Simultaneous Delorme's procedure and inter-sphinteric prosthetic implant for the treatment of rectal prolapse and faecal incontinence: Preliminary experience and literature review

Cavazzoni, Emanuel; Rosati, Emanuele; Zavagno, Valentina; Graziosi, Luigina; Donini, Annibale

doi:10.1016/j.ijsu.2014.12.031

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Anal function was also weakened by atrophy and sphincteric injuries, whereby emergency continence was not working. For all these reasons, in patients with rectal prolapse with fecal incontinence, it is better to use surgical procedures other than Delorme's procedure or to perform a simultaneous treatment for fecal incontinence such as prosthetic intersphincteric implant [26].…”

Section: Delormementioning

confidence: 99%

Post-surgical fecal incontinence

Pucciani

2017

Updates Surg

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The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients were analyzed (114 women and 55 men: mean age 58.9 ± 6.3): clinical evaluation, endoanal ultrasound and anorectal manometry reports were scanned. The duration of incontinence was very long, with a mean of 21.7 months. The mean number of bowel movements/week was 18.2 ± 7.2. Urge incontinence was present in 82.2% of patients, mixed with passive incontinence in 44 patients. Patients' Fecal Incontinence Severity Index (FISI) score was 27.0 ± 6.6. Operated patients had significantly lower anal resting pressure (P < 0.01) than controls while patients with colo-anal anastomosis and those who underwent Delorme operation had lowest values (P < 0.01). Maximal tolerated volume and rectal compliance were significantly impaired in operated patients with rectum involvement (colo-anal anastomosis, Delorme, restorative procto-colectomy and STARR). External anal sphincter (EAS) defects were present in 33.1% of all patients and internal anal sphincter (IAS) was damaged in 44.3%: a combined lesion of anal sphincters was detected in 39 patients (23.0%). A positive correlation was found between patients' FISI score and thickness of both sphincters (EAS: ρ 73; IAS: ρ = 81). Malfunctioning continence factors may induce fecal incontinence involving each time, in a different way, the volumetric capacity and/or the motility of the rectum, the perception of the fecal bolus and anal sphincter contraction.

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Section: Delormementioning

confidence: 99%

Post-surgical fecal incontinence

Pucciani

2017

Updates Surg

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“…Rectal prolapse is a serious problem in the aging population, and its prevalence has increased in recent years ( 28 ). For a long time, rectal prolapse has been recognized as a symptom that needs to be focused on discovering its underlying pathology or disease ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

PER2/P65-driven glycogen synthase 1 transcription in macrophages modulates gut inflammation and pathogenesis of rectal prolapse

Ding,

Ge,

et al. 2023

Journal of Biological Chemistry

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“…For old, risky patients, Delorme operation seems a straightforward approach coupled with posterior levatorplasty with the aim of reducing recurrence and improving continence. Recently, Cavazzoni [60], in a very preliminary study, proposed the implant of Gatekeeper prosthesis after Delorme operation with the aim of improving continence. Those patients with better physical performance are managed preferably by means of an abdominal operation also performed laparoscopically.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Surgical Treatment of Rectal Prolapse

Pietroletti¹

2018

Proctological Diseases in Surgical Practice

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The approach to a patient with overt rectal prolapse remains controversial since the choice of the most appropriate technical option may be a difficult task. The different approaches are based upon patients' age, comorbidities, sex, size of prolapse, associated incontinence, constipation, and urinary and genital disturbances. However, analysis of the literature failed to detect a significant evidence favoring one among the large number of those different surgical techniques proposed for the treatment of rectal prolapse. In fact, many randomized prospective controlled trials, comparing perineal and abdominal operations, rectopexy alone, resection alone and/or resection plus rectopexy could not find significant differences in terms of morbidity, mortality, improvement of incontinence or constipation, quality of life and recurrence. Therefore, without a clear-cut support by the literature, a pragmatic approach is necessary, applying common sense, experience and considering the availability of resources as well. Nevertheless, we may expect that definitive answers to many open questions about surgery of rectal prolapse may come from larger studies and longer follow-up.

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Simultaneous Delorme's procedure and inter-sphinteric prosthetic implant for the treatment of rectal prolapse and faecal incontinence: Preliminary experience and literature review

Cited by 4 publications

References 10 publications

Post-surgical fecal incontinence

Post-surgical fecal incontinence

PER2/P65-driven glycogen synthase 1 transcription in macrophages modulates gut inflammation and pathogenesis of rectal prolapse

Challenges in the Surgical Treatment of Rectal Prolapse

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