Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach.

PURPOSE: A variety of surgical procedures have been developed to treat rectal prolapse, but there is still no consensus on the operation of choice. The aim of this study was to evaluate the functional results of operative treatment of rectal prolapse during an 11-year period in our department. METHODS: All patients treated for complete rectal prolapse during an 11-year period, from 1985 to 1995, in a single university hospital were included. Of the 123 patients, 22 were men, and the mean age was 59 (range, 15-88) years. The medical records of all patients were reviewed retrospectively, and a questionnaire on bowel symptoms before and after surgery was sent to all 95 living patients. RESULTS: The majority of the procedures (91 percent) were performed by abdominal approach, and the most frequently used open technique was posterior rectopexy with mesh (78 percent). Of the incontinent patients, 35 (63 percent), all those less than 40 years of age and 64 percent of those 40 years or older, were continent postoperatively (P = 0.0001) after a median follow-up of five (range, 1-72) months. According to the questionnaire, after a median follow-up of 85 (range, 16-144) months, only 38 percent of the incontinent patients in the mesh or suture group, 78 percent of patients less than 40 years of age (n = 18), and 52 percent of those 40 years or older (n = 47) claimed to be continent postoperatively. The proportion of patients with constipation was greater after the operation than preoperatively (P = 0.02) and more patients used medication for constipation after than before the operation (P = 0.0001). The overall complication rate was 15 percent, and the mortality rate was 1 percent (1/123). In the mesh or suture group there were 6 (6 percent) recurrent complete prolapses and 11 (12 percent) mucous prolapses. CONCLUSION: Posterior rectopexy with mesh gave good results in our hands. Older age and longer follow-up seem to have a negative effect on the functional outcome of the operation and on the recurrence rate.

Y-V anoplasty combined with internal sphincterotomy for stenosis of the anal canal.

OBJECTIVE: To review the results of Y-V anoplasty combined with internal sphincterotomy in the treatment of anal stenosis. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 10 patients with stenosis of the anal canal. MAIN OUTCOME MEASURES: Improvement of symptoms and function. RESULTS: Nine patients improved postoperatively. Six of the patients had good results, three had fair results and one had a poor result. There were no postoperative complications. CONCLUSION: Y-V anoplasty combined with internal sphincterotomy is a safe and simple procedure that gives good results. We recommend its use to treat stenosis of the anal canal.

The effect of proctocolectomy on serum antibody levels against cow's milk proteins in patients with chronic ulcerative colitis, with special reference to liver changes.

BACKGROUND: The levels of antibodies against cow's milk proteins in ulcerative colitis (UC) were used to study whether mucosal inflammation leads to immune recognition, as a marker of enhanced permeability, of dietary proteins. A further purpose was to study the effect of proctocolectomy on the serum antibody levels against cow's milk proteins and their relation to biochemical and histologic liver abnormalities associated with ulcerative colitis. METHODS: Serum antibody levels against six cow's milk proteins, alpha-casein, alpha-lactalbumin (LA), beta-lactoglobulin A (LGA), beta-lactoglobulin B (LGB), bovine serum albumin (BSA), and whole milk powder (MP) were determined before and after (mean, 24 months) proctocolectomy in 15 patients with ulcerative colitis. Simultaneously, serum liver enzymes were analyzed. A liver biopsy specimen was also obtained at proctocolectomy. RESULTS: Before proctocolectomy IgA antibody levels were significantly increased against all antigens except BSA. Increased levels of IgM antibodies against LGA, LGB, and BSA were also detected. IgG antibodies were significantly increased only against LGA. After proctocolectomy IgA and IgM antibody levels decreased significantly (p < 0.05) against LGA, LGB, and LA, whereas IgG antibodies increased significantly (p < 0.01). In the patient group with abnormal liver histology (n = 9) the IgA antibodies to all cow's milk proteins were significantly higher (p < 0.02) than in the group with normal liver histology both before and after proctocolectomy. The IgA antibody levels showed a significant positive correlation with alanine amino-transferase and gamma-glutamyltransferase (r value from 0.460 to 0.721, p value from < 0.05 to < 0.01), but not with alkaline phosphatase. CONCLUSIONS: These results suggest that the inflamed mucosa in UC allows the antigenic contents of the bowel to escape. Proctocolectomy alters the antibody levels against certain milk proteins, which may serve as a model to suggest that proctocolectomy, probably by eliminating inflammation, may have positive effects by reducing the foreign pathogenic antigen and immune complex load.

Evaluation of immediate and late results of transurethral resection of the prostate.

A total of 401 men who underwent transurethral resection of the prostate (TURP) between 1983 and 1986, were prospectively evaluated in 1987, 167 of them were sent a questionnaire about their ability to pass urine 1990. Our results showed that TURP was safe with no immediate mortality. The hospital stay was, however, long (median 7.0 days). It should be possible to shorten the hospital stay of those in the age group 60 and 70 years. After a mean of 6.5 years, 92% of patients were satisfied with their ability to pass urine.