Long-term outcome of perineal rectosigmoidectomy for rectal prolapse

Pinheiro, Lílian Vital; Leal, Raquel Franco; Coy, Cláudio Saddy Rodrigues; Fagundes, João José; Ayrizono, Maria de Lourdes Setsuko

doi:10.1016/j.ijsu.2016.06.040

Cited by 28 publications

(14 citation statements)

References 37 publications

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“…This study has confirmed that DR has a low complication rate. The complication rate after PR was higher in this study when compared to the literature of 1.8–12.5% . However, in an Italian study by the Rectal Prolapse Study Group, the morbidity after PR was, similar to this series, 22.6% .…”

Section: Discussioncontrasting

confidence: 63%

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Long‐term outcomes of surgical management of rectal prolapse

Levitt

Makin

et al. 2019

ANZ Journal of Surgery

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Background: Various surgical options for rectal prolapse are available but none have been shown to be clearly superior. The aims of this study were to investigate the long-term recurrence rate of a variety of surgical approaches, their associated morbidities and the types of reoperation used to treat recurrence. Methods: A retrospective analysis was performed of all cases of rectal prolapse surgery within one colorectal surgical unit between January 2000 and June 2017. Abdominal approaches consisted of rectopexy (RP) and resection rectopexy (RRP); perineal approaches included perineal rectosigmoidectomy (PR) and Delorme's repair (DR). Complications were graded according to the Clavien-Dindo classification. The median follow-up was 4.5 years (interquartile range 1.5-10.1, maximum 16.5). Statistical analysis was performed using Kaplan-Meier to determine recurrence rates. Results: A total of 157 patients were included in the study. The numbers for each procedure were: DR (n = 55), RRP (n = 44), RP (n = 38) and PR (n = 20). The majority were females (94%). The perineal group were significantly older than the abdominal group (80 versus 67 years, P = 0.0001). At 5 years, the recurrence rates were 52%, 30%, 5% and 3% for DR, PR, RP and RRP, respectively. Morbidity was highest in PR (20%) followed by RRP (18%), RP (16%) and DR (7%) (n.s.). The overall morbidity rates for perineal group and abdominal group were 10.7% and 17.1%, respectively (n.s.). Conclusion: Abdominal approaches have a significantly lower recurrence rate at 5 years but tend to be associated with higher morbidity.

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Section: Discussioncontrasting

confidence: 63%

“…Published recurrence rates vary from 0% to 20% . Table records the recurrence rates of both abdominal and perineal approaches published in the last decade …”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of surgical management of rectal prolapse

Levitt

Makin

et al. 2019

ANZ Journal of Surgery

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“…It has a risk of fatal complications, such as anastomotic breakdown, rectal bleeding, and perianal abscess. This approach has been reported to have a postoperative mortality rate of 1.6% after surgery [ 9 , 10 ]. The STARR operation involves excision of the redundant rectal mucosa with a colorectal anastomosis that only applies to a mucosal protrusion of less than 5 cm long [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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

Wang

et al. 2021

BMC Surg

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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.

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“…Fecal incontinence has been variably reported in between 36% and 96% of patients presenting with full-thickness rectal prolapse. 20,21 Incontinence etiology is multifactorial with anal sphincter injury from prolapse distraction, rectoanal propulsive incoordination, a mass effect of the prolapse, and altered rectal mucosal sensitivity. 22 In most reports, this preoperative symptom improves significantly when the anatomical prolapse is successfully managed by surgery.…”

Section: Discussionmentioning

confidence: 99%