Large Anal Polyp Disguised as Rectal Prolapse.

Rectal prolapse is a relatively rare condition where the rectal mucosa protrudes out of the anal canal. The diagnosis is made through a physical exam and clinical evaluation, and surgical treatment options can vary. Anal polyps masquerading as rectal prolapse have rarely been described in the literature. A 79-year-old man presented with a four-year history of a bulging, protruding mass from his anus that is exacerbated with defecation and bowel movements. He was initially diagnosed with rectal prolapse and had a proctosigmoidectomy performed robotically. Shortly after the procedure, his symptoms recurred, and he was referred to a different surgeon for reevaluation. A large, prolapsed polyp was visible on the physical exam. A colonoscopy and an anoscopy were performed. The CT abdomen/pelvis revealed a mass within the rectum, and the biopsy showed an adenomatous polyp with high-grade dysplasia. The patient underwent a transanal excision of the rectal polyp, with symptoms permanently resolving. For an accurate diagnosis, it is crucial to conduct a comprehensive assessment of the patient's history, a physical exam, and an unusual clinical course of rectal prolapse. The rarity of large, prolapsed polyps, along with their similar presentation to that of other anorectal conditions, may have contributed to this patient's diagnosis of rectal prolapse and the subsequent proctosigmoidectomy in place of a transanal excision of a polyp. The palpation of a stalk on a physical exam should raise suspicion of a polyp, and further workup, such as a colonoscopy and/or anoscopy, should be conducted to confirm the diagnosis.

Ventral mesh rectopexy for recurrent rectal prolapse after Altemeier perineal proctosigmoidectomy: feasibility and outcomes.

PURPOSE: Recurrence of rectal prolapse following the Altemeier procedure is reported with rates up to 40%. The optimal surgical management of recurrences has limited data available. Ventral mesh rectopexy (VMR) is a favored procedure for primary rectal prolapse, but its role in managing recurrences after Altemeier is unclear. VMR for recurrent prolapse involves implanting the mesh on the colon, which has a thinner wall, more active peristalsis, no mesorectum, less peritoneum available for covering the mesh, and potential diverticula. These factors can affect mesh-related complications such as erosion, migration, or infection. This study assessed the feasibility and perioperative outcomes of VMR for recurrent rectal prolapse after the Altemeier procedure. METHODS: We queried our prospectively maintained database between 01/01/2008 and 06/30/2022 for patients who had experienced a recurrence of full-thickness rectal prolapse following Altemeier's perineal proctosigmoidectomy and subsequently underwent ventral mesh rectopexy. RESULTS: Ten women with a median age of 67 years (range 61) and a median BMI of 27.8 kg/m2 (range 9) were included. Five (50%) had only one Altemeier, and five (50%) had multiple rectal prolapse surgeries, including Altemeier before VMR. No mesh-related complications occurred during a 65-month (range 165) median follow-up period. Three patients (30%) experienced minor postoperative complications unrelated to the mesh. Long-term complications were chronic abdominal pain and incisional hernia in one patient, respectively. One out of five (20%) patients with only one previous prolapse repair had a recurrence, while all patients (100%) with multiple prior repairs recurred. CONCLUSION: Mesh implantation on the colon is possible without adverse reactions. However, high recurrence rates in patients with multiple previous surgeries raise doubts about using VMR for secondary or tertiary recurrences.

Neorectal prolapse following proctectomy: a novel application of mesh sacral pexy.

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.

Incarcerated Rectal Procidentia: A Case Report and Review.

Rectal procidentia is an uncommon perineal disease that is rare in males. There is no specific medical role in treatment of rectal procidentia and surgical intervention is the treatment of choice. Various surgical approaches have been performed, but there is no consensus on which procedure is most effective in terms of patient condition, recurrence rate, bowel function, and risk. This case presentation of a healthy male patient with experience of uncomplicated reducible rectal prolapse and a history of chronic constipation. Presented with complicated rectal prolapse in the presence of incarcerated rectal prolapse after a failed trial with conservative maneuvers, he ended up with abdominal approach sigmoidectomy and posterior mesh rectopexy.

Transanal Surgery: A History of taTME Ancestry.

Transanal total mesorectal excision (taTME) is the culmination of major developments in rectal cancer management and minimally invasive surgery. This surgical breakthrough holds great promise and excitement for the care of the rectal cancer patient. We would be remiss in discussing taTME to not acknowledge the role of transanal abdominal transanal proctosigmoidectomy, transanal endoluminal microsurgery, laparoscopy, and natural orifice transluminal endoscopic surgery that got us to this modern day explosion of the taTME approach. In this article, we detail and explain the convergence of these disparate experiences, how they culminated in the development of the taTME, and explore future directions in this field.

Full-thickness neorectal prolapse after transanal transabdominal proctosigmoidectomy for low rectal cancer: a cohort study.

AIM: Transanal transabdominal proctosigmoidectomy (TATA) with a coloanal anastomosis is an alternative to abdominoperineal excision of the rectum (APR) for low rectal cancer. Neorectal prolapse is an unusual complication following TATA. This study aimed to determine the incidence of neorectal prolapse after TATA for low rectal cancer. METHOD: This cohort study was conducted in a tertiary referral colorectal centre. From a prospectively maintained database including 1093 patients treated for rectal cancer between 1984 and 2016 we identified those who underwent sphincter-preserving surgery. Data regarding the incidence, management and outcomes of neorectal prolapse were analysed. RESULTS: A total of 409 patients were identified, of whom 185 underwent open surgery and 224 a minimally invasive surgical procedure (MIS). All received neoadjuvant chemoradiation. Neorectal prolapse occurred in 4.6% (n = 19) with an incidence of 2.2% in the open and 6.7% in the MIS group (P = 0.023), with no difference between MIS techniques. There was one recurrence of neorectal prolapse (5.9%). The incidence of neorectal prolapse was higher in women (9.5%) than men (2.5%) (P = 0.011). There were no differences in local recurrence rates between the neorectal prolapse group (5.3%) and our population without prolapse (3.4%) (P = 0.79). CONCLUSION: Neorectal prolapse is a rare occurrence following minimally invasive sphincter-saving surgical procedures performed for rectal cancer. It appears to be more frequent in patients who undergo MIS procedures and in women.