Clinical and functional evaluation of patients with rectocele and mucosal prolapse treated with transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS).

BACKGROUND: The aim of the present study was to make a preoperative and postoperative clinical and functional evaluation of patients who underwent transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS procedure) as treatment for obstructed defecation syndrome (ODS) caused by rectocele and rectal mucosal prolapse (RMP). METHODS: This prospective study included 35 female patients, 34 multiparous and one nulliparous, with an average age of 47.5 years (range 31-67 years), rectocele grade II (n = 13/37.1%) or grade III (n = 22/62.9%), associated with RMP. The study parameters included ODS, constipation, functional continence scores and pre- and postoperative cinedefecographic findings. RESULTS: The average preoperative ODS score, the constipation score and the functional continence score were significantly reduced after surgery from 10.63 to 2.91 (p = 0.001), 15.23 to 4.46 (p = 0.001) and 2.77 to 1.71 (p = 0.001), respectively. Between the first and the eighth postoperative day, the average visual analog scale pain score fell from 5.23 to 1.20 (p = 0.001). Satisfaction with treatment outcome was 79.97, 86.54, 87.65 and 88.06 at 1, 3, 6 and 12 months, respectively. Cinedefecography revealed average reductions in rectocele size from 19.23 ± 8.84 mm (3-42) to 6.68 ± 3.65 mm (range 0-7) at rest and from 34.89 ± 12.30 mm (range 20-70) to 10.94 ± 5.97 mm (range 0-25) during evacuation (both P = 0.001). CONCLUSION: The TRREMS procedure is a safe and efficient technique associated with satisfactory anatomic and functional results and with a low incidence of postoperative pain and complications.

Prolapso rectal en un recién nacido con diarrea por Shigella / Rectal prolapse in a neonate with Shigella diarrhea

Se describe un caso de prolapso rectal secundario a diarrea por Shigella en un neonato de 10 días de vida, alimentado con pecho exclusivo. Su hermano de 2 años había tenido diarrea por el mismo patógeno hasta 2 semanas antes. El coprocultivo fue positivo para Shigella flexneri II, resistente a amoxicilina; los hemocultivos y el cultivo de líquido cefalorraquídeo fueron negativos. El tratamiento con ceftriaxone por vía parenteral revirtió el prolapso en 48 h. Conclusión. El prolapso rectal es una complicación poco común de la diarrea por Shigella en la infancia. Se ha descripto en edades mayores, pero nunca antes en un neonato.(AU)

Prolapso rectal en un recién nacido con diarrea por Shigella / Rectal prolapse in a neonate with Shigella diarrhea

Se describe un caso de prolapso rectal secundario a diarrea por Shigella en un neonato de 10 días de vida, alimentado con pecho exclusivo. Su hermano de 2 años había tenido diarrea por el mismo patógeno hasta 2 semanas antes. El coprocultivo fue positivo para Shigella flexneri II, resistente a amoxicilina; los hemocultivos y el cultivo de líquido cefalorraquídeo fueron negativos. El tratamiento con ceftriaxone por vía parenteral revirtió el prolapso en 48 h. Conclusión. El prolapso rectal es una complicación poco común de la diarrea por Shigella en la infancia. Se ha descripto en edades mayores, pero nunca antes en un neonato.

Prolapso rectal: abordaje laparoscópico / Rectal prolapse: laparoscopic approach

This study details a comparison between laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse. The surgical technique and the results obtained are commented. The laporoscopic approach of the rectal prolapse combines the good reults of the abdominal procedure with the low postoperative morbility of the mini-invasive surgery. The advantages of the laparoscopic approach are: less postopertive pain, less hospitalization time, diminution of time before return to work, similar results to conventional surgery, independently of the technique employed; the advanced age should not be a contraindications for the laparoscopic approach. All types of rectopexi show similar results. We perform sigmoideal resection only in presence of constipation and justly studied. Many old patients with co-morbilities, previously destinated to perineal procedures, can be suitable candidates to the laparoscopic approach. It is very probable that this procedure will achieve a high level of accuracy in order to define it as "Gold Standard".(AU)

Prolapso rectal: abordaje laparoscópico / Rectal prolapse: laparoscopic approach

This study details a comparison between laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse. The surgical technique and the results obtained are commented. The laporoscopic approach of the rectal prolapse combines the good reults of the abdominal procedure with the low postoperative morbility of the mini-invasive surgery. The advantages of the laparoscopic approach are: less postopertive pain, less hospitalization time, diminution of time before return to work, similar results to conventional surgery, independently of the technique employed; the advanced age should not be a contraindications for the laparoscopic approach. All types of rectopexi show similar results. We perform sigmoideal resection only in presence of constipation and justly studied. Many old patients with co-morbilities, previously destinated to perineal procedures, can be suitable candidates to the laparoscopic approach. It is very probable that this procedure will achieve a high level of accuracy in order to define it as "Gold Standard".

Perineal rectosigmoidectomy (Altemeier's procedure): a review of physiology, technique and outcome.

Perineal rectosigmoidectomy (Altemeier's procedure), as used for the surgical treatment of full-thickness rectal prolapse, has a long history. The physiological derangement in patients with rectal prolapse is complex, frequently showing impairment of the rectoanal inhibitory reflex, intermittent high-pressure rectal motor activity, disturbances in anorectal sampling and attendant pudendal neuropathy. There are currently few defined preoperative factors in patients presenting with rectal prolapse and fecal leakage which predict for the restoration of continence after surgery. This review describes our technique of Altemeier's procedure and analyzes the reported results of this operation, presenting those studies which assessed postoperative continence and prolapse recurrence in particular. The lack of prospective randomized data regarding this perineal approach makes clinical interpretation difficult at the present time.

Prolapso rectal / Rectal prolapse

Se hace una revisión de los conceptos actuales que se aplicaron en el estudio diagnóstico y en el tratamiento del prolapso rectal.

Procidencia Rectal / Rectum procidentia

Antecedentes: Se han desarrollado numerosas técnicas para tratar la procidencia rectal, enfermedad poco común que es manejada ocasionalmente por el cirujano general. Objetivo: Se realizó este artículo de revisión para discutir los cambios más recientes en la patofisiología, diagnóstico y manejo de la procidencia rectal. Resultados: Se discuten la fisiopatología y características clínicas de la procidencia rectal. Hay numerosas alternativas para tratamiento quirúrgico, pero las técnicas más utilizadas incluyen rectopexia con o sin resección de sigmoides. Conslusión: El mejor entendimiento de la fisiopatología, la cada vez más objetiva evaluación de la función anorrectal de sus alteraciones, aunados al desarrollo de materiales biocompatibles y de técnicas más precisas, han dado como resultado el poder ofrecer al paciente con esta patología el tratamiento que mejor se adapte a su condición particular

[Rectal prolapse]. / Procidencia rectal.

BACKGROUND: Numerous techniques have been developed in order to treat rectal procidentia, an uncommon pathology that is managed occasionally by the general surgeon. PURPOSE: This review article was performed in order to discuss the most recent changes in the pathophysiology, diagnosis and management of rectal procidentia. RESULTS: The pathophysiology and clinical characteristics of rectal procidentia are discussed. There are numerous alternatives for surgical treatment, but the most employed techniques include rectopexy with or without sigmoid resection. CONCLUSION: The better understanding of the physiopathology, the increasingly accurate evaluation of the anorectal function and its disorders, and the development of new biocompatible materials and finer techniques offer the patient the treatment that better suits to his or her particular problem.