RESUMO
INTRODUCTION: The aim of this video case series is to demonstrate our experience of the clinical findings and the surgical management of the rapid onset de novo rectal prolapse (RP) following colpocleisis METHODS: This is a case series of three patients who developed de novo RP within 1 month after colpocleisis, which was repaired by laparoscopic ventral mesh rectopexy (LVMR). The video shows the physical, radiological, and intraoperative findings of these patients. A retrospective review of our surgical cases of RP was also performed to analyze the onset timing of de novo RP after various pelvic organ prolapse (POP) procedures. RESULTS: The pathological condition of all three patients' RP was evacuation enterocele, and LVMR was feasible without postoperative complications or recurrences. In the retrospective case review of 158 RP surgeries in our institution (June 2015 to September 2023), 18 cases (11.4%) occurred following POP surgery. De novo RP following colpocleisis developed significantly earlier than those following other procedures (average: 6.1 vs 66.4 months, p = 0.010). CONCLUSIONS: Although de novo RP following colpocleisis is relatively rare, this complication could have a detrimental effect on patients' quality of life. Preoperative informed consent may be advisable before planning colpocleisis.
Assuntos
Complicações Pós-Operatórias , Prolapso Retal , Humanos , Feminino , Prolapso Retal/cirurgia , Prolapso Retal/etiologia , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas/efeitos adversos , Laparoscopia/efeitos adversos , Vagina/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Fatores de TempoRESUMO
INTRODUCTION: Minimally invasive ventral mesh rectopexy is considered the standard of care in the surgical management of rectal prolapse syndromes in fit patients. We aimed to investigate the outcomes after robotic ventral mesh rectopexy (RVR) and compare them with our laparoscopic series (LVR). Additionally, we report the learning curve of RVR. As the financial aspect for the use of a robotic platform remains an important obstacle to allow generalized adoption, cost-effectiveness was also evaluated. PATIENTS AND METHODS: A prospectively maintained data set including 149 consecutive patients who underwent a minimally invasive ventral rectopexy between December 2015 and April 2021 was reviewed. The results after a median follow-up of 32 months were analyzed. Additionally, a thorough assessment of the economic aspect was performed. RESULTS: On a total of 149 consecutive patients 72 underwent a LVR and 77 underwent a RVR. Median operative time was comparable for both groups (98 min (RVR) vs. 89 min (LVR); p = 0.16). Learning curve showed that an experienced colorectal surgeon required approximately 22 cases in stabilizing the operative time for RVR. Overall functional results were similar in both groups. There were no conversions or mortality. There was, however, a significant difference (p < 0.01) in hospital stay in favor of the robotic group (1 day vs. 2 days). The overall cost of RVR was higher than LVR. CONCLUSIONS: This retrospective study shows that RVR is a safe and feasible alternative for LVR. With specific adjustments in surgical technique and robotic materials, we developed a cost-effective way of performing RVR.
Assuntos
Laparoscopia , Prolapso Retal , Procedimentos Cirúrgicos Robóticos , Humanos , Prolapso Retal/cirurgia , Prolapso Retal/etiologia , Procedimentos Cirúrgicos Robóticos/métodos , Estudos Retrospectivos , Telas Cirúrgicas , Resultado do Tratamento , Laparoscopia/métodos , Reto/cirurgiaAssuntos
Colonoscopia , Hemorragia Gastrointestinal , Lipossarcoma , Neoplasias Retais , Humanos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Neoplasias Retais/cirurgia , Neoplasias Retais/complicações , Lipossarcoma/complicações , Lipossarcoma/cirurgia , Lipossarcoma/diagnóstico por imagem , Colonoscopia/métodos , Masculino , Recidiva , Prolapso Retal/cirurgia , Prolapso Retal/complicações , Prolapso Retal/etiologia , Idoso , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: A rectal prolapse is mainly a disease of the elderly population, occurring more frequently among women. The medical practitioner has an important role in the recognition and initiation of therapy for rectal prolapse. Appropriate therapy can have an important impact on symptom reduction and healthcare resources. Surgical therapy includes perineal or transabdominal surgery, with increasing use of minimally invasive techniques such as mesh rectopexy. This operation is indicated and feasible regardless of age. The management of the rectal prolapse in specialized pelvic floor centres with interdisciplinary expertise for diagnosis and therapy is recommended.
Assuntos
Intussuscepção , Laparoscopia , Prolapso Retal , Humanos , Feminino , Idoso , Prolapso Retal/diagnóstico , Prolapso Retal/etiologia , Prolapso Retal/cirurgia , Defecação , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/cirurgia , Resultado do Tratamento , Diafragma da Pelve , Reto/cirurgia , Telas Cirúrgicas , Laparoscopia/métodosRESUMO
PURPOSE: to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early. METHODS: A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group. Experimental group: Thread-drawing during operation and anal enlargement after PPH. Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone. The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years. RESULTS: The effective rate of mixed hemorrhoid treatment in the 4 groups was 100%. There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C. CONCLUSION: Multipoint thread-drawing and anal enlargement after PPH can avoid postoperative rectal stenosis and can strengthen anastomosis and reduce bleeding, while being a simple procedure that can be easily popularized.
Assuntos
Hemorroidas , Prolapso Retal , Humanos , Hemorroidas/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/prevenção & controle , Prolapso , Canal Anal/cirurgia , Complicações Pós-Operatórias , Anastomose Cirúrgica , Prolapso Retal/etiologia , Prolapso Retal/cirurgiaRESUMO
BACKGROUND: The incidence and optimal management of rectal prolapse following repair of an anorectal malformation (ARM) has not been well-defined. METHODS: A retrospective cohort study was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium registry. All children with a history of ARM repair were included. Our primary outcome was rectal prolapse. Secondary outcomes included operative management of prolapse and anoplasty stricture following operative management of prolapse. Univariate analyses were performed to identify patient factors associated with our primary and secondary outcomes. A multivariable logistic regression was developed to assess the association between laparoscopic ARM repair and rectal prolapse. RESULTS: A total of 1140 patients met inclusion criteria; 163 (14.3%) developed rectal prolapse. On univariate analysis, prolapse was significantly associated with male sex, sacral abnormalities, ARM type, ARM complexity, and laparoscopic ARM repairs (p < 0.001). ARM types with the highest rates of prolapse included rectourethral-prostatic fistula (29.2%), rectovesical/bladder neck fistula (28.8%), and cloaca (25.0%). Of those who developed prolapse, 110 (67.5%) underwent operative management. Anoplasty strictures developed in 27 (24.5%) patients after prolapse repair. After controlling for ARM type and hospital, laparoscopic ARM repair was not significantly associated with prolapse (adjusted odds ratio (95% CI): 1.50 (0.84, 2.66), p = 0.17). CONCLUSION: Rectal prolapse develops in a significant subset of patients following ARM repair. Risk factors for prolapse include male sex, complex ARM type, and sacral abnormalities. Further research investigating the indications for operative management of prolapse and operative techniques for prolapse repair are needed to define optimal treatment. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: II.
Assuntos
Malformações Anorretais , Fístula Retal , Prolapso Retal , Doenças Uretrais , Fístula Urinária , Criança , Humanos , Masculino , Malformações Anorretais/epidemiologia , Malformações Anorretais/etiologia , Malformações Anorretais/cirurgia , Prolapso Retal/epidemiologia , Prolapso Retal/etiologia , Prolapso Retal/cirurgia , Estudos Retrospectivos , Incidência , Fístula Retal/cirurgia , Fístula Urinária/cirurgia , Doenças Uretrais/cirurgia , Fatores de Risco , Reto/cirurgia , Reto/anormalidadesRESUMO
Neorectal prolapse following proctectomy for cancer has seldom been reported and treatment has mostly consisted in the resection of the prolapse via a perineal approach. Management of a patient with neorectal J-pouch prolapse using mesh sacral pexy via an abdominal approach is reported. By analogy with native rectal prolapse due to pelvic static disorders, laparoscopic mesh sacral pexy is likely to afford the same advantages of low morbidity and durability when applied to neorectal prolapse following rectal cancer surgery.
Assuntos
Protectomia , Prolapso Retal , Humanos , Telas Cirúrgicas/efeitos adversos , Canal Anal/cirurgia , Reto/cirurgia , Prolapso , Prolapso Retal/etiologia , Prolapso Retal/cirurgiaRESUMO
Rectosigmoid intussusception is a rare cause of bowel obstruction, accounting for only approximately 1%-2% of all bowel obstruction cases. While intussusception in adults typically occurs intra-abdominally and presents with signs and symptoms of intestinal obstruction, in rare cases, it can mimic a rectal prolapse if the intussusceptum protrudes through the anal canal. We herein report a case where an octogenarian woman presented with rectosigmoid intussusception through the anal canal, due to a sigmoid colon submucosal lipoma, who eventually required an open Hartmann's procedure. Patients with rectal prolapse symptoms should be carefully examined to rule out intussuscepting masses as a differential, as it would necessitate earlier surgical intervention.
Assuntos
Neoplasias do Colo , Obstrução Intestinal , Intussuscepção , Lipoma , Prolapso Retal , Adulto , Feminino , Idoso de 80 Anos ou mais , Humanos , Prolapso Retal/diagnóstico , Prolapso Retal/etiologia , Prolapso Retal/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Reto , Neoplasias do Colo/diagnóstico , Obstrução Intestinal/complicações , Lipoma/diagnóstico , Lipoma/diagnóstico por imagemRESUMO
PURPOSE: Rectal prolapse after radical surgery for anorectal malformations (ARMs) is a common postoperative complication that causes bleeding and stenosis, and sometimes requires surgical treatment. Different surgical techniques have been reported, but most are associated with high recurrence rates and a long postoperative stay. We performed the hemi-circumferential mucosal resection and anastomosis procedure (HCMR) to preserve anal muscle and anal function. Here, we report the success of our minimally invasive surgical approach to correct rectal prolapse in patients with ARMs. METHODS: The subjects of this retrospective review were patients who underwent HCMR for rectal prolapse after radical surgery for ARMs between January, 2014 and August, 2021. HCMR involves rectal mucosal resection without muscle plication. RESULTS: A collective 15 HCMR procedures were performed in 10 patients. The median age at repair was 1.8 years (range, 10 months-18 years). The median operation time and postoperative length of stay were 46 min (range, 17-85 min) and 3 days (range, 1-7 days), respectively. The median postoperative observation period was 3 years 4 months (range, 8 months-7 years 10 months) and no complications or recurrences were observed. CONCLUSIONS: HCMR is a safe and effective surgical treatment for rectal prolapse after radical operation for ARMs, which is minimally invasive and preserves rectal muscle and function.
Assuntos
Malformações Anorretais , Prolapso Retal , Humanos , Lactente , Prolapso Retal/cirurgia , Prolapso Retal/etiologia , Malformações Anorretais/cirurgia , Seguimentos , Reto/cirurgia , Resultado do Tratamento , Anastomose Cirúrgica/efeitos adversos , Complicações Pós-Operatórias/etiologia , RecidivaRESUMO
A 2.5-kg castrated male Maltese dog, suspected to be older than 10 y, was presented with a prolapsed mass at the anus. This had occurred on 2 previous occasions within the last 4 mo and had been managed with manual reduction and purse-string sutures. The rectal prolapse had viable tissue and was reducible but resulted in straining and fecal accumulation. Colopexy (with intracorporeal sutures) was performed laparoscopically using 3 ports; the distal colon was retracted cranially and attached to the abdominal wall with 3 simple interrupted sutures in a single row. The dog recovered uneventfully, had good appetite and normal activity, did not strain, and defecated without issues. There were no wound-healing complications and at 12-month post-operative examination, the patient was in good condition without clinical signs. Based on this case report, laparoscopic colopexy is clinically practical for management of rectal prolapse in small-breed dogs.
Colopexie laparoscopique pour prolapsus rectal récurrent chez un chien maltais. Un chien maltais mâle castré de 2,5 kg, suspecté d'avoir plus de 10 ans, a été présenté avec une masse faisant prolapsus à l'anus. Cela s'était produit à deux reprises au cours des quatre derniers mois et avait été géré avec une réduction manuelle et des sutures en bourse. Le prolapsus rectal avait des tissus viables et était réductible mais a entraîné des efforts et une accumulation fécale. La colopexie (avec sutures intracorporelles) a été réalisée par laparoscopie à l'aide de trois ouvertures; le côlon distal a été rétracté crânialement et attaché à la paroi abdominale avec trois sutures interrompues simples en une seule rangée. Le chien s'est rétabli sans incident, avait un bon appétit et une activité normale, ne s'est pas fatigué et a déféqué sans problème. Il n'y avait pas de complications de cicatrisation et lors de l'examen postopératoire de 12 mois, le patient était en bon état sans signes cliniques. Sur la base de ce rapport de cas, la colopexie laparoscopique est cliniquement pratique pour la gestion du prolapsus rectal chez les chiens de petite race.(Traduit par Dr Serge Messier).
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Doenças do Cão , Laparoscopia , Prolapso Retal , Animais , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/veterinária , Doenças do Cão/etiologia , Doenças do Cão/cirurgia , Cães , Laparoscopia/métodos , Laparoscopia/veterinária , Masculino , Prolapso Retal/etiologia , Prolapso Retal/cirurgia , Prolapso Retal/veterinária , Suturas/efeitos adversosRESUMO
AIM: Due to the paucity of data and controversy regarding the etiology and surgical approach for managing anorectal prolapse (ARP) after anorectoplasty, we sought to investigate the underlying anatomic disorder and the surgical outcome in managing this challenging complication. METHODS: We performed a retrospective study on 83 patients with ARP related to anorectal malformations (ARM). Logistic regression analyses were performed to detect the risk factors for the ARP severity. Surgical procedures were stratified according to identified anatomical abnormalities and surgical outcomes were analyzed. RESULTS: 50 patients (62.7%) had high-type ARM. The original anorectoplasty had a higher rate of ARP in laparoscopic-assisted anorectoplasty (n = 49, 59.0%) versus posterior sagittal anorectoplasty (n = 11, 13.3%). ARP was associated with rectal fat hyperplasia (67.5%), dilated muscular tunnel (79.5%), longitudinal muscle (LM) discontinuity (16.9%), rectal dilation (22.9%), mislocated anus (7.2%), and excessive mobile mesorectum (3.6%). Based on the ARP severity, the patients were divided into a severe group (Group 1, n = 38) and a moderate group (Group 2, n = 45). Binary logistic regression analysis showed that hyperplasia rectal fat (OR 4.55, 95% CI 1.16-17.84), rectal dilation (OR 4.21, 95% CI 1.05-16.94), and high-type ARM (OR 2.90, 95% CI 1.14-7.39) were independent risk factors for the development of severe ARP. Complications after stratified surgical repair included wound infection in six patients (7.2%), anal stenosis in one patient (1.2%), and ARP recurrence in two patients (2.4%). Twenty-six patients without colostomy before prolapse repair were followed up for 2 to 12 years. All the patients maintained voluntary bowel movements. Following ARP repair, there was an overall higher rate of no soiling or grade 1 soiling (88.5 vs. 65.4%), but 3 of 12 patients with grade 2 constipation were upgraded to grade 3. CONCLUSION: Our study shows that ARM-related anorectal prolapse is associated with excessive rectum, hyperplasia of rectal fat, mobile mesorectum, loose muscular tunnel, LM discontinuity, and anal mislocation. Surgical repair with techniques stratified according to the patients' underlying risk factors is effective to prevent recurrence and improve the soiling continence.
Assuntos
Malformações Anorretais , Procedimentos de Cirurgia Plástica , Prolapso Retal , Canal Anal/cirurgia , Malformações Anorretais/complicações , Malformações Anorretais/cirurgia , Humanos , Hiperplasia/complicações , Lactente , Procedimentos de Cirurgia Plástica/efeitos adversos , Prolapso Retal/etiologia , Prolapso Retal/cirurgia , Reto/cirurgia , Estudos RetrospectivosRESUMO
Benign anorectal disease refers to a diverse group of frequent anorectal complaints that cause considerable discomfort, disability, and often constitute a significant problem for the child and his or her family. Hemorrhoids, fissures, rectal prolapse, and perianal abscess and fistulas are the most common anorectal disorders in pediatric population and their appearance may be age-specific. Although they generally follow a benign course, a careful examination must be performed in order to exclude other serious and complicated underlying pathology. Their diagnosis is based on the patient's medical history, physical examination, endoscopy, and imaging. Moreover, the management of these disorders includes medical and surgical treatment options, and if they are treated promptly and properly may be limited and short lived. This review presents the currently available data in the literature on the diverse aspects of these disorders, including the definition, epidemiology, clinical presentation, pathogenesis, diagnosis, indications for surgery, and long-term outcomes.
Assuntos
Doenças do Ânus , Hemorroidas , Doenças Retais , Fístula Retal , Prolapso Retal , Abscesso/diagnóstico , Abscesso/terapia , Doenças do Ânus/diagnóstico , Doenças do Ânus/epidemiologia , Doenças do Ânus/terapia , Criança , Endoscopia , Feminino , Hemorroidas/diagnóstico , Hemorroidas/epidemiologia , Hemorroidas/terapia , Humanos , Masculino , Doenças Retais/diagnóstico , Doenças Retais/epidemiologia , Doenças Retais/terapia , Fístula Retal/diagnóstico , Fístula Retal/terapia , Prolapso Retal/diagnóstico , Prolapso Retal/etiologia , Prolapso Retal/terapiaRESUMO
BACKGROUND: The aim of this study was to compare patients' mid-term functional and quality of life (QoL) outcomes following robotic ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR). METHODS: The data of consecutive female patients who underwent minimally invasive ventral mesh rectopexy for external or symptomatic internal rectal prolapse at 3 hospitals in Finland between January 2011 and December 2016 were retrospectively collected. Patients were matched by age and diagnosis at a 1:1 ratio. A disease-related symptom questionnaire was sent to all living patients at follow-up in July 2018. RESULTS: After a total of 401 patients (RVMR, n = 187; LVMR, n = 214) were matched, 152 patients in each group were included in the final analyses. The median follow-up times were 3.3 (range 1.6-7.4) years and 3.0 (range 1.6-7.6) years for the RVMR and LVMR groups, respectively. The postoperative QoL measures did not differ between the groups. Compared with the LVMR group, the RVMR group had lower postoperative Wexner Incontinence Score (median 5 vs. median 8; p < 0.001), experienced significant ongoing incontinence symptoms less often (30.6% vs. 49.0%; p < 0.001) and reported less postoperative faecal incontinence discomfort evaluated with the visual analogue scale (median 11 vs. median 39; p = 0.005). RVMR patients had a shorter hospital stay (2.2 days vs. 3.8 days; p < 0.001) but experienced more frequent de novo pelvic pain (31.8% vs. 11.8%; p < 0.001). CONCLUSION: RVMR and LVMR patients had equal functional and QoL outcomes. Those who underwent RVMR had lower mid-term anal incontinence symptom scores but suffered more frequent de novo pelvic pain.
Assuntos
Incontinência Fecal , Laparoscopia , Prolapso Retal , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Laparoscopia/efeitos adversos , Análise por Pareamento , Qualidade de Vida , Prolapso Retal/etiologia , Prolapso Retal/cirurgia , Reto/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Resultado do TratamentoRESUMO
Mucosal prolapse syndrome most commonly involves the rectum and presents as solitary rectal ulcer syndrome and proctitis cystica profunda. Symptoms and endoscopic appearances are nonspecific. Histologically, mucosal prolapse is characterized by fibromuscular obliteration of the lamina propria, and displacement of crypts into submucosa and muscularis mucosae. Mucosal prolapse presenting as polyposis is rare and has only been reported involving the rectosigmoid colon. In this report, we describe a case of mucosal prolapse syndrome presenting as diffuse polyposis and colitis cystica profunda involving the hepatic, splenic flexures and descending colon in a teenage boy suffering from refractory fibrostenosing Crohn's disease. This patient was found to have possibly deleterious homozygous single nucleotide polymorphisms in both SULT1A1 and SULT1A2 genes within a unique polygenic variation of altered cell adhesion.
Assuntos
Polipose Adenomatosa do Colo , Arilsulfotransferase/genética , Colectomia/métodos , Doença de Crohn , Mucosa Intestinal , Prolapso Retal , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Polipose Adenomatosa do Colo/diagnóstico , Polipose Adenomatosa do Colo/etiologia , Adolescente , Adesão Celular/genética , Colite/diagnóstico por imagem , Colite/etiologia , Colite/patologia , Colonoscopia/métodos , Doença de Crohn/diagnóstico , Doença de Crohn/genética , Doença de Crohn/fisiopatologia , Testes Genéticos/métodos , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Polimorfismo de Nucleotídeo Único , Prolapso Retal/diagnóstico , Prolapso Retal/etiologia , Índice de Gravidade de DoençaAssuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Diafragma da Pelve/cirurgia , Prolapso Retal/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Humanos , Diafragma da Pelve/patologia , Períneo/patologia , Períneo/cirurgia , Prolapso Retal/diagnóstico , Prolapso Retal/etiologia , Prolapso Retal/patologia , Reto/patologia , Telas CirúrgicasRESUMO
PURPOSE: The choice of surgical procedure for rectal prolapse (RP) is challenging because of the high recurrence and morbidity rates. We aimed to clarify whether laparoscopic suture rectopexy (lap-rectopexy) is suitable for Japanese patients with recurrent RP. METHODS: We retrospectively evaluated 77 recurrent RP patients who had been treated on average 1.5 times between June 2008 and April 2016. Forty-one patients underwent lap-rectopexy and 36 underwent perineal procedures. We compared surgical outcomes and recurrence rate following surgery between the two groups. The multivariable logistic regression analysis was performed to determine risk factors of recurrent RP. RESULTS: In patients' characteristics, significant differences were observed in the type of anesthesia (p < 0.01) and length of recurrent RP (p = 0.030). The mean operative time was significantly longer in the lap-rectopexy group (p < 0.001). Blood loss, length of hospitalization, and postoperative complications were similar. The recurrence rate was significantly lower in the lap-rectopexy group (17.1% vs. 38.9%, p = 0.032). Multivariate analysis showed that only the laparoscopic approach was significantly associated with a low recurrence following surgery (odds ratio 0.273, 95% CI - 2.568 to - 0.032). CONCLUSION: Lap-rectopexy is recommended for recurrent RP because its low recurrence rate and safety profile are similar to those of perineal procedures.
Assuntos
Endoscopia Gastrointestinal/métodos , Laparoscopia/métodos , Prolapso Retal/cirurgia , Reto/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Prolapso Retal/epidemiologia , Prolapso Retal/etiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Segurança , Prevenção Secundária/métodos , Resultado do Tratamento , Adulto JovemRESUMO
Anorectal malformation includes various types of anomalies. The goal of definitive surgery is achievement of fecal continence. Twenty years have passed since laparoscopically assisted anorectoplasty (LAARP) was reported by Georgeson. Since LAARP is gaining popularity, its long-term outcomes should be evaluated. Presently, there is no evidence regarding the optimal method of ligating and dividing the fistula correctly and creating the pull-through canal accurately. Rectal prolapse and remnant of the original fistula (ROOF) tend to develop more often in LAARP patients than in posterior sagittal anorectoplasty (PSARP) patients; however, robust evidence is not available. Prolapse may be prevented by suture fixation of the rectum to the presacral fascia; however, if prolapse occurs, the indication, timing, and the best method for surgical correction remain unclear. Most patients with ROOF are asymptomatic, and there is controversy regarding the indications for ROOF resection. This article aimed to detail the various modifications of the LAARP procedures reported previously and to describe the surgical outcomes, particularly focusing on rectal prolapse, ROOF, and fecal continence, by reviewing the literature. Functional outcomes after LAARP were almost similar to those noted after PSARP, and we have demonstrated that LAARP is not inferior to PSARP with respect to fecal continence. Although there is controversy regarding the application of LAARP for recto-bulbar cases, we believe that LAARP is still evolving, and we can achieve better outcomes by improving the procedure.
Assuntos
Canal Anal/cirurgia , Malformações Anorretais/cirurgia , Laparoscopia , Procedimentos de Cirurgia Plástica , Reto/cirurgia , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Humanos , Lactente , Fístula Intestinal/etiologia , Fístula Intestinal/prevenção & controle , Fístula Intestinal/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Prolapso Retal/etiologia , Prolapso Retal/prevenção & controle , Técnicas de SuturaRESUMO
PURPOSE: Mucosal prolapse at the site of anastomosis is a long-term complication unique to ISR. It reduces the QOL of patients due to a worsened anal function and local symptoms around the anus. We herein sought to assess the surgical outcomes after Delorme surgery for these patients. METHODS: ISR was performed in 720 patients with low rectal cancer between January 2001 and March 2019 at the National Cancer Center Hospital East. Among these patients, the 33 (4.5%) who underwent initial Delorme surgery for postoperative colonic mucosal prolapse were identified from the medical records and then were analyzed retrospectively. We estimated the anal function using Wexner's incontinence score and assessed whether local anal symptoms due to the prolapse improved postoperatively. RESULTS: Stoma closure was performed before Delorme surgery in 15 (45.5%) patients, and we compared the preoperative and postoperative anal function in these patients. The average Wexner's incontinence score changed from 15.1 before to 12.9 after Delorme surgery. Local symptoms around the anus improved in all 33 (100%) patients. Recurrence of colonic mucosal prolapse occurred in 5 patients (15%), and Delorme surgery was reperformed in these cases. CONCLUSION: Delorme surgery for colonic mucosal prolapse following ISR has clinical benefits for both improving anal local symptoms and slightly improving the anal function.