ABSTRACT
AIM: To compare results of rectosacropexy and posterior-loop rectopexy in rectal prolapse management. MATERIAL AND METHODS: Study included 122 patients operated for rectal prolapse for the period January 2007 to August 2014. Patients' age ranged from 19 to 85 years (mean 47.3±16.1). Main group consisted of 60 (49.2%) patients who underwent rectosacropexy (D'Hoore's procedure). Control group included 62 (50.8%) patients in whom posterior-loop rectopexy was applied (Wells's procedure). RESULTS: Long-term results were followed-up in 94 (77.0%) patients including 48 and 46 from main and control group respectively. Recurrent prolaple incidence after rectosacropexy and posterior-loop rectopexy was 2% and 8.7% respectively. Multivariant analysis statistically confirmed that postoperative impaired colon motility was independent risk factor of recurrence. Recurrent disease is observed 5.7 times more often in this case. Rectosacropexy does not significantly impair colon motility because of ileus occurs in 8.3% of operated patients. Impovement of anal continence does not depend on rectopexy method and occurs in all patients with degree 1-2 of anal sphincter failure. CONCLUSION: Rectosacropexy may be preferred in rectal prolapse. However, further highly significant studies are necessary to optimize rectal prolapse management.
Subject(s)
Digestive System Surgical Procedures , Fecal Incontinence , Ileus , Postoperative Complications , Rectal Prolapse/surgery , Adult , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/methods , Fecal Incontinence/diagnosis , Fecal Incontinence/epidemiology , Fecal Incontinence/etiology , Female , Humans , Ileus/diagnosis , Ileus/epidemiology , Ileus/etiology , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Rectal Prolapse/diagnosis , Recurrence , Retrospective Studies , Suture Techniques , Treatment OutcomeABSTRACT
The purpose of the investigation was to study the extension of a physiologic hypoganglionic area in the distal rectum in adults and to define its implication in diagnosing Hirschprung's disease. Thirty-five cadaver distal rectal portions were examined. The extension of a physiologic hypoganglionic area in adults ranged from 7.5 to 50.0 mm (24.4+/-10.9 mm). The authors could determine any element of the intramural nervous system to a level of 40 mm where there was a compact ganglionic deposit with nerve commissures, which is typical of the normal structure of an intermuscular nerve plexus. The extension of a physiologic hypoganglionic area was as large as 40.0 mm in 4 of the 35 cases and 50.0 mm in 1 case. By taking into account these data, it is expedient to use the modified O. Swenson transanal biopsy.
Subject(s)
Enteric Nervous System/pathology , Hirschsprung Disease/pathology , Rectum/innervation , Adult , Aged , Anal Canal/innervation , Anal Canal/pathology , Female , Humans , Male , Middle Aged , Rectum/pathologyABSTRACT
Thirty-five autopsied specimens of rectum's distal part and anal canal part were studied. It was revealed that length of physiological hypogangliosis zone ranged from 7.5 to 50.0 mm (mean 24.4+/-10.9 mm). With regard to this wide range the modification of transanal Svenson's biopsy of rectal wall was proposed for diagnosis of malformations of intramural nervous system of the colon. The method was used in 21 patients with megacolon. The results demonstrate accuracy and safety of this diagnostic method.
Subject(s)
Autonomic Nervous System Diseases/pathology , Rectum/innervation , Submucous Plexus/abnormalities , Adult , Aged , Biopsy/methods , Diagnosis, Differential , Female , Humans , In Vitro Techniques , Male , Megacolon/pathology , Middle Aged , Reproducibility of ResultsABSTRACT
The author's experience shows that in a number of patients with deformities of the hand following burns alloplasty can provide a considerable improvement, and even sometimes a complete recovery of functions including damages of nerve trunks, with disturbed innervation of muscles and sensitivity of the hand. He believes that the alloplasty should be performed under the restored normal skin and be often combined with other restorative-reconstructive surgery.
Subject(s)
Burns/complications , Hand Deformities, Acquired/surgery , Tendon Injuries/surgery , Tendons/transplantation , Adolescent , Adult , Burns/surgery , Follow-Up Studies , Hand Deformities, Acquired/etiology , Humans , Male , Methods , Middle Aged , Time Factors , Transplantation, HomologousABSTRACT
The author's experience with a large number of burnt patients enabled them to conclude that treatment of extensive deep burns is of most extreme difficulty. Many specialists should participate in treatment and rehabilitation of burnt patients. It is necessary to organize special centers of rehabilitation and dispensary control over such patients, and a further program in this respect is greatly warranted.
