Rectopexia laparoscópica con técnica de Orr-Loygue para el tratamiento del prolapso rectal / Laparoscopic Orr-Loygue rectopexy with mesh for the treatment of rectal prolapse

Introducción: Existen múltiples alternativas para el tratamiento quirúrgico del prolapso rectal mediante procedimientos de fijación, resección o combinados. Si bien el abordaje perineal evita el acceso a la cavidad peritoneal, se acompaña de una tasa de recidiva mayor en relación al abordaje abdominal. Descripción: Se presenta una paciente de 66 años, histerectomizada por vía laparotómica, con un prolapso rectal externo y reductible de 1 año de evolución, sin incontinencia fecal ni constipación. La endoscopia preoperatoria descartó patología colónica asociada. Abordaje laparoscópico en posición de Trendelenburg lateralizado a la derecha. Como es habitual en estos casos se observa la presencia de dolicosigma y fondo de saco de Douglas profundo y se evidencia también la cicatriz de la cesárea. El procedimiento comienza con la apertura peritoneal a nivel del promontorio y la movilización de la unión rectosigmoidea, identificando el uréter izquierdo. Se continua la disección circunferencial tras la apertura de la reflexión peritoneal hasta la altura de la cúpula vaginal. La rectopexia se realiza según la técnica de Orr-Loygue mediante la fijación de la malla por una parte a ambas caras laterales del recto y por otra al promontorio sacro con puntos de polipropileno 2-0, cuidando de no lesionar los vasos ilíacos y los uréteres. Finalmente se cierra la reflexión peritoneal con poliglactina para aislar las mallas protésicas del contenido visceral. La paciente tuvo una buena evolución postoperatoria, otorgándose el alta a las 48 h. Tras 8 meses de seguimiento se encuentra asintomática, con tránsito digestivo y continencia fecal sin alteraciones. Conclusión: El abordaje laparoscópico para el tratamiento del prolapso rectal es seguro y ofrece las ventajas de la cirugía mini-invasiva. La rectopexia con malla protésica es un procedimiento técnicamente desafiante, aunque con mejores resultados alejados. (AU)

Introduction: There are multiple alternatives for the surgical treatment of rectal prolapse through fixation, resection or combined procedures. Although the perineal approach avoids access to the peritoneal cavity, it is associated with a higher recurrence rate than the abdominal approach. Description: The video shows a 66-year-old female patient, hysterectomized by laparotomy, with a 1-year history of reduciblefull-thickness rectal prolapse, without fecal incontinence or constipation. Preoperative endoscopy ruled out associated colonic pathology. The laparoscopic approach is done with the patient placed in Trendelenburg and tilted to the right. As usual in these cases, the presence of dolichosigma and deep Douglas pouch is observed, as well as the cesarean section scar. The procedure begins with the peritoneal opening at the level of the promontory and the mobilization of the rectosigmoid junction, identifying the left ureter. Circumferential dissection is continued after opening the peritoneal reflection up to the level of the vaginal vault. Rectopexy is performed according to the Orr-Loygue technique by fixing the mesh to both lateral aspects of the rectum on one side and to the sacral promontory on the other side with 2-0 polypropylene interrupted sutures, taking care not to injure the iliac vessels and ureters. Finally, the peritoneum is closed with a running suture with polyglactin to isolate the prosthetic mesh from the visceral content. The patient had a good postoperative outcome and was discharged at 48 h. After 8 months of follow-up, she is asymptomatic and has normal colonic transit and fecal continence. Conclusion: the laparoscopic approach for the treatment of rectal prolapse is safe and offers the advantages of minimally invasive surgery. Prosthetic mesh rectopexy is a technically challenging procedure, although has better distant results. (AU)

Macroligaduras hemorroidales. Tratamiento ideal del prolapso hemorroidario. Seguimiento a 5 años / Hemorrhoidal macro rubber band ligations. Ideal treatment of hemorrhoidal prolapse. Follow-up at 5 years

Introducción: Entre los tratamientos alternativos de las hemorroides se destaca por ser costo-eficientes las ligaduras elásticas convencionales. Las macroligaduras elásticas se hayan en difusión por similares resultados que las bandas elasticas convencionales. La literatura es aun escasa. El objetivo fue analizar los resultados, morbilidad y recidiva a corto y mediano plazo de hemorroides tratadas con macroligaduras. Diseño: Estudio observacional analítico prospectivo. Pacientes: 188 pacientes (110 varones y 78 mujeres). Periodo: 2011-2014. Lugar: Institución privada universitaria. Métodos: Inclusión: pacientes tratados con hemorroides internas sintomáticas. Exclusión: enfermedad anoperineal asociada, tratamiento previo, inmunocompromiso o anticoagulación. Se registraron resultados, complicaciones y recidiva. La técnica empleada fue la descripta por Reis Neto. El Seguimiento fue a 10, 30 días y 6 y 12 meses y 5 años. Resultados: Todos fueron tratados con internación de corta estadía. La edad fue 49,5 años (23-76). Los síntomas fueron prolapso 96, sangrado 44 y ambos 48. Se realizó sólo una sesión en 178 casos (94,6%). Se trataron 2 paquetes en 122 y 3 en 66. El dolor moderado fue en 5 casos y prolongado en 2. El sangrado leve y tenesmo se presentó en la mayoría de los pacientes, pero desapareció en la primera semana. Se registró sangrado inmediato moderado en 5% sin sangrado severo inmediato. Otras complicaciones inmediatas: 2 trombosis y 3 congestión/edema local. En 1 paciente ocurrió un sangrado que requirió de internación sin necesidad de cirugía en forma alejada. Sólo en 3 casos se realizó resección local de plicomas previos. En 139 casos se realizó como único procedimiento. La recidiva fue 6 casos. (2 al primer año y 4 a los 5 años), 5 se trataron con nueva macroligadura y 1 con cirugía. No se registró ninguna complicacion severa, infecciosa o única relacionada al procedimiento. El seguimiento a 1 año fue del 100% y a 5 años del 96%. Discusión y conclusiones: El tratamiento con macroligaduras para el prolapso hemorroidario presentó con baja morbilidad sin complicaciones severas. Los resultados son reproducibles entre diferentes autores. Son el tratamiento ideal para las hemorroides grado III con poco componente externo. (AU)

Introduction: Alternative therapies for internal hemorrhoid plexus are several procedures with specific indications for each grade of hemorrhoid. Due to some major advantages, rubber band ligation has become probably in the most popular between colorectal surgeons. The high-macro rubber band ligation appears to be as the first choice but literature is few. Objective: To analyze results, morbidity and recurrence of internal hemorrhoid disease treated with high-macro rubber band ligation. Design: Observational non-randomized prospective analysis. Patients: 188 patients (110 male). Period: 2011-2014. Setting: Private Institution. Methods: Patients with symptomatic internal hemorrhoid disease (grade II-III-IV). Results, Immediate and late complications and 5 years recurrence were registered. Technique used was the original description by Reis Neto. Patients with immunosuppression, additional perianal disease, previous treatment and anticoagulation were excluded. Results: There was only one session in 178 cases. Two banding were placed in 122 and 3 in 66. Symptoms were prolapse in 96, bleeding in 44 and both in 48. 139 patients were treated as only procedure. Tenesmus and light hemorrhage occurred in most cases. Moderate or late pain was registered in 7 cases, and immediate moderate bleeding in 5%. There was no severe immediate bleeding. Immediate morbidity was 2 thrombosis and 3 anal congestion. There was one moderate late bleeding at day 28 and required admission. Recurrence occurred in six cases, 5 were ligated again and 1 was treated by conventional surgery. There was none severed or unique complication or infection associated. Discussion and conclusion: Macrorubber band presented low morbidity and there are no severe complications at 5 years follow-up. Recurrence of prolapse is low and could be treated by a new session with equal morbidity. Results are equivalent and reproducible by different authors. This procedure might be the ideal treatment for hemorrhoid prolapse. (AU)

Prolapso rectal como presentación inhabitual de enfermedad celiaca. A propósito de 2 casos clínicos / Rectal prolapse as an unusual presentation of celiac disease. Report of two cases

Resumen Introducción: El prolapso rectal (PR) está relacionado a un aumento de presión intrabdominal, patología del piso pélvico o esfínter anal, siendo las causas más frecuentes la constipación, fibrosis quística, tos convulsiva y diarrea disentérica. La enfermedad celiaca no está considerada entre las patologías relacionadas a PR. Objetivo: Dar a conocer una asociación escasamente descrita entre PR y enfermedad celiaca. Casos Clínicos: Se presentan 2 preescolares en quienes el motivo de consulta fue el PR, cuyo estudio se enfocó como diarrea prolongada, debido al antecedente de deposiciones de consistencia pastosa. En los exámenes destacaron títulos de anticuerpos anti-transglutaminasa tisular (Ac anti-tTG) elevados, y biopsias duodenales con atrofia vellositaria y aumento de linfocitos in-traepiteliales, compatible con enfermedad celiaca. Ambos tuvieron una excelente respuesta a la dieta libre de gluten, con rápida normalización de las deposiciones, sin nuevos episodios de PR, desarrollo pondoestatural normal y Ac anti-tTG negativos en los controles anuales a 5 años de seguimiento. Conclusiones: Aunque la asociación entre PR y enfermedad celiaca prácticamente no ha sido descri ta, debe considerarse en pacientes que se presenten con PR.

Abstract Introduction: Rectal prolapse (RP) is related to an increase of intra-abdominal pressure, pelvic floor disease or anal sphincter. The most common causes of RP are constipation, cystic fibrosis, whooping cough and dysenteric diarrhea. However, celiac disease is not considered among the pathologies re lated to RP. Objective: To present a scarcely described association between RP and celiac disease. Clinical Cases: We presented 2 preschoolers in whom the reason for consultation was RP, whose study was focused on as prolonged diarrhea, due to the antecedent of pasty consistency of stools. The tests showed elevated anti-tissue transglutaminase (anti-tTG) antibody titers, and duodenal biopsies with villous atrophy and increased intraepithelial lymphocytes, consistent with celiac disease. Both had an excellent response to the gluten-free diet, with rapid normalization of depositions, without presenting any episodes of RP after treatment. Both with normal staturo-ponderal development and anti-tTG-negative controls at the annual 5-year follow-up. Conclusions: Although the association between RP and celiac disease has not been described yet, it should be considered in diagnosis and treatment.

Rectosigmoidectomía perineal para el tratamiento del prolapso rectal completo / Perineal rectosigmoidectomy for the treatment of rectal prolapse

Objetivo: Presentamos nuestra experiencia en el tratamiento quirúrgico de esta patología con la técnica de la rectosigmoidectomía perineal. Material y método: Se trata de una serie retrospectiva, consecutiva de 17 pacientes. Resultados: Predomina el género femenino y el promedio de edad es de 62 años. La morbilidad alcanza el 23%, aunque casi toda de menor gravedad, con solo un paciente reoperado. La recidiva es del 6%, con mejoría de los síntomas en un 88%. Conclusión: Concluimos que es una técnica segura, con una morbilidad controlada y con buenos resultados a mediano plazo con un adecuado control de la recidiva y mejoría de la continencia en un alto porcentaje de los pacientes.

Aim: We present our experience with perineal rectosigmoidectomy for the treatment of rectal prolapse. Material and method: It is a retrospective, consecutive series of 17 patients. Results: Predominantly female and the average age is 62 years. Morbidity reached 23%, but almost all less serious, with only one reoperation. Recurrence is 6%, and the improvement in continence is 88%. Conclusion: We conclude that it is a safe technique with a controlled morbidity and good results with low recurrence and improvement of continence in a high percentage of patients.

Prolapso rectal, abordaje laparoscópico: un tratamiento simple y efectivo / Rectal prolapse, laparoscopic approach: a simple and effective treatment

Antecedentes: El prolapso rectal es una afectación poco frecuente. La elección del procedimiento depende de la edad y estado del paciente. El abordaje abdominal ofrece mejores resultados funcionales y menor recidiva. La laparoscopía, en los últimos, años ha agregado las ventajas de una técnica mínimamente invasiva favoreciendo una rápida recuperación. Objetivos: Evaluar los resultados de una serie de pacientes con prolapso rectal que fueron abordados por laparoscopía, utilizando una técnica de promontopexia simple y efectiva. Material y Métodos: Se diseño un estudio retrospectivo, observacional y longitudinal de una serie sucesiva de casos, durante el período comprendido entre diciembre de 2001 a marzo de 2011. Se evaluaron 25 pacientes intervenidos quirúrgicamente con diagnóstico de prolapso total de recto mediante abordaje laparoscópico. Los resultados anátomo-funcionales se evaluaron antes y después de la cirugía con una escala diseñada especialmente. Se analizaron como variables la corrección anatómica del prolapso, la recurrencia, los resultados funcionales, el índice de conversión, el riesgo anestesiológico, el tiempo quirúrgico, la morbilidad, y la mortalidad. Se definió recidiva a la aparición de prolapso completo luego de la cirugía. Considerando por separado la recidiva mucosa. Resultados: Se incluyeron 25 pacientes, 15 de sexo femenino y 10 masculino. La media de edad de la serie fue de 51.4 (18-87) años. 17 (68%) pacientes tenían constipación y 8 (32%) incontinencia. En 20 casos se realizó rectopexia sola sin resección, en los 5 casos restantes se agrego resección sigmoidea a la fijación. El tiempo operatorio medio fue 110 min (50-155); sin complicaciones intraoperatoria ni conversiones. La morbilidad temprana fue 4% por un caso de hemoperitoneo postoperatorio. No registrándose morbilidad alejada ni mortalidad. La media de la estadía hospitalaria fue de 2,6 (6-1) días. Con una media de seguimiento de 39 (6-96) meses...

Background: Rectal prolapse is a rare affectation. The choice of procedure depends on the age and condition of the patient. The abdominal approach offers better functional results and recurrence. Laparoscopy in recent years has added benefits of a minimally invasive technique favoring a rapid recovery. Objectives: Evaluate the results of a series of patients with rectal prolapse who were approached by laparoscopy technique using a simple and effective promontopexy. Material and Methods: It was designed a retrospective, observational and longitudinal a successive series of cases during the period from December 2001 to March 2011. We evaluated 25 patients who underwent surgery with a diagnosis of rectal prolapse by total laparoscopic approach. The anatomical and functional results were evaluated before and after surgery with a specially designed scale. Variables were analyzed as anatomical correction of prolapse, recurrence, functional results, the conversion rate, the risk anesthesiologist, surgical time, morbidity and mortality. Recurrence was defined as the apparition of complete prolapse after surgery. Considering separately mucosa recurrence. Results: We included 25 patients, 15 female and 10 male. The mean age of the series was 51.4 (18-87) years. Seventeen (68%) patients had constipation and 8 (32%) incontinence. In 20 patients underwent resection rectopexy alone without resection. In the remaining five cases were added to the fixing sigmoid resection. The mean operative time was 110 min (50-155), without intraoperative complications or conversions . Early morbility was 4% for a case of postoperative hemoperitoneum, without registration of morbility or mortality remote. The mean hospital stay was 2.6 (6-1) days. With a mean follow up of 39 (6-96) months. Were recorded three mucosal prolapse that were resolved with elastic ligatures...

TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial / Procedimento TRREMS (reparo transanal de retocele e mucosectomia retal com um grampeador circular): estudo multicêntrico prospectivo

CONTEXT: Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. OBJECTIVE: To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. METHODS: It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7 percent) and grade 3 (73.3 percent) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0 percent) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. RESULTS: All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3 percent) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6 percent). Forty-nine patients (65.3 percent) required 1 hospitalization day, the remainder (34.7 percent) 2 days. Postoperatively, 3 (4.0 percent) patients complained of persistent rectal pain and 7 (9.3 percent) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6 percent). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSION: Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

CONTEXTO: Como a anoretocele está sempre associada a prolapso mucoso e/ou intussuscepção retal, foi desenvolvida uma técnica cirúrgica grampeada, utilizando somente um grampeador mecânico. OBJETIVO: Demonstrar os resultados do estudo multicêntrico que realizou o tratamento cirúrgico de pacientes com anorretocele associado a prolapso mucoso, utilizando o reparo transanal da retocele e mucosectomia com grampeador circular mecânico. MÉTODO: Foram incluídos 75 pacientes, média de idade 49,6 anos, com sintomas de evacuação obstruída, apresentando escore médio de constipação de Wexner de 16 e diagnóstico de anorretocele grau II (26.7 por cento), grau III (73,3 por cento) associado a prolapso mucoso e intussuscepção (52 por cento). Todos foram avaliados com exame proctológico, defecografia, manometria anorretal e tempo de trânsito colônico. O procedimento cirúrgico foi realizado por 14 cirurgiões e consiste na remoção manual da parede do reto no local da retocele e mucosectomia circunferencial com um grampeador circular mecânico. O seguimento médio foi de 21 meses. RESULTADOS: Os pacientes apresentavam sintomas de evacuação obstruída, mesmo após tratamento clinico. O tempo operatório médio foi de 42 minutos. Houve sangramento transanal na linha de sutura em 13 (17,3 por cento) pacientes, sutura grampeada incompleta em 2 (2,6 por cento) e dor retal persistente em 3 (4,0 por cento). O tempo médio de internação hospitalar foi de 1 dia em 49 (65,3 por cento) e 2 dias em 34,7 por cento. Ocorreu redução na linha de sutura em 7 (9,3 por cento), sendo necessário estricturotomia cirúrgica sob anestesia (n = 1), utilizando "hot biopsy" (n = 3) e dilatação anal (3). Defecografia no pós-operatório demonstrou anorretocele residual grau I em 8 (10.6 por cento). O escore de constipação de Wexner reduziu 16 para 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). CONCLUSÃO: O resultado do estudo multicêntrico demonstrou que a técnica cirúrgica apresentada é segura e efetiva para tratamento da anorretocele associada a prolapso mucoso. Apresenta baixo custo pois utiliza um grampeador circular mecânico.

Tratamiento del prolapso hemorroidal con macroligaduras altas / Hemorrhoidal prolapse treatment with high macro rubber band ligation

Introducción: Las macroligaduras son una variante de las ligaduras elásticas tradicionales para hemorroides. El objetivo de este estudio es evaluar los resultados a corto y largo plazo de esta técnica. Pacientes y Métodos: Pacientes con hemorroides internas grado II y III, tratados con macroligaduras entre Junio de 2006 y Mayo de 2007. El seguimiento se realizó en consultorio y telefónicamente a las 24 hs, 7, 15 y 30 días y al año. Resultados: Tratamos 108 pacientes. El 68 por ciento de los pacientes no refirió molestias en el postoperatorio. En el seguimiento (de 12 a 24 meses), 19 no pudieron ser localizados (17.6 por ciento), 77.5 por ciento respondieron estar libres de síntomas. Refirieron recurrencia sintomática moderada 17.9 por ciento de los pacientes. Sólo el 3.4 por ciento requirieron una hemorroidectomía para el control de los síntomas. Hubo 5.65 por ciento de complicaciones. No se observaron complicaciones severas. Conclusiones: La macroligadura es una técnica mini-invasiva, ofrece una alternativa a las otras técnicas para el tratamiento de las hemorroides. Se asocia a menor dolor postoperatorio, bajo índice de complicaciones y a resultados satisfactorios.

Introduction: Hemorrhoidal macroligation is a modification of the rubber band ligation widely used. The aim of this study is to evaluate the short and long term results of this technique. Patients and Methods: Data on 108 patients treated between June 2006 and May 2007 with hemorrhoidal macroligation were retrieved. Patients had grade II or III hemorroidal prolapse. Telephone interview was performed for follow up. Results: 108 patients were treated. 68 per cent had no postoperative pain. Mean follow up was 16 month (1-12). 19 were lost in follow up (17.6 per cent), 77.5 per cent were symptoms free. 17.9 per cent had mild symptoms. 3.4 per cent required an hemorrhoidectomy. Overall complication rate was of 5.65 per cent. No serious complication was observed. Conclusions: Hemorrhoidal macroligation is a safe alternative with low morbility and postoperative pain to hemorrhoidectomy to treat patients with hemorrhoidal prolapse.

Resultados de tratamento do prolapso retal pela técnica de delorme e de retopexia / Surgical treatment of rectal prolapse by the Delorme technique and rectopexy

OBJETIVO: A retopexia é a técnica preferencial para tratamento do prolapso retal e as técnicas perineais são reservadas para os idosos com comorbidades. A técnica de Delorme tem sido indicada para essa situação por ser a cirurgia de menor porte, entretanto pode apresentar maior índice de recidiva. Analisamos os resultados da correção do Prolapso retal pela técnica de Delorme e de retopexia. MÉTODOS: Estudo retrospectivo de 31 doentes portadores de prolapso retal tratado entre 1997 a 2005, sendo 15 doentes (grupo A) tratados pela técnica de retopexia e 16 doentes tratadas pela técnica de Delorme (grupo B). Foram comparados os dois grupos: tempo de permanência hospitalar, morbidade, complicações cirúrgicas e taxa de recidiva. RESULTADOS: Houve maior tempo de permanência, sete dias (3 a 11 dias) no grupo A e quatro dias (2 a 6 dias) no grupo B. A taxa de recidiva foi semelhante, respectivamente 13,3 por cento e 6,6 por cento (diferença não significante). A maioria dos doentes permanece com esfíncteres hipotônicos apresentando baixa pressão de repouso e contração, porém a metade deles ficou continente após a cirurgia (grupo A=53 por cento e grupo B=50 por cento). A morbidade foi 40 por cento e 18,9 por cento, respectivamente para grupo A e B. Houve um caso de hemorragia sacral (grupo A) que foi controlada no ato cirúrgico e um caso de sangramento no grupo B que não necessitou de reintervenção. Houve uma estenose no grupo B que foi tratada com dilatação digital no ambulatório. CONCLUSÃO: A técnica de Delorme para tratamento do prolapso retal apresenta a eficácia comparável à técnica da retopexia, porém com menor morbidade, podendo ser indicada com maior freqüência.

OBJECTIVE: Rectopexy is the most common technique used to correct rectal prolapse. Perineal procedures such as the Delorme technique and others are employed for older frail patients with significant comorbidity because of the higher recurrence rate. This study evaluated results of the Delorme technique and rectopexy. METHODS: Retrospective study of 31 patients with rectal prolapse treated from 1997 to 2005. Among them, 15 patients (group A) were treated by rectopexy and 16 by the Delorme technique (group B). Analysis of hospital stay, morbidity, complications and recurrence rate was carried out. RESULTS: There was longer hospital stay, seven days (3 to 11days) in group A, compared to four days (2 to 6 days) in group B. Recurrence rate was similar, respectively 13.3 percent and 6.6 percent (not significant). Most patients presented low rest and squeezing pressure, although half of them became fully continent after surgery (group A=53 percent and group B =50 percent). Morbidity was 40 percent and 18.9 percent, respectively for groups A and B. Sacral hemorrhage occurred in one patient and was controlled during rectopexy. A case of bleeding occurred in group B and ceased spontaneously without surgical procedure. There was a rectal stricture in group B treated successfully with digital dilatation at the doctor's office. CONCLUSION: The Delorme technique for treatment of rectal prolapse is a safe procedure and presents results similar to rectopexy. In addition it also has lower morbidity, and could be more often indicated.

Prolapso total do reto: analise de 30 casos / Total rectal prolapse: an analysis of 30 cases

Foram analisados retrospectivamente 30 pacientes (21 do sexo feminino e 9 do sexo masculino) portadores de Prolapso Total de Reto, tratados pelos Servicos de Proctologia do Hospital de Caridade (HC) e Hospital Universitario (HU), Florianopolis, SC, estudando-se a idade, doencas associadas e as tecnicas cirurgicas utilizadas para a correcao da procidencia. O estudo demonstrou que 23 (76,7//) pacientes tinham idade acima de 50 anos, havendo predominio de mulheres (70,0//-21 pacientes). A incidencia das afeccoes associadas foi de 73,3//(22 pacientes), sendo as mais frequentes a insuficiencia cardiaca congestiva, doenca pulmonar obstrutiva cronica e hipertensao arterial sistemica.As tecnicas cirurgicas utilizadas foram Cirugia de Thiersch (21 casos), Cirurgia de Carrapatoso (4 casos), Sacropromontofixacao (3 casos), Retossigmoidectomia perineal (1 caso) e Cirurgia de Thiersch associada a Cirurgia de Delorme (1 caso).Observou-se um maior numero de anestesias locais associadas as Cirurgias de Thiersch. Acirurgia foi realizada ambulatorialmente em 46,7//, sendo o tempo de permanencia hospitalar de 12,39 dias para os outros 53,3//dos casos. A recidiva foi de 10,0//e a conclusao e de que ha um lugar no tratamento desta afeccao para a operacao de Thiersch...