Novel combined approach in the management of non-healing solitary rectal ulcer syndrome – laparoscopic resection rectopexy and transanal endoscopic microsurgery

Ihnát, Peter; Martínek, L; Vávra, P; Zonča, P

doi:10.5114/wiitm.2015.52060

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…TEM is a minimal invasive technique that has been proven to be an alternative for radical surgery aimed at rectal adenomas and early rectal cancer[ 14 - 18 ]. TEM can also, arguably, give the same surgical advantages for non-adenomatous rare lesions, unless these lesions are easily reached by instrumentation[ 19 - 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Trans-anal endoscopic microsurgery for non- adenomatous rectal lesions

Shilo Yaacobi,

Bekhor,

Khalifa

et al. 2023

World J Gastrointest Surg

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BACKGROUND Trans-anal endoscopic microsurgery (TEM) enables a good visualization of the surgical field and is considered the method of choice for excision of adenomas and early T1 rectal cancer. The rectum and retro-rectal space might be the origin of uncommon neoplasms, benign and aggressive, certain require radical trans-abdominal surgery, while others can be treated by a less aggressive approach. In this study we report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years. AIM To report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years. METHODS Between January 2008 to December 2019 a retrospective analysis was completed for all patients who underwent TEM for non-adenomatous rectal lesion or retro-rectal mass in our institution. Patients were discharged once diet was well tolerated and no complications were identified. They were evaluated at 3 wk post operatively, then at 3-mo intervals for the first 2 years and every 6 mo depending on the nature of the final pathology. Clinical examination and rectoscopy were performed during each of the follow-up visits. RESULTS Out of 198 patients who underwent TEM during the study period, 18 had non-adenomatous rectal or retro-rectal lesions. Mean age was 47 years. The mean size of the lesions was 2.9 mm, with a mean distance from the anal margin of 7.9 cm. Mean surgical time was 97.8 min. There were no intra-operative neither late post-operative complications. Mean length of stay was 2.5 d. Mean patient follow-up duration was 42 mo. CONCLUSION TEM allows for reduced morbidity given its minimally invasive nature. Surgeons should be familiar with the technique but careful patient selection should be considered. It can be used safely for uncommon rectal and selected retro-rectal lesions without compromising outcomes. We believe that it should be reasonably considered as one of the surgical methods when treating rare lesions.

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Section: Discussionmentioning

confidence: 99%

“…TEM technique may provide a safe and effective way for full thickness excision of the rectal wall with a 1-cm margin. TEM, as a surgical approach, allows for rectal resection with clear and detail view, specifically for rectal lesions such as SRUS[ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Trans-anal endoscopic microsurgery for non- adenomatous rectal lesions

Shilo Yaacobi,

Bekhor,

Khalifa

et al. 2023

World J Gastrointest Surg

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“…The treatment of SRUS ranges from a conserva tive treatment such as topical enemas (5aminosalic ylate or steroid), oral 5aminosalicylate or sucralfate, biofeedback, followed by endoscopical steroid injec tions, to surgery (rectopexy, excision of ulcer) [9,11]. In a nonhealing SRUS, conservative treatment manage ment, laparoscopic resection rectopexy, and transanal endoscopic microsurgery were reported as safe, feasi ble, and effective treatment methods [12]. Endoscopy can also be used for the treatment of bleeding SRUS, which we successfully managed endoscopically by an adrenaline injection and clip lining.…”

Section: Discussionmentioning

confidence: 99%

Gastric antral vascular ectasia and solitary rectal ulcer syndrome - two rare diagnoses as the cause of anemia in a single patient: case report

Kunovský¹,

Dastych²,

Kroupa³

et al. 2017

Vnitr Lek

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Gastric antral vascular ectasia (GAVE) and solitary rectal ulcer syndrome (SRUS) are both mentioned in the literature as rare causes of iron deficiency anemia and gastrointestinal (GI) bleeding. GAVE accounts for up to 4 % of upper nonvariceal GI bleeding; SRUS is a rare benign disorder that presents with rectal bleeding. We present the case of a 75yearold patient who was admitted to our facility with anemia. In the same patient, we encountered chronic bleeding from GAVE and SRUS. Both diagnoses were treated endoscopically: GAVE by argon plasma coagulation and a subsequent treatment with proton pump inhibitors and SRUS by adrenaline injection and clipping, consec utively treated with mesalazine enemas. The patient was successfully cured, resulting in a stable level of hemoglo bin and no recurrent GI bleeding. We report a unique case of chronic GI bleeding caused by two uncommon dia gnoses. The cooccurrence of GAVE and SRUS has not been previously described or published.

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“…SRU is difficult to treat because the pathogenesis is not clearly understood, and it is also associated with various pelvic floor disorders (57). Therefore, the choice of treatment depends on the severity of the disease and whether or not it is associated with pelvic floor disorders (58).…”

Section: Treatmentmentioning

confidence: 99%

Solitary Rectal Ulcer: A Literature Review

2015

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Context: Solitary rectal ulcer (SRU) is a disease with many challenging issues. There are several controversies about the basic pathophysiology of this disease. Despite its name, "solitary rectal ulcer", more than a quarter of patients do not show any ulcer in colonoscopy. Instead, many patients show multiple polypoid lesions. Some previous reports have suggested calling this disease "rectal mucosal prolapse" instead of SRU, however, most of the patients do not have mucosal prolapse. In addition, colonoscopic findings can be very similar to cancer and inflammatory bowel disease, so without histologic evaluation, accurate diagnosis is not always possible. In patients with SRU, sometimes the rectal mucosa is so fibrotic that mucosal biopsy is inadequate, and even a pathologist cannot diagnose the characteristic histologic findings. There are various therapeutic approaches for the treatment of SRU, both surgical and nonsurgical, all of which are not optimal, and recurrence rates are still high with many patients experiencing complications even after surgery, resection and rectopexy. Evidence Acquisition: Although this disease is not uncommon in Iran, there are very few studies from Iran, therefore, in this review we will describe our experience with patients with SRU in affiliated hospitals of Shiraz University of Medical Sciences. We will also review previously published articles about SRU that are indexed in PubMed and Google scholar, emphasizing the challenging issues. Results: SRU is not an uncommon disease in Iran, however the number of published articles about it, is very low. Multicentric studies are necessary to find out the definite reason of this issue. Conclusions: There are still many conflicting controversies about the etiology, pathogenesis, diagnosis and also treatment of SRU, which need further investigation and longer follow up of the patient in each therapeutic approach to be better understood.

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Novel combined approach in the management of non-healing solitary rectal ulcer syndrome – laparoscopic resection rectopexy and transanal endoscopic microsurgery

Cited by 5 publications

References 16 publications

Trans-anal endoscopic microsurgery for non- adenomatous rectal lesions

Trans-anal endoscopic microsurgery for non- adenomatous rectal lesions

Gastric antral vascular ectasia and solitary rectal ulcer syndrome - two rare diagnoses as the cause of anemia in a single patient: case report

Solitary Rectal Ulcer: A Literature Review

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