In search of the optimal operation for rectal prolapse: the saga continues…

Cirocco, William C.

doi:10.1007/s10151-019-01937-8

Cited by 3 publications

(4 citation statements)

References 8 publications

(8 reference statements)

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“…The abdominal approach is considered a major operation in elderly patients with multiple comorbidities and frailty. In these patients with significant comorbidities that pose an anesthetic risk, precluding a general anesthesia, perineal proctosigmoidectomy under spinal anesthesia is favored due to a lower operative morbidity rate and quicker recovery compared to the abdominal approach [2]. The advantage of perineal proctosigmoidectomy lies in the presence of a coloanal anastomosis and hence, when there is a leak in the anastomosis it will naturally drain through the anus.…”

Section: Discussionmentioning

confidence: 99%

Table Sugar as a Bridge from Emergency to Elective Perineal Proctosigmoidectomy for Incarcerated Rectal Prolapse

Saad

Saikaly

2021

Dubai Med J

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Incarcerated rectal prolapse is a rare pathology and is considered an emergency, using table sugar can shift the emergency surgery to an elective one. If left untreated, rectal prolapse may present as an emergency, be it incarceration or strangulation. In an emergency presentation for incarcerated rectal prolapse every attempt should be taken to reduce the prolapsed rectum, if not successful, emergency surgery is indicated, with perineal approach being the first choice in elderly with multiple comorbidities.

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Section: Discussionmentioning

confidence: 99%

Table Sugar as a Bridge from Emergency to Elective Perineal Proctosigmoidectomy for Incarcerated Rectal Prolapse

Saad

Saikaly

2021

Dubai Med J

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“…Abdominal operations do not provide access for levatorplasty, but still the recurrence rates are much lower. Cirocco suggests that it is time to reconsider a combined abdominal and perineal approach [7].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our results show that a perineal rectosigmoidectomy confers a mortality advantage compared to abdominal approaches for rectal prolapse, with recurrence rates and symptomatic improvement, that may be equivalent [2, 8–10]. However, in very frail patients in whom the risk of resection is considered to be too high, a Delorme’s procedure may still be the procedure of choice [7, 41, 42].…”

Section: Discussionmentioning

confidence: 99%

“…However, this can be a major operation in elderly patients with multiple comorbidities and frailty, as well as in infirm younger patients. In these patients with significant comorbidities that pose an anesthetic risk, precluding a general anesthesia, perineal rectosigmoidectomy under spinal anesthesia is favored due to a lower operative morbidity rate and quicker recovery compared to the intra-abdominal approach [7]. Unfortunately, the perineal approach is associated with an increased rate of recurrence [8, 9], and a poorer functional outcome [2, 10].…”

Section: Introductionmentioning

confidence: 99%

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Perineal rectosigmoidectomy for rectal prolapse—the preferred procedure for the unfit elderly patient? 10 years experience from a UK tertiary centre

et al. 2019

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BackgroundRectal prolapse is a disease presentation with a prevalence of about 1%, mainly affecting older women. It usually presents with symptoms of rectal mass, rectal bleeding, fecal incontinence or constipation, with patients frequently feeling socially isolated as a result. Perineal rectosigmoidectomy is associated with lesser morbidity and mortality than the abdominal procedure, but with a much higher recurrence rate. Therefore, this technique is mainly suitable for the frail elderly patient. Specific outcomes in an elderly population have been described in only a few studies. We evaluated the morbidity, mortality, recurrence rate and functional results after this procedure related to age.MethodsAll patients who underwent a perineal rectosigmoidectomy over a 10-year period in two tertiary referral centers were included in the study. American Society of Anesthesiology (ASA) grade, pre- and postoperative symptoms, pathology-reported post-fixation specimen length, length of in-patient stay, 30-day morbidity/mortality, and recurrence were measured.ResultsA total of 45 patients underwent a perineal rectosigmoidectomy. Forty-three (95%) were female, with a median age of 82.0 years (IQR 70.5–86.5), ASA grade III and median follow-up of 20 months (range 8.5–45.5 months). Half of the cohort was over 80 years old. Significant symptomatic relief was achieved, predominantly the resolution of rectal mass (8.9% vs. 60.0% preoperatively), fecal incontinence (15.6% vs. 46.7%) and constipation (4.4% vs. 26.7%). The median length of stay was 6 days, while morbidity occurred in 14 patients (31.1%) and recurrence occurred in 6 patients (13%). There were no deaths within 30 days of the procedure and outcomes were comparable in the < 80 and ≥ 80 age group.ConclusionsPerineal rectosigmoidectomy is safe for older patients with greater comorbidities resulting in good functional results and is associated with low morbidity and mortality.

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Complete rectal prolapse: still a lot of work to do

Gallo

Trompetto²

2019

Tech Coloproctol

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In search of the optimal operation for rectal prolapse: the saga continues…

Cited by 3 publications

References 8 publications

Table Sugar as a Bridge from Emergency to Elective Perineal Proctosigmoidectomy for Incarcerated Rectal Prolapse

Table Sugar as a Bridge from Emergency to Elective Perineal Proctosigmoidectomy for Incarcerated Rectal Prolapse

Perineal rectosigmoidectomy for rectal prolapse—the preferred procedure for the unfit elderly patient? 10 years experience from a UK tertiary centre

Complete rectal prolapse: still a lot of work to do

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