Perineal Rectosigmoidal Resection for Complete Rectal Prolapse

BACKGROUND: Rectal prolapse (RP) (rectal Providencia) is a disorder manifest by full-thickness intussusceptions of the rectal wall that protrudes externally through the anus. AIM: A retrospective study was done to evaluate the outcome of rectosigmoidal resection for complete rectal prolapse (CRP) in our hospital from 2008 to 2020. METHODS: This study analyzes the data of post-operative outcomes for 25 patients with CRP treated by perineal rectosigmoidal resection; eight patients were male and 17 were female. RESULTS: A total of 25 patients enrolled with the median age of 50 years. There was an improvement in the general condition of patients regarding constipation, bleeding per rectum, incontinence, and perineal discomfort. There were no mortality, no major complication, and a low recurrence rate. CONCLUSION: Altemier’s procedure for CRP improves patients’ general condition regarding constipation and incontinence, no mortality, low complication rate, and negligible rate of recurrence.

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

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.

Perineal stapled prolapse resection in combination with Thiersch operation for relapsed rectal prolapse: a case report

Background Treatment options for complete rectal prolapse include over 100 procedures. In previous reports, operative rectal prolapse repair, regardless of the technique by perineal approach, was associated with high recurrence rates. However, there is no consensus on the optimal surgical procedure for relapsed rectal prolapse. Case presentation A 97-year-old woman was admitted to our hospital with a chief complaint of complete rectal prolapse measuring > 5 cm. The patient had a history of laparoscopic anterior suture rectopexy without sigmoid resection under general anesthesia for complete rectal prolapse one year prior. The patient’s postoperative course was uneventful. However, her dementia worsened (Hasegawa’s dementia scale: 5/30 points) after the first operation. Further, moderate-to-severe aortic valve stenosis was first diagnosed with heart failure 6 months after the operation. Nine months after the initial surgery, she experienced a recurrence of complete rectal prolapse measuring approximately 5 cm. Considering the coexistence of advanced age, severe dementia, and aortic valve stenosis, surgery under general anesthesia was not indicated. Perineal stapled prolapse resection in combination with the t operation was planned because of its minimal invasiveness and shortened hospital stay. The procedure was performed by a team of two surgeons in the jack knife position, under spinal anesthesia. The prolapse was cut along the long-axis direction with three linear staplers and resected along the short-axis direction with four linear staplers. The cross-section of the linear stapler was reinforced with 3-0 Vicryl sutures. After rectal resection, the Thiersch operation using 1-0 nylon thread 1 cm away from the anal verge was additionally performed. The operative time was 24 min, and intraoperative blood loss was 1 mL. The postoperative course was uneventful. Three months after the operation, no recurrence was observed, and defecation function was good with improvements of Wexner score. Conclusions Perineal stapled prolapse resection in combination with the Thiersch operation could be a useful option for patients with relapsed rectal prolapse and with poor general condition, who are not indicated for other surgical procedures.

An Age-Old Problem: The Surgical Treatment of Complete Rectal Prolapse

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Evaluation of Delorme’s Procedure in the Treatment of Complete Rectal Prolapse- A Comparison with Abdominal Rectopexy (Well’s procedure)

Background: There are versatile operative techniques for treating complete rectal prolapse. Every procedure has some advantages and disadvantages. Delorme’s procedure and abdominal rectopexy (Well’s procedure) have gained more popularity. But to determine which approach is better, it is needed to evaluate the functional outcome of both procedures. Objective: To compare the outcome of Delorme’s procedure and abdominal rectopexy to treat complete rectal prolapse. Methodology: A randomized control trial was conducted in 25 patients with complete rectal prolapse in the department of Surgery, RMCH. They were divided into two groups by randomization. Fifteen patients included in Group-I underwent Delorme’s procedure, and ten patients included in group-II underwent abdominal rectopexy (Well’s procedure). The outcome of both procedures was compared postoperatively. Results: In group-1, we have found uneventful outcomes of 10 (66.66%) patients, and hemorrhage, minor incontinence, and retention of urine were found in 2(13.3%), 1(6.66), and 4(26.66%) patients, respectively. In group-2 patients, 5(50%) patients recovered uneventfully, whereas hemorrhage, surgical site infection, retention of urine, bladder dysfunction, and constipation were found in 2(20%), 1(10%), 1(10%), 1(10%) and 2(20%) patients respectively. The mean operation time in group-I was 92.86 min and in Group 2 was 124.00 min with a p-value of 0.001. The average post-operative hospital stay after Delorme’s procedure was <4 days in 4 patients and 4-6 days in the rest 11 patients. But the hospital stay is a little lengthier in the case of abdominal rectopexy (Well’s procedure), where seven patients were discharged within 4-6 days, and three patients were discharged after the 5th day of operation. In group I, expenditure was <7000 taka in 10 (66.66%) patients, whereas in group-2 , the cost was 10000-15000 in 7(70%) patients with a p-value of 0.001. Conclusion: We can conclude that Delorme’s procedure is comparatively safer and cost-effective than Well’s procedure, considering different vital parameters. TAJ 2021; 34: No-1: 40-46