scholarly journals 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 ◽  
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.

scholarly journals A New Modified Gant-Miwa-Thiersch Combined With Internal and External Rectal Sclerosant Injection Procedure for The Treatment of Full-Thickness Rectal Prolapse in Elderly Women

2021 ◽  
Author(s):  
Jinxi Wang ◽  
Huiyu Li ◽  
Xiaoming Ma ◽  
Gang Du ◽  
Jun Ma ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Rectal Prolapse ◽  
Frail Elderly ◽  
Elderly Women ◽  
Systolic Pressure ◽  
Full Thickness ◽  
Recurrence Rates ◽  
Incontinence Score ◽  
Mortality Cost ◽  
Wide Adaptation

Abstract Background: Full-thickness rectal prolapse (FTRP) occurs frequently in 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 rates of GMT that reach 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 in accordance with 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, there was no significant change between preoperative and postoperative Wexner constipation scores (WCS) (17.3±2.25 vs. 15.4±2.89, P =0.1047). The AST were 38.1±5.34 mL; after the operation, it became 23.5±3.61 mL (P =0.0002).The maximum rectal tolerance (MRT) was 157.1±16.73 mL; after the operation, it became 121.2±12.45 mL (P =0.0009). The patients had no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median 2 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 recurrence, complications, mortality, cost and wide adaptation, minimally invasive, technically simple. It should be considered as the first option for the treatment of FTRP in frail elderly women.

Therapeutic Effect of Changqiang Acupoint Injection on Children with Functional Fecal Incontinence

2021 ◽  
Author(s):  
Changying Yi ◽  
Jie Zhang ◽  
Meili Fan
Keyword(s):  
Treatment Group ◽  
Fecal Incontinence ◽  
Cleveland Clinic ◽  
Control Group ◽  
Incontinence Score ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Stool Incontinence ◽  
Acupoint Injection ◽  
Significant Difference

<B>Objective:</B> Functional fecal incontinence in children (FFIC), also known as functional fecal disorder in children, is a type of childhood diseases characterized by excretory dysfunction. In the study, we observed the clinical effect of Changqiang acupoint injection on functional fecal incontinence in children (FFIC) by randomized controlled clinical trials. <BR><B>Materials and methods:</B> 140 children with functional fecal incontinence who met the screening criteria were respectively assigned into the treatment group (100 cases) and the control group (40 cases) according to the completely randomized controlled design. In the treatment group, Chuankezhi injection was administrated at the Changqiang acupoint once a week for three weeks (one course of treatment). In contrast, the subjects in the control group was instructed to receive sphincter exercise and defecation training, followed by an assessment on the therapeutic efficacy after one course of treatment. <BR><B>Results:</B> The overall response rate of the two groups was 93.00% (93/100) and 57.50% (23/40), respectively, with a statistically significant difference (P<0.01). The treatment group showed a performance superior to the control group based on the Cleveland Clinic Florida Fecal Incontinence Score System (CCF-FI)—dry stool incontinence, liquid incontinence, gas incontinence, lifestyle change, necessity of using pads or antidiarrheals, the ability to delay defecation, and the total score. The inter-group comparison revealed a statistically significant difference (P<0.01). <BR><B>Conclusion:</B>Changqiang acupoint injection has significant curative effect on FFIC as demonstrated by significant relief in the symptoms associated with fecal incontinence, and thus is considered as a useful approach to be widely applied in clinical practice.

Rectal Prolapse: Perineal Procedures

2019 ◽  
Author(s):  
Steven D. Wexner ◽  
Susan M. Cera ◽  
Victoria Valinluck Lao
Keyword(s):  
Fecal Incontinence ◽  
Rectal Prolapse ◽  
Key Words ◽  
Rectal Wall ◽  
Preoperative Evaluation ◽  
Full Thickness ◽  
Recent Advances

Rectal prolapse is a condition wherein a full thickness intussusception of the rectal wall protrudes out of the anus. The diagnosis is rare, ~ 0.5% of the population, and occurs most often in elderly females. The diagnosis is associated with constipation, fecal incontinence, or both. The repair of rectal prolapse can be divided into perineal and abdominal procedures. In this review, we will discuss preoperative evaluation, management and planning as well as describe key widely accepted perineal procedures, the Delorme and Altemeier, and report recent advances. Abdominal procedure and advances in that arena will be discussed in a separate review. This review contains 9 figures, 7 tables, and 32 references.  Key words: Rectal prolapse, perineal procedure, resection, Altemeier, Delorme, Thiersch wire, perineal stapled resection, levatoroplasty

Rectal Prolapse: Abdominal Procedures

2019 ◽  
Author(s):  
Steven D. Wexner ◽  
Susan M. Cera ◽  
Victoria Valinluck Lao
Keyword(s):  
Fecal Incontinence ◽  
Rectal Prolapse ◽  
Key Words ◽  
Sigmoid Colon ◽  
Rectal Wall ◽  
Full Thickness ◽  
Resection Rectopexy ◽  
Benign Condition ◽  
Operative Evaluation

Rectal prolapse is the full thickness intussusception of the rectal wall with protrusion out of the anus.  It is a benign condition associated with multiple anatomic abnormalities such as a redundant sigmoid colon, attenuation of sacral attachments, diastasis of the levators, a patulous anus, and a deep cul-de-sac.  It often presents with concomitant symptoms of fecal incontinence and constipation, or both.  In this review, we will discuss widely accepted abdominal procedures for the repair of rectal prolapse as well as advances in the arena.  Pre-operative evaluation, management and planning as well as perineal procedures are discussed in a separate review. This review contains 9 figures, 1 table, and 44 references.  Key Words:  Rectal prolapse, abdominal procedures, resection, rectopexy, mesh, laparoscopic, robotic

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

2021 ◽  
Vol 41 (01) ◽  
pp. 052-057
Author(s):  
Alimohammad Bananzadeh ◽  
Hamed Shariat Razavi ◽  
Shahin Khodaei ◽  
Maytham Hameed Al-Qanbar ◽  
Seyed Mohammad Kazem Tadayon ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Rectal Prolapse ◽  
Rectal Surgery ◽  
Complete Rectal Prolapse ◽  
Exclusion Criteria ◽  
The Social ◽  
Significant Difference ◽  
History Of ◽  
Altemeier Procedure ◽  
Baseline Values

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.

scholarly journals Long-term impact of full-thickness rectal prolapse treatment on fecal incontinence

Surgery ◽  
2015 ◽  
Vol 158 (1) ◽  
pp. 104-111 ◽  
Author(s):  
Timothée Wallenhorst ◽  
Guillaume Bouguen ◽  
Charlène Brochard ◽  
Diane Cunin ◽  
Véronique Desfourneaux ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Rectal Prolapse ◽  
Full Thickness ◽  
Long Term Impact

scholarly journals Telomere Length as a Biomarker for Race-Related Health Disparities

Genes ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 78
Author(s):  
Vaithinathan Selvaraju ◽  
Megan Phillips ◽  
Anna Fouty ◽  
Jeganathan Ramesh Babu ◽  
Thangiah Geetha
Keyword(s):  
Blood Pressure ◽  
Telomere Length ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Single Copy ◽  
Normal Weight ◽  
Length Ratio ◽  
Hierarchical Regression ◽  
Significant Difference ◽  
The Usa

Disparities between the races have been well documented in health and disease in the USA. Recent studies show that telomere length, a marker of aging, is associated with obesity and obesity-related diseases, such as heart disease and diabetes. The current study aimed to evaluate the connection between telomere length ratio, blood pressure, and childhood obesity. The telomere length ratio was measured in 127 children from both European American (EA) and African American (AA) children, aged 6–10 years old. AA children had a significantly high relative telomere to the single copy gene (T/S) ratio compared to EA children. There was no significant difference in the T/S ratio between normal weight (NW) and overweight/obese (OW/OB) groups of either race. Blood pressure was significantly elevated in AA children with respect to EA children. Hierarchical regression analysis adjusted for race, gender, and age expressed a significant relationship between the T/S ratio and diastolic pressure. Low T/S ratio participants showed a significant increase in systolic pressure, while a high T/S ratio group showed an increase in diastolic pressure and heart rate of AA children. In conclusion, our findings show that AA children have high T/S ratio compared to EA children. The high T/S ratio is negatively associated with diastolic pressure.

scholarly journals Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

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