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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rectal fixation to the sacrum is considered the most rational operation in the surgical treatment of massive or complete prolapse of the rectum, since it eliminates the anatomic defect which is fundamental in the pathogenesis of this disease. Many techniques have been used to join the posterior wall of the rectum to the sacrum, ranging from the use of simple sutures with nonabsorbable material to prosthetic materials, such as Teflon sheets or Ivalon, polyvinyl, sponges which are placed around the rectum and attached to the sacrum. A variant consists of using Marlex mesh instead of Teflon. In an experience with 24 patients, only one patient died postoperatively. In a follow-up period of ten years, no recurrences have been observed in any of the remaining patients.
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PMID:Sacrofixation with Marlex mesh in massive prolapse of the rectum. 38 98

There are two schools of thought concerning the aetiology of rectal prolapse. On the one hand it was conceived to be a sliding hernia through a defect in the pelvic fascia, while on the other hand radiological studies have demonstrated prolapse to be represented by an intussusception of the rectum. Various operative procedures have been proposed for the treatment of rectal prolapse based on the belief in one or the other of these concepts. The anatomic defects which have been described with prolapse include a defect in the pelvic floor with diastasis of the levatores ani, loss of the normal horizontal position of the rectum, an abnormally deep cul-de-sac of Douglas, a redundant rectosigmoid, and a patulous anal sphincter. The popularly used procedure in Great Britain is that in which a sheet of Ivalon sponge is sutured to the sacrum and wrapped around the rectum thus anchoring it in place. Various authors have reported good results using this technique. The mortality and morbidity rate appear to be acceptable. In the U.S.A. a popular procedure is the Ripstein technique where a sheet of Teflon is wrapped around the rectum anteriorly anchoring the rectum to the sacrum. This technique also has its proponents who rport satisfactory results. Abdominal proctopexy and sigmoid resection, although not in common general use, has been found to be effective with an acceptable morbidity and mortality rate. These three procedures have some drawbacks but the one problem common to all the repairs so far developed for prolapse is their inability to guarantee to restore continence. Probably half the patients operated upon continue to be incontinent. Faradic stimulation of the sphincter has not proved to be as helpful as initially hoped.
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PMID:Treatment of rectal prolapse. 118 58

To compare the methods of abdominal rectopexy and to elucidate the mechanism by which rectopexy restores continence in patients with rectal prolapse, the role of sphincter recovery, rectal morphological changes and improved rectal sensation were assessed in 68 patients (eight men, 60 women) of median age 63 (range 18-83) years undergoing resection rectopexy (n = 29), anterior and posterior Marlex rectopexy (n = 20), posterior Ivalon rectopexy (n = 9) or suture rectopexy (n = 10). Preoperative and postoperative manometry, radiology and electrosensitivity measurements were made. Age and duration of follow-up were similar in all groups and the prolapse was controlled in all patients. Significantly improved continence was seen in all but the Ivalon group. There was no evidence of increasing postoperative constipation. Sphincter length and voluntary contraction were unaltered, but improved resting tone was seen in the resection and suture groups. This was not seen in the prosthetic groups. Improved continence correlated with recovery of resting pressure. Upper and sensation was improved in all groups. Radiological changes did not correlate with improved continence. We conclude that continence is improved by all rectopexy procedures but seems better without prosthetic material. Sphincter recovery seems to be the most important factor.
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PMID:Abdominal rectopexy for rectal prolapse: a comparison of techniques. 155 53

A case with an unusual presentation of sepsis after Ivalon sponge rectopexy is reported. A strong index of suspicion is important for correct diagnosis. Early removal of infected sponge allows quick resolution of the sepsis without recurrent prolapse.
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PMID:Sepsis after Ivalon sponge rectopexy: an unusual case. 205 83

Bowel habit in 57 rectal prolapse patients was assessed before and after abdominal Ivalon rectopexy. There was a significant (chi-square = 8.7, P less than 0.01) increase in prevalence of constipation from 30 percent before to 51 percent after surgery. There were two explanations for this increased constipation. It was mainly the result of a 28 percent increase in prevalence of constipation among patients who were incontinent before rectopexy. Incontinent prolapse patients were more likely to acquire a predictable bowel habit after rectopexy if they became constipated. There was also a small (7 percent) increase in prevalence of constipation among continent patients, which could be attributed to the rectopexy procedure. In a subgroup of 15 patients, rectal wall thickness after rectopexy was assessed by pelvic computed tomographic scan carried out before and after surgery, or at more than one year after surgery. There was a significant (t = 4.5, P less than 0.001) increase in rectal wall thickness by 24 weeks after rectopexy, compared with before operation. This increase was also seen in a further five patients undergoing abdominal rectopexy without Ivalon sponge, suggesting that it was a consequence of rectal mobilization rather than the Ivalon sponge. This increased rectal wall thickness may impede the passage of formed stool into the lower rectum and contribute to the increased constipation found after rectopexy.
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PMID:Effect of abdominal Ivalon rectopexy on bowel habit and rectal wall. 236 21

In 46 patients with complete rectal prolapse a simple method of rectopexy was used, fixing the mobilized rectum to the sacrum with sutures. In 17 cases the rectopexy was supplemented with levator sutures. The patients' age range was 20-87 years and follow-up was 6 months to 17 years. There was no associated mortality and almost no morbidity. Prolapse recurred in two cases, in one of them due to incomplete fixation because of a congenital pelvic deformity. Rectopexy with sutures seemed to give results as good as the Teflon mesh and Ivalon sponge methods in regard to recurrence rate, while avoiding the complication risks associated with insertion of foreign material.
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PMID:Repair of rectal prolapse by rectosacral suture fixation. 328

Twenty-four consecutive patients (mean age: 74 years) with complete rectal prolapse, fifteen of whom were incontinent of solid stool, have been treated by postanal repair and intersphincteric Ivalon sponge rectopexy. There was no operative mortality, or serious morbidity. There was one recurrence of complete prolapse which occurred 14 days after operation. The other 23 patients have been followed for up to 4 years. All patients who were incontinent of solid stool pre-operatively have been rendered continent. This type of operation may be the treatment of choice in the elderly, where an abdominal procedure is considered unwise and in cases of rectal prolapse associated with faecal incontinence.
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PMID:Postanal repair and intersphincteric Ivalon sponge rectopexy for the treatment of rectal prolapse. 359 29

Thirty-four patients with complete rectal prolapse were treated by Lahaut's operation in which the mobilised rectosigmoid was implanted in the posterior rectus sheath. There were no prolapse recurrences, but one patient died postoperatively. Of the 12 patients with incontinence, 11 were improved by the procedure. Lahaut's operation is a simple and effective procedure which avoids the potential problems associated with a surgical implant of Ivalon or Teflon.
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PMID:Lahaut's operation for rectal prolapse. 669 93

Fifty-one cases of solitary rectal ulcer syndrome diagnosed over the past 10 years have been studied. The syndrome, of which solitary ulceration was a feature in only 35 per cent of cases, included patients with multiple 'solitary' ulcers (22 per cent), broad-based polypoid lesions (25 per cent) and patchy granular hyperaemic rectal mucosa (18 per cent). The syndrome was found to be strongly associated with abnormal rectal descent. Full-thickness prolapse to or beyond the anal verge was present in 59 per cent of patients while a further 32 per cent had lesser degrees of rectal descent. In only 9 per cent was no such abnormality demonstrated. Treatment with high roughage diet supplemented with bulking agents benefited two-thirds of 27 patients so treated. Ivalon sponge rectopexy has been performed in 6 patients with associated complete rectal prolapse, and in the first 3 of these (followed for a sufficient period) the results have been satisfactory.
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PMID:Solitary rectal ulcer syndrome in Northern Ireland. 1971-1980. 728 39

Between 1985 and 1991, 112 patients underwent posterior abdominal rectopexy (n = 59 Ivalon sponge, n = 53 Vicryl-rectopexy) for complete rectal prolapse. The follow-up period was 3 months to 9 1/2 years. 25 patients with severe constipation and rectal prolapse were treated by rectopexy combined with colectomy (left colectomy n = 18, sigmoidectomy n = 3, ileo-sigmoidostomy n = 4). Left colectomy combined with Ivalon or Vicryl-rectopexy does not seem to increase operative and postoperative morbidity but tends to diminish constipation in 84% of patients. There were no complications attributable to bowel resection or anastomosis. Following abdominal rectopexy without resection constipation was reduced 7.5% only, the bowel function was unchanged in 69% and obstipation was improved after the operation in 23%. In the group of patients without evident constipation (n = 74) treated with synchrone resection has no benefit with regard to the new occurred constipation, recurrence prolapse and continence ability. Infection around the prosthesis developed in 1.5% in the resection group, and in 2.1% in the rectopexy alone group. The prolapse recurrence rate was 2.6%. Conclusion. Resection in conjunction with abdominal rectopexy tends to diminish postoperative constipation does not seem to increase operative morbidity, and is indicated in patients with constipation only.
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PMID:[Surgical therapy of rectal prolapse using rectopexy and resection. Effect of resection treatment on postoperative constipation and sphincter muscle function--a follow-up study of 112 patients]. 788 87


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