What operation for recurrent rectal prolapse after previous Delorme’s procedure? A practical reality

Javed, Muhammad Ahsan; Afridi, Faryal G.; Artioukh, D. Y.

doi:10.4240/wjgs.v8.i7.508

Cited by 10 publications

(15 citation statements)

References 11 publications

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“…This is called an external rectal prolapse. It affects 2.5 per 100,000 people every year in the UK [22] and is more common in women [23]. Risk factors include traumatic vaginal delivery, multiple vaginal deliveries, straining, and old age [24].…”

Section: Rectal Prolapsementioning

confidence: 99%

Fecal incontinence and rectal prolapse

Kumar

2019

Indian J Gastroenterol

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Fecal incontinence is the involuntary loss of flatus, liquid, or solid stool from the anus. It is more common in women than men. The prevalence of fecal incontinence increases with advancing age. It is either idiopathic or due to injury to the sphincter complex. In women, obstetric trauma is the commonest cause of anal sphincter injury leading to incontinence. Other causes include iatrogenic sphincter injury during hemorrhoidectomy and fistula surgery and acute trauma to the perineum. Overt sphincter damage due to third-or fourth-degree vaginal tears during childbirth has been reported in up to 0.7% of all vaginal deliveries resulting in symptomatic fecal incontinence [1, 2]. The pudendal nerve can also be damaged during childbirth trauma resulting in late development of fecal incontinence [3]. Some patients sustain both mechanical and neurological trauma to the sphincter complex [4]. Risk factors associated with sphincter injury include forceps delivery, primiparous mother, birth weight of the baby > 4 kg, and occipito-posterior presentation. A posterolateral episiotomy does not protect against a sphincter tear [5]. Anal endosonography has enabled accurate imaging of the sphincter complex resulting in accurate recognition of occult anal sphincter defects [6-8]. In one study of 62 women with a history of obstetric trauma, endoanal ultrasonography revealed an external anal sphincter defect in 90% and an internal sphincter defect in 65% of patients [9]. In 8 of the 10 women who had a forceps-assisted delivery, there was evidence of sphincter damage. In another study [10], 127 women who had a vaginal delivery underwent endoanal ultrasonography postpartum. Of the 79 primiparous mothers who had intact sphincters before childbirth, 28 showed damage to one or both sphincter muscles following delivery. The extent of the damage to the sphincter complex was

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Section: Rectal Prolapsementioning

confidence: 99%

Fecal incontinence and rectal prolapse

Kumar

2019

Indian J Gastroenterol

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“…In our study, we found that older age and the use of a perineal surgical approach were important predictors of recurrence of rectal prolapse. Javed et al proposed that early recurrences of DR were secondary to generalized pelvic floor weakness . Technical failures were also proposed as important reasons for early recurrences .…”

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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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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“…Rectal prolapse affects about 2.5 per 100 000 people each year in the United Kingdom 1. It is more common in women 2. Risk factors include multiple deliveries, straining, anorexia, traumatic vaginal delivery, and old age 3.…”

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confidence: 99%

“…In this article we focus on surgical management of full thickness rectal prolapse. There are a range of surgical techniques available (box 1),23 but there is no consensus on which is the most effective 5. Traditionally, the open abdominal procedure was reserved for younger, fitter patients, and perineal procedures were preferred for older people as they are considered safer 3…”

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confidence: 99%