Experiences of ivalon-sponge implant for complete rectal prolapse at St. Mark's Hospital, 1960–70

Abstract

faradism, however, have not shown any objective improvement in performance.Subsequent operations for incontinence are difficult to evaluate in this series because of the small numbers involved. A few patients make an early and urgent demand for operation, while others are relieved to be rid of their prolapse, are quite happy to wear a pad to control incontinence, and do not wish to have another operation. Certainly in the present series we have not pressed additional operations on these patients, mainly because we are uncertain of success. The Thiersch operation is useful but it has a number of problems associated with it, viz., faecal impaction, and as many of these patients are constipated, this can present a serious problem. When wire is used it may fracture or cause ulcers. Nylon thread has proved to be more satisfactory.The most useful operation is the post-anal intersphincteric nylon-floss operation repair described by Parks (1967). Nevertheless, this is not an easy undertaking and there is often delay in wound healing. It is not advocated for minor degrees of incontinence or leakage.It is also clear, from our experience of I case, that colostomy is not necessarily the answer to incontinence.Lastly, there are a number of patients who might well be benefited by operations for their incontinence. The majority of these patients has declined the operation when the offer has been made, being content to be free of their prolapse. In a small number a further operation was inadvisable as their general health was poor. SUMMARYExperience of using Ivalon-sponge implants in IOI patients with complete rectal prolapse at St. Mark's Hospital is reviewed. It is a straightforward operation with minimal complications producing long-term control of the prolapse in 97 per cent of cases.Of those patients who had been incontinent, satisfactory restoration of continence was achieved in 70 per cent of cases for solid faeces and in 33 per cent for fluid faeces.Ivalon sponge is a foreign material that only produces moderate fibrosis in the tissues. It persists for at least 6 years in humans.COMPLETE rectal prolapse is a very disabling but non-lethal condition. Many operations have been devised to cure it but none has been entirely satisfactory. At the present time the Ivalon-sponge implant is being increasingly used throughout Great Britain. This paper reports our experiences using this operation during the years 1960-70. MATERIALSOne hundred and one patients underwent repair of complete rectal prolapse using an Ivalon-sponge implant (Fig. I). The youngest was ZI years and the oldest 82 years. Thirty patients had had previous surgery for the prolapse, including 14 Thiersch wire or nylon operations, 6 rectosigmoidectomies, 4Thiersch operations and rectosigmoidectomies, and 6 miscellaneous perineal repair procedures METHODSThe technique described by Wells (1959) using a 3-mm.-thick piece of polyvinyl alcohol (Ivalon) sponge placed behind the rectum was used. The sponge was perforated and soaked in saline before insertion. It was then ...

Laparoscopically-Assisted Resection Rectopexy for Rectal Prolapse: Ten Years' Experience

“…The rate of recurrence varies according to the technique: up to 10 percent after resection rectopexy, 1,5,7,9 up to 20 percent after rectopexy alone, 26,27 and as high as 58 percent after perineal procedures. 28 reports for recurrence rates after laparoscopy are encouraging, although with a shorter follow-up.…”

Long-Term Functional Outcomes After Laparoscopic and Open Rectopexy for the Treatment of Rectal Prolapse

“…14 The long-term operative recurrence rate of 4 percent in this study is comparable with other trials that look at longterm outcomes after OR. [15][16][17][18] There were an additional seven patients who required operative procedures. The increase in recurrence compared with our prospective clinical trial (which was 0 percent recurrence at 24 months for LR) lends weight to the fact that recurrent FTRP is a phenomenon that increases as follow-up lengthens.…”

Surgical Management of Rectal Prolapse

“…Therefore, Kuijpers believed that the purpose of using an implant to evoke an intense fibrous tissue formation is not always achieved by using prosthetic material. In 1972, Penfold and Hawley 30 conceded that the polyvinyl alcohol sponge tends to fragment but persists in human tissues for 5 years. Indeed, many authors 77 now believe that rectal fixation by suture only seems sufficient, with reported recurrence rates of 3% or less.…”