randomized Study

Minimally Invasive Surgery ◽

10.1155/2020/3057528 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

AbdelAziz Yehya ◽

Ibrahim Gamaan ◽

Mohamed Abdelrazek ◽

Mohamed Shahin ◽

Ashraf Seddek ◽

...

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Operative Time ◽

Randomized Study ◽

Complete Rectal Prolapse ◽

University Hospitals ◽

Laparoscopic Suture ◽

Suture Rectopexy ◽

Group B ◽

Mesh Rectopexy

Purpose. To compare laparoscopic mesh rectopexy with laparoscopic suture rectopexy. Patients and Methods. The prospective study was conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between Feb 2010 and Jan 2015. Seventy-eight children with persistent complete rectal prolapse were subjected to laparoscopic rectopexy. Fourteen parents refused to participate. All patients received initial conservative treatment for more than one year. The remaining 64 patients were randomized divided into two equal groups. Group A; 32 patients underwent laparoscopic mesh rectopexy and group B, 32 underwent laparoscopic suture rectopexy. The operative time, recurrence rate, post-operative constipation, and effect on fecal incontinence, were reported and evaluated for each group. Results. Sixty-four cases presented with persistent complete rectal prolapse were the material of this study. They were 40 males and 24 females. Mean age at operation was 8 (5–12) years. All cases were completed laparoscopically. Mean operative time in laparoscopic suture rectopexy was shorter than laparoscopic mesh rectopexy group. No early post-operative complications were encountered. No cases of recurrence with mesh rectopexy group while in suture rectopexy group it was 4 cases (14.2%). Post-operative constipation occurred in one case (3.57%) in suture rectopexy group and occurred in one case (3.3%) in mesh rectopexy group. Fecal incontinence improved in 26/28 cases (92.8%) in suture rectopexy while in mesh rectopexy it was improved in 30/30 cases (100%) of cases. Conclusion. Both laparoscopic mesh and suture rectopexy are feasible and reliable methods for the treatment of complete rectal prolapse in children. However, no recurrence, low incidence of constipation and high improvement of incontinence at follow up more than 36 months with mesh rectopexy accordingly, we considered mesh rectopexy to be the procedure of choice in treatment of complete rectal prolapse.

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A new modified Gant-Miwa-Thiersch combined with submucosal and perirectal sclerosant injection procedure for full-thickness rectal prolapse in elderly women: clinical analysis of 34 cases

BMC Surgery ◽

10.1186/s12893-021-01284-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jinxi Wang ◽

Huiyu Li ◽

Xiaoming Ma ◽

Gang Du ◽

Jun Ma ◽

...

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Frail Elderly ◽

Elderly Women ◽

Systolic Pressure ◽

Clinical Analysis ◽

Full Thickness ◽

Incontinence Score ◽

Minimal Invasiveness ◽

Significant Difference

Abstract Background Full-thickness rectal prolapse (FTRP) frequently occurs in elderly women, and more than 100 surgical procedures have been proposed to restore FTRP. The Gant-Miwa-Thiersch (GMT) procedure is the most used treatment in China. However, the recurrence rate of FTRP post-GMT, which is as high as 23.8%, is concerning. We described a new modified GMT combined with internal and external rectal sclerosant injection (nmGMTSI) procedure to address this problem. Methods The nmGMTSI was performed under spinal anesthesia in 34 frail, elderly female patients with FTRP. The surgical results of FTRP were assessed. Fecal incontinence and constipation were evaluated using the Wexner score, and anal canal rest pressure (ACRP), maximum anal systolic pressure (MASP), anorectal sensation thresholds (AST), and maximum rectal tolerance (MRT) using anorectal manometry preoperatively and postoperatively. The causes of recurrence and complications were analyzed. Results All patients were cured according to the clinical cure standard. The perioperative Wexner fecal incontinence score (WFIS) was 10.3 ± 3.31, which became 3.7 ± 2.43 (P < 0.0001) postoperatively. The perioperative ACRP was 2.0 ± 0.56 kPa, which became 8.5 ± 2.25 kPa (P < 0.0001) postoperatively. The perioperative MASP was 4.5 ± 1.16 kPa, which became 18.6 ± 2.50 kPa (P < 0.0001) postoperatively. However, no significant difference was observed between the preoperative and postoperative Wexner constipation scores (WCS) (17.3 ± 2.25 vs. 15.4 ± 2.89, P = 0.1047). The perioperative and postoperative AST were 38.1 ± 5.34 mL and 23.5 ± 3.61 mL, respectively (P = 0.0002). The maximum rectal tolerance (MRT) was 157.1 ± 16.73 mL, which became 121.2 ± 12.45 mL postoperatively (P = 0.0009). The patients developed no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median two years follow-up period. The most common cause of relapse after nmGMTSI was the removal of infected threads used in the Thiersch procedure. Conclusion The benefits of nmGMTSI include low rates of recurrence, complications, and mortality, cost-effectiveness, wide adaptation, minimal invasiveness, and technical simplicity. Hence, it should be considered the first option for the treatment of FTRP in frail elderly women.

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Altemeier procedure for complete rectal prolapse – a video vignette

Colorectal Disease ◽

10.1111/codi.15250 ◽

2020 ◽

Vol 22 (11) ◽

pp. 1807-1808

Author(s):

G. Gallo ◽

D. Cuccurullo ◽

E. Stratta ◽

A. Realis Luc ◽

G. Clerico ◽

...

Keyword(s):

Rectal Prolapse ◽

Complete Rectal Prolapse ◽

Altemeier Procedure ◽

Video Vignette

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Spontaneous evisceration of small bowel through the rectum in the background of rectal prolapse

SAGE Open Medical Case Reports ◽

10.1177/2050313x211011809 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110118

Author(s):

Oshan Basnayake ◽

Umesh Jayarajah ◽

AM Thilak Wijerathne

Keyword(s):

Small Bowel ◽

Rectal Prolapse ◽

Primary Repair ◽

Anterior Wall ◽

Emergency Laparotomy ◽

Complete Rectal Prolapse ◽

Significant Morbidity ◽

Treatment Unit ◽

Vaginal Deliveries ◽

History Of

Small bowel evisceration secondary to rectal prolapse is an uncommon complication with significant morbidity and mortality if left untreated. We report a rare case of the spontaneous evisceration of the small bowel through the rectum in the background of rectal prolapse. A 73-year-old female presented to the emergency treatment unit with sudden worsening of her rectal procidentia (rectal prolapse) and pain for 3 h precipitated by straining at defecation. She had a history of complete rectal prolapse for 4 years and three uncomplicated vaginal deliveries. On examination, she was found to have evisceration of the small bowel through the anus without any evidence of strangulation. Emergency laparotomy was performed and small bowel was reduced into the abdomen with ease. She was found to have a linear tear on the anterior wall of the rectum. Primary repair of the rectal defect was carried out and a proximal defunctioning ileostomy was created. Histology was unremarkable and the recovery was uneventful. Old age, history of previous vaginal deliveries, and long-standing rectal prolapse were probable risk factors in this patient. Delay in treating this condition may result in significant morbidity and even mortality. Therefore, timely intervention is necessary.

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Perineal Proctectomy With Bio-Thiersch Procedure for Complete Rectal Prolapse With Fecal Incontinence

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000338 ◽

2015 ◽

Vol 58 (4) ◽

pp. e45 ◽

Cited By ~ 3

Author(s):

Jed F. Calata ◽

Ajit Pai ◽

Slawomir Marecik ◽

Leela M. Prasad ◽

John J. Park

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Complete Rectal Prolapse ◽

Thiersch Procedure

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EP.TH.772Meta-analysis of laparoscopic mesh rectopexy versus posterior sutured rectopexy for management of complete rectal prolapse

British Journal of Surgery ◽

10.1093/bjs/znab309.084 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh

Keyword(s):

Rectal Prolapse ◽

Hospital Stay ◽

Cleveland Clinic ◽

Length Of Hospital Stay ◽

Controlled Vocabulary ◽

Complete Rectal Prolapse ◽

Free Text ◽

Procedure Time ◽

Significant Difference ◽

Mesh Rectopexy

Abstract Objectives To evaluate comparative outcomes of laparoscopic mesh rectopexy (LMR) and laparoscopic posterior sutured rectopexy (LPSR) in patients with rectal prolapse Methods We conducted a systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Recurrence, Cleveland Clinic Incontinence Score (CCIS), Cleveland Clinic Constipation Score (CCCS), surgical site infections, procedure time, and length of hospital stay were the evaluated outcome measures. Results We identified 5 comparative studies reporting a total of 307 patients evaluating outcomes of LMR (n = 160) or LPSR (n = 147) in patients with rectal prolapse. LMR was associated with significantly lower recurrence rate (OR:0.28, P = 0.009) but longer procedure time (MD:23.93, P < 0.0001) compared to LPSR. However, there was no significant difference in CCIS (MD:-1.02, P = 0.50), CCCS (MD:-1.54, P = 0.47), surgical site infection (OR:1.48, P = 0.71), and length of hospital stay (MD:-1.54, P = 0.47) between two groups. No mesh erosion was reported in any of the included studies at maximum follow-up point. Sub-group analyses with respect to ventral mesh rectopexy, posterior mesh rectopexy, randomised studies and adult patients were consistent with the main analysis. Conclusions LMR seems to be associated with lower recurrence but longer procedure time compared to LPSR. Although no mesh related complications have been reported by the included studies, no definitive conclusions can be made considering that the included studies were inadequately powered for such outcome. Future high quality randomised studies with adequate sample size are required.

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The Social Origins and Provenance of the English Bishops during the Reign of Edward II

Transactions of the Royal Historical Society ◽

10.1017/s0080440100017540 ◽

1959 ◽

Vol 9 ◽

pp. 51-79

Author(s):

K. Edwards

Keyword(s):

Middle Ages ◽

Social Background ◽

Early Career ◽

The Political ◽

Social Origins ◽

Political Activities ◽

Edward Ii ◽

The Social ◽

Complete Study ◽

History Of

During the last twenty or twenty-five years medieval historians have been much interested in the composition of the English episcopate. A number of studies of it have been published on periods ranging from the eleventh to the fifteenth and early sixteenth centuries. A further paper might well seem superfluous. My reason for offering one is that most previous writers have concentrated on analysing the professional circles from which the bishops were drawn, and suggesting the influences which their early careers as royal clerks, university masters and students, secular or regular clergy, may have had on their later work as bishops. They have shown comparatively little interest in their social background and provenance, except for those bishops who belonged to magnate families. Some years ago, when working on the political activities of Edward II's bishops, it seemed to me that social origins, family connexions and provenance might in a number of cases have had at least as much influence on a bishop's attitude to politics as his early career. I there fore collected information about the origins and provenance of these bishops. I now think that a rather more careful and complete study of this subject might throw further light not only on the political history of the reign, but on other problems connected with the character and work of the English episcopate. There is a general impression that in England in the later middle ages the bishops' ties with their dioceses were becoming less close, and that they were normally spending less time in diocesan work than their predecessors in the thirteenth century.

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Individual differences, social attention, and the history of the social motivation hypotheses of autism

Behavioral and Brain Sciences ◽

10.1017/s0140525x18002509 ◽

2019 ◽

Vol 42 ◽

Author(s):

Peter C. Mundy

Keyword(s):

Individual Differences ◽

Early Development ◽

Emotional Development ◽

Social Motivation ◽

Social Attention ◽

Social Emotional Development ◽

Social Emotional ◽

Precise Understanding ◽

The Social ◽

History Of

Abstract The stereotype of people with autism as unresponsive or uninterested in other people was prominent in the 1980s. However, this view of autism has steadily given way to recognition of important individual differences in the social-emotional development of affected people and a more precise understanding of the possible role social motivation has in their early development.

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