scholarly journals Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse

2004 ◽  
Vol 51 (2) ◽  
pp. 53-55 ◽  
Author(s):  
R. Bergamaschi ◽  
K. Lovvik ◽  
R. Marvik
Keyword(s):  
Rectal Prolapse ◽  
Anastomotic Leak ◽  
Sigmoid Resection ◽  
Complete Rectal Prolapse ◽  
Levator Ani Muscle ◽  
Superior Rectal Artery ◽  
Laparoscopic Sigmoid Resection ◽  
Anal Ultrasound ◽  
Estimated Blood Loss ◽  
The Impact

Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use however has been limited due to fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During 30 months data on 33 selected patients with CRP were prospectively collected. Three patients were withdrawn from the analysis, as they had neither resection nor anastomosis. Twenty-nine women and one man (median age 55 range 21-83 years) underwent LSR with preservation of SRA for a median CRP of 8 (3- 15) cm. There were 20 ASA I and 10 ASA II patients. Ten patients had undergone previous surgery. Four patients complained of dyschezia, whereas incontinence was present in 26 patients. Anal ultrasound showed isolated internal sphincter defects in two patients. Four young adults (21-32 years) had normal CTT, whereas 26 older patients had a median CTT of 5 (4-6) days. Defecography demonstrated 10 enteroceles, two sigmoidoceles, and one rectal hernia through the levator ani muscle. Mortality was nil. Median operating room time was 180 (120-330) min, suprapubic incision length 5 (3-7) cm, estimated blood loss 150 (50-500) ml, specimen length 20 (12-45) cm, solid food resumption 3 (1-6) days, and length of stay 4.5 (2-7) days. Thirty-day complications were not related to anastomosing and occurred in 20% of the patients. Although the evidence provided by the present study suggests that sparing SRA has a favorable impact on anastomotic leak rates, these nonrandomized results need further evaluation. The division of the mesorectum at the rectosigmoid junction seems not necessary, and its sparing should therefore be considered as it may contain anastomotic leak rates.

scholarly journals Preserving the superior rectal artery in laparoscopic anterior resection for complete rectal prolapse

2002 ◽  
Vol 49 (2) ◽  
pp. 25-26 ◽  
Author(s):  
D. Ignjatovic ◽  
R. Bergamaschi
Keyword(s):  
Rectal Prolapse ◽  
Anterior Resection ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Current Practice ◽  
Sigmoid Resection ◽  
Complete Rectal Prolapse ◽  
Complication Rates ◽  
Superior Rectal Artery ◽  
Laparoscopic Anterior Resection

Anterior resection for the treatment of full thickness rectal prolapse has been around for over four decades. 1 However, its use has been limited due to fear of anastomotic leakage and related morbidity. It has been shown that high anterior resection is preferable to its low counterpart as the latter increases complication rates. 2 Although sparing the inferior mesenteric artery in sigmoid resection for diverticular disease has been shown to decrease leak rates in a randomized setting, 3 vascular division is current practice. We shall callenged this current practice of dividing the mesorectum in anterior resection for complete rectal prolapse developing a technique that allows the preservation of the superior rectal artery.

532 Laparoscopic Sigmoid Resection and Rectopexy for Rectal Prolapse: A 3 Step Procedure

2009 ◽  
Vol 136 (5) ◽  
pp. A-874
Author(s):  
Philippe Bouchard ◽  
Jacques Heppell ◽  
Jonathan E. Efron ◽  
Tonia Young-Fadok
Keyword(s):  
Rectal Prolapse ◽  
Sigmoid Resection ◽  
Laparoscopic Sigmoid Resection ◽  
Step Procedure

Laparoscopic sigmoid resection for a giant colonic diverticulum – a video vignette

2021 ◽  
Author(s):  
Juan Ocaña ◽  
Alfredo Vivas ◽  
María Labalde ◽  
Pablo Pelaez ◽  
Sandra García ◽  
...  
Keyword(s):  
Sigmoid Resection ◽  
Colonic Diverticulum ◽  
Laparoscopic Sigmoid Resection ◽  
Giant Colonic Diverticulum ◽  
Video Vignette

Contemporary Surgical Management of Juvenile Nasopharyngeal Angiofibroma

2021 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Kristen M. Scheitler ◽  
Garret Choby ◽  
Jeffrey Janus ◽  
Eric J. Moore ◽  
...  
Keyword(s):  
Surgical Management ◽  
Intracranial Extension ◽  
Preoperative Embolization ◽  
Tumor Diameter ◽  
Historical Cohort ◽  
Nasopharyngeal Angiofibroma ◽  
Estimated Blood Loss ◽  
The Impact ◽  
Previous Series

Abstract Objectives Juvenile nasopharyngeal angiofibromas (JNAs) are uncommon tumors with an evolving treatment paradigm. The objective of this study was to compare our prior experience reported in 2005 with our most contemporary series to compare practice improvements and the impact of expanded endonasal procedures. Design Retrospective review comparing a contemporary 22 patients with JNA who underwent surgical management between 2005 and 2019, compared with a historical cohort of 65 patients from the same center. Results The most common presenting symptom was epistaxis (68%). The median maximum tumor diameter was 4.4 cm. All patients underwent preoperative embolization. An endoscopic endonasal approach (EEA) was used in 18 patients (82%), compared with 9% in the series prior to 2005. Gross total resection was achieved in all patients. The median estimated blood loss was 175 and 350 mL for EEA and open (transfacial) cases, respectively. Only two patients (9%) required a blood transfusion compared with 52% on the previous series. The median follow-up was 19 months. The overall recurrence rate was 9% in this series and 24% in the previous series. No patient required radiation therapy in follow-up compared with 3% in our historical cohort. Conclusion There have been significant changes regarding the management of patients with JNA compared with the previous Mayo Clinic experience. The EEA has become the preferred route over the transfacial approaches to treat JNA in selected patients who do not have intracranial extension. Preoperative embolization has aided in reducing the postoperative transfusion rates.

Robotic Frykman‐Goldberg procedure for complete rectal prolapse – A video vignette

2021 ◽  
Author(s):  
Antonio Sciuto ◽  
Raffaele Emmanuele Maria Pirozzi ◽  
Alfredo Pede ◽  
Gianluca Lanni ◽  
Luca Montesarchio ◽  
...  
Keyword(s):  
Rectal Prolapse ◽  
Complete Rectal Prolapse ◽  
Video Vignette

Reduction of Complete Rectal Prolapse

1992 ◽  
Vol 22 (4) ◽  
pp. 180-180
Author(s):  
D S Bhandarkar ◽  
R G Tamhane
Keyword(s):  
Rectal Prolapse ◽  
Complete Rectal Prolapse

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

2004 ◽  
Vol 59 (4) ◽  
pp. 168-171 ◽  
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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