Surgery for complete rectal prolapse in adults

Tou, Samson; Brown, S. R.; Malik, Ali Irqam; Nelson, Richard L.

doi:10.1002/14651858.cd001758.pub2

Cited by 174 publications

(181 citation statements)

References 21 publications

Supporting

Mentioning

162

Contrasting

Unclassified

Order By: Relevance

“…Traditionally, a perineal approach has been considered the operation of choice in any elderly or high-risk patient, because it was associated with lower perioperative morbidity, decreased pain, and a shorter length of hospital stay [6]. However, advances in minimally invasive techniques have called into question the optimal procedure for rectal prolapse, especially when considering long-term outcomes such as recurrence or anorectal function [7].Although there is currently no established consensus as to the best surgical treatment, a laparoscopic approach to rectal prolapse repair has become increasingly popular ever since its description in 1992 [8]. Several studies have shown the benefits of laparoscopy when compared to open rectopexy (OR) [9,10].…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?

et al. 2014

View full text Add to dashboard Cite

Background Patients with rectal prolapse often have significant comorbidities that lead surgeons to select a perineal resection for treatment despite a reported higher recurrence rate over abdominal approaches. There is a lack of data to support this practice in the laparoscopic era. The objective of this study was to evaluate if risk-adjusted morbidity of perineal surgery for rectal prolapse is actually lower than laparoscopic surgery.Design A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database as performed for patients undergoing surgical treatment of rectal prolapse between 2005 and 2011. Outcomes were analyzed according to procedure-type: laparoscopic rectopexy (LR), laparoscopic resection/rectopexy (LRR), open rectopexy (OR), open resection/rectopexy (ORR), and perineal resection (PR). A multivariate logistic regression was used to compare riskadjusted morbidity and mortality between each procedure. Main outcome measures were 30-day morbidity and mortality.Results Among 3,254 cases sampled, a laparoscopic approach was used in 22 %, an open abdominal approach in 30 %, and PR in 48 %. Patients undergoing PR were older (76) and had a higher ASA (3) compared to laparoscopic (58, 2) and open abdominal procedures (58, 2). Risk-adjusted mortality could not be assessed due to a low overall incidence of mortality (0.01 %). Overall morbidity was 9.3 %. ORR was associated with a higher risk-adjusted morbidity compared to PR (OR: 1.89 CI (1.19-2.99), p = 0.03). There were no significant differences in risk adjusted morbidity found between LR and LRR compared to PR p = 0.18;), p = 0.18). Laparoscopic cases averaged 27 min longer than open cases (p\0.001).Conclusion Laparoscopic rectal prolapse surgery has comparable morbidity and mortality to perineal surgery. A randomized trial is indicated to validate these findings and to assess recurrence rates and functional outcomes.The Delorme procedure for the surgical treatment of rectal prolapse was first described by the French surgeon Edmond Delorme in 1900 [1,2]. Since that time, over 100 different surgical procedures have been proposed for the management of this condition [3,4]. Although the majority of these procedures are now of only historical interest, many different techniques are still being used today. Procedures to address rectal prolapse can broadly be split into two main approaches-abdominal and perineal. The primary goals of the operation are to correct the prolapse, alleviate preoperative discomfort, and to prevent or improve fecal incontinence or constipation [5]. Traditionally, a perineal approach has been considered the operation of choice in any elderly or high-risk patient, because it was associated with lower perioperative morbidity, decreased pain, and a shorter length of hospital stay [6]. However, advances in minimally invasive techniques have called into question the optimal procedure for rectal prolapse, especially when considering long-term outcomes such as recurrence or an...

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era?

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The addition of sigmoidectomy to the operation was felt to be associated with a lower recurrence rate and improved functional outcome with a minimal increase in morbidity [23,24]. It seems to reduce constipation significantly in those who report this symptom preoperatively in some studies [23,25,26]. However, in our study, none of the patient had worsening or new onset of constipation in the postoperative period.…”

Section: Constipationmentioning

confidence: 51%

“…However, in elderly, morbidity and mortality is slightly higher with an abdominal approach, making the consideration of patient comorbidities essential in deciding the appropriate repair [10,11]. Perineal approach results in less perioperative morbidity and pain, and a reduced length of hospital stay, though recurrence rates that are slightly higher than those for abdominal operations and functional outcome are comparatively poor [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perineal Stapled Prolapse Resection

Bajaj¹,

Wani²,

Sheikh³

et al. 2014

Indian J Surg

View full text Add to dashboard Cite

Perineal stapled prolapse resection is a new technique for external rectal prolapse introduced in 2007. We have done stapled perineal resection for 12 patients with full thickness rectal prolapse between January 2010 and April 2012. Elderly patients with comorbidities and young patients who want to avoid risk of nerve damage, with rectal prolapse up to 8-10 cms were included prospectively for perineal stapled rectal prolapse resection. Functional outcome, complications, operating time, and hospital stay were assessed in all patients. Perineal stapled prolapse resection was performed without major complications in a median operating time of 45 (range, 40-90)min and median Hospital stay was 3 days (3 to 11 days). Preoperative severe fecal incontinence and constipation improved postoperatively in 90 and 66 % of the patients, respectively, and there was no incidence of de novo onset or worsening of constipation in any of the patient. One patient developed small extra peritoneal collection which was managed by conservative treatment. No other complications occurred. At median follow-up of 36 months, all patients were well and showed no early recurrence of prolapse.Perineal stapled rectal prolapse resection is a new surgical procedure for external rectal prolapse, which is safe, easy, and quick to perform.

show abstract