Echinococcosis in a non-endemic country - 20-years' surgical experience from a Norwegian tertiary referral Centre.

BACKGROUND: In Scandinavia, the incidence of cystic echinococcosis (CE) and alveolar echinococcosis (AE) is low and almost exclusively an imported disease following the trends of immigration. The aim of the study was to review available data on clinical management and outcome for patients treated at Oslo University Hospital, a referral centre for echinococcosis in Norway, with special emphasis on surgical treatment. METHODS: All patients admitted with echinococcosis between January 2000 and December 2020 were identified. Medical records were reviewed retrospectively concerning patient demographics, treatment strategy, surgical procedures, complications and outcomes. RESULTS: A total of 92 patients with median age 37 years (range 4-85) were identified. Sixty-eight patients (74%) were symptomatic. All patients, except for two, were immigrants to Norway and born in endemic areas. Ninety patients were diagnosed with CE and two with AE. Location of the cysts was most commonly in the liver (86%) followed by peritoneum, lungs, and spleen. All patients with active cysts were treated with albendazole. Surgical treatment was performed in 51 (56%) patients. The most common reason for abstaining from surgical treatment was that the diagnostic work-up revealed inactive cysts or interventional radiology was performed. Of the 51 patients who underwent surgery, a radical procedure was performed in 32 (64%) cases, a conservative procedure in 12 (24%), and a combination in six (12%). Clavien Dindo grade ≥3 complications occurred in 30%, and 90-day mortality was 2%. Bile leakage occurred in seven patients and was treated successfully with endoscopic retrograde cholangiopancreatography with biliary stent placement in all patients. CONCLUSION: In a low-endemic area like Norway, management of echinococcus includes medical therapy, surgery, and/or interventional radiology. Surgical intervention seems to be effective, and is associated with acceptable morbidity rates.

Is there need for routine CT colonography after CT-verified uncomplicated diverticulitis of the sigmoid colon?

BACKGROUND: Following an episode of acute diverticulitis, surgical guidelines commonly advise routine colonic follow-up to rule out underlying malignancy. However, as a CT of the abdomen is frequently performed during clinical work-up, the routine need for colonic follow-up has become debated. PURPOSE: To evaluate the need for routine CT colonography after an episode of CT-verified uncomplicated sigmoid diverticulitis to rule out underlying colorectal malignancy. MATERIAL AND METHODS: This study retrospectively evaluated 312 patients routinely referred to colonic evaluation by CT colonography following an episode of acute diverticulitis. Patients were excluded if lacking diagnostic CT of the abdomen at time of diagnosis, if presenting with atypical colonic involvement, or if CT findings were suggestive of complicated disease (e.g., abscess or perforation). CT colonography exams were routinely reviewed by experienced abdominal radiology consultants on the day of the procedure. If significant polyps were detected, or if colorectal malignancy could not be excluded, patients were referred to same-day optical colonoscopy. For these patients, medical records were reviewed for optical colonoscopy results and histology reports if applicable. RESULTS: Among 223 patients with CT-verified uncomplicated sigmoid diverticulitis, no patients were found to have underlying colorectal malignancy. 27 patients were referred to optical colonoscopy based on CT colonography findings. 18 patients consequently underwent polypectomy, all with either hyperplastic or adenomatous histology. CONCLUSIONS: This study indicates that routine colonic evaluation by CT colonography following an episode of CT-verified uncomplicated sigmoid diverticulitis may be unwarranted, and should arguably be reserved for patients with protracted or atypical clinical course.

Very long-term outcome after resection rectopexy for internal rectal intussusception.

BACKGROUND: Both at short- and long-term follow-up we have reported major improvement of the symptom of constipation in patients treated with resection rectopexy for internal rectal intussusception (IRI). The aim was to study whether this improvement also persisted in a cohort of these patients after very long-term follow-up. METHODS: Observational and mainly prospective study of a cohort of 13 out of 48 patients with IRI who initially had ligament-preserving resection rectopexy with suture by laparoscopic (n = 11) or open (n = 2) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report and HRQL. RESULTS: Thirteen out of the 48 initial patients (27%) reported data at very long-term follow-up. Months from preoperatively to short-, long- and very long-term follow-up were median 6, 76 and 159, respectively. Corresponding mean (95% CI) constipation scores were 11.5 (8.3-14.7), 4.2 (1.7-6.6) (p < .001), 5.3 (3.6-7.0) (p < .05) and 13.6 (8.2-19.0). Number of constipated patients were (score ≥ 10) were 8, 1, 0, 1 and 9, respectively. Scores for anal incontinence were 6.1 (2.4-11.4), 5.8 (2.0-9.5), 4.9 (0.9-9.0) and 7.9 (4.3-11.5), respectively. HRQL life was reduced for bodily pain, social functioning, mental health and general health perception. Percentage patients reporting symptomatic improvement were 100, 70 and 53, respectively. CONCLUSIONS: Patients with IRI have a symptomatic relief for more than 6 years after resection rectopexy. The operation did not inflict permanent patient sequela. Motivated patients must be informed about very long-term deterioration of symptomatic relief.

Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center.

BACKGROUND: Radiofrequency ablation (RFA) is widely used for treatment of colorectal liver metastases (CRLM). PURPOSE: To evaluate the effect of increased experience in RFA of CRLM on morbidity and survival, and the trends in patient management and outcomes during the last decade. MATERIAL AND METHODS: Hospital records of the initial 52 consecutive patients who underwent RFA (56 procedures/70 lesions) were retrospectively reviewed. The patients were divided into two groups according to time period of treatment, period I (2001-2006: n = 26) and period II (2007-2011: n = 26). RESULTS: Concomitant liver resection was performed in 15 patients in each period. Operative morbidity decreased from 47% to 19% (P = 0.047). Most complications were found in patients who underwent a concomitant liver resection and not related to the ablation per se. Local recurrence rate decreased from 19.4% to 12.9% (P = 0.526). At least one risk factor for recurrence was found in patients with local recurrence (n = 11): subcapsular localization (n = 4), tumor size >3 cm and subcapsular localization (n = 2), and perivascular localization (portal veins/hepatic veins) (n = 5). Median overall survival was 32 months in period I and 49 months in period II, whereas estimated 5-year survival was 19% and 36%, respectively (P = 0.09). Adjuvant chemotherapy was given to four patients (15.4%) in period I and 13 patients (50%) in period II (P = 0.017). CONCLUSION: RFA alone or in combination with liver resection is a potentially curative treatment to selected patients with CRLM. Over time, the morbidity and survival have improved in RFA of CRLM. Although a possible effect of a learning curve should be taken into consideration in the appraisal of this improvement, it is more likely to be attributable to optimization of indication, development in surgical techniques, and increased use of perioperative chemotherapy.

Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993-2010.

BACKGROUND: The Norwegian Rectal Cancer Project was initated in 1993 with the aims of improving surgery, decreasing local recurrence rates, improving survival, and establishing a national rectal cancer registry. Here we present results from the Norwegian Colorectal Cancer Registry (NCCR) from 1993 to 2010. MATERIAL AND METHODS: A total of 15 193 patients were diagnosed with rectal cancer in Norway 1993-2010, and were registered with clinical data regarding diagnosis, treatment, locoregional recurrences and distant metastases. Of these, 10 796 with non-metastatic disease underwent tumour resection. The results were stratified into five time periods, and the treatment outcomes were compared. Recurrence rates are presented for the 9785 patients who underwent curative major resection (R0/R1). RESULTS: Among all 15 193 patients, relative five-year survival increased from 54.1% in 1993-1997 to 63.4% in 2007-2010 (p < 0.001). Among the 10 796 patients with stage I-III disease who underwent tumour resection, from 1993-1997 to 2007-2010, relative five-year survival improved from 71.2% to 80.6% (p < 0.001). An increasing proportion of these patients underwent surgery at large-volume hospitals; and 30- and 100-day mortality rates, respectively, decreased from 3.0% to 1.4% (p < 0.001) and from 5.1% to 3.0% (p < 0.011). Use of preoperative chemoradiotherapy increased from 6.5% in 1993 to 39.0% in 2010 (p < 0.001). Estimated local recurrence rate after major resection (R0/R1) decreased from 14.5% in 1993-1997 to 5.0% in 2007-2009 (p < 0.001), and distant recurrence rate decreased from 26.0% to 20.2% (p < 0.001). CONCLUSION: Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.

Standardized cine-loop documentation in renal ultrasound facilitates skill-mix between radiographer and radiologist.

BACKGROUND: The radiographers' role in ultrasound (US) has been debated due to the operator-dependent aspect of diagnostic US. With standardized cine-loop ultrasound (SCUS) a reliable diagnosis can be achieved by reading SCUS independently from performing the procedure. PURPOSE: To study the correlation between sonographic findings when SCUS is performed and read by a radiologist and when SCUS is performed by a radiographer and read by a radiologist, and to assess the radiologists' confidence when reading SCUS examinations performed by a radiographer. MATERIAL AND METHODS: Thirty-four patients (64 kidneys) who underwent SCUS of the kidneys were included in this study. All patients underwent two consecutive SCUS examinations, one performed by an experienced radiologist reading his own examination (online), and one performed by a SCUS-trained radiographer, read by an experienced radiologist who was not involved in the examination of the patient (offline). Study reports were made using a structured report form designed for this study. Confidence was measured on a visual analog scale ranging from 0 (no confidence) to 100 (extremely confident). The final diagnosis (the reference standard) was defined as the consensus between two US-experienced radiologists. All personnel were blinded to each other's results. RESULTS: We found discordance between image findings for online and offline in eight out of 64 kidneys. There was no systematic difference between online and offline reading. There was a good correlation between online and offline, kappa 0.75 (95% CI 0.60-0.90, P < 0.001). Kappa correlation for online and offline compared to reference standard was 0.94 (95% CI 0.86-1.00, P < 0.001) and 0.81 (95% CI 0.66-0.96, P < 0.001), respectively. Radiologists reported a confidence level of 88 (range, 74-94) and 85 (range, 67-92) in the online and offline group, respectively (P = 0.005). CONCLUSION: There is a high degree of correlation between reported findings in radiologist and radiographer performed SCUS examinations.

Standardized cine-loop documentation in abdominal ultrasound facilitates offline image interpretation.

BACKGROUND: One of the main disadvantages of conventional ultrasound is its operator dependency, which might impede the reproducibility of the sonographic findings. A new approach with cine-loops and standardized scan protocols can overcome this drawback. PURPOSE: To compare abdominal ultrasound findings of immediate bedside reading by performing radiologist with offline reading by a non-performing radiologist, using standardized cine-loop sequences. MATERIAL AND METHODS: Over a 6-month period, three radiologists performed 140 dynamic ultrasound organ-based examinations in 43 consecutive outpatients. Examination protocols were standardized and included predefined probe position and sequences of short cine-loops of the liver, gallbladder, pancreas, kidneys, and urine bladder, covering the organs completely in two planes. After bedside examinations, the studies were reviewed and read out immediately by the performing radiologist. Image quality was registered from 1 (no diagnostic value) to 5 (excellent cine-loop quality). Offline reading was performed blinded by a radiologist who had not performed the examination. Bedside and offline reading were compared with each other and with consensus results. RESULTS: In 140 examinations, consensus reading revealed 21 cases with renal disorders, 17 cases with liver and bile pathology, and four cases with bladder pathology. Overall inter-observer agreement was 0.73 (95% CI 0.61-0.91), with lowest agreement for findings of the urine bladder (0.36) and highest agreement in liver examinations (0.90). Disagreements between the two readings were seen in nine kidneys, three bladder examinations, one pancreas and bile system examinations each, and in one liver, giving a total number of mismatches of 11%. Nearly all cases of mismatch were of minor clinical significance. The median image quality was 3 (range, 2-5) with most examinations deemed a quality of 3. Compared to consensus reading, overall accuracy was 96% for bedside reading and 94% for offline reading. CONCLUSION: Standardized cine-loop documentation enables accurate offline reading in abdominal ultrasound and shows high agreement with immediate bedside reading.

Impact of contrast-enhanced intraoperative ultrasound on operation strategy in case of colorectal liver metastasis.

BACKGROUND: Surgical treatment is the only option for long-term survival in patients with colorectal liver metastasis (CRLM). Contrast-enhanced CT and MRI are usually used for preoperative liver imaging. The initial surgical strategy for liver resection is based upon these findings. Further optimization of the surgical strategy by contrast-enhanced intraoperative ultrasound (CE-IOUS) might further improve the surgical outcome. PURPOSE: To evaluate the current impact of CE-IOUS with SonoVue(®) on the initial surgical strategy for CRLM. MATERIAL AND METHODS: Eighty-six consecutive patients undergoing open liver resection for CRLM were evaluated retrospectively over a 2.5-year period. The patients underwent 97 operations. Preoperative staging was performed with contrast-enhanced CT in all patients and MRI was available in 66 of 86 patients. CE-IOUS was performed in all patients according to a standardized examination technique. Curved array and linear transducers were used. CRLM were identified in venous phase as hypovascular lesions. CE-IOUS findings were compared with preoperative staging. RESULTS: Combined CT/MRI identified preoperatively 328 CRLM (mean 3.4, range 0-14). Seventy-two additional lesions (18%) were identified in 38 patients during the operation. Intraoperatively 41 additional CRLM in 20 patients were identified by inspection, palpation, and CE-IOUS (10%), and another 31 CRLM in 17 patients were identified by CE-IOUS alone (8%). All additional CRLM detected by CE-IOUS were confirmed by histology if resection was performed. CE-IOUS changed planned operation strategy in 29.9% of operations. A larger resection was necessary in 13.4% of the cases, reduced liver resection was found sufficient in 11.3%, and 5.2% were found inoperable. For patients diagnosed preoperatively with solitary lesions CE-IOUS changed operation strategy in 19% and radical tumor resection would have failed in 4.8% without CE-IOUS. CONCLUSION: CE-IOUS is essential to ensure optimal and complete tumor resection both in patient with solitary CRLM and multiple metastases.

Long-term outcome after resection rectopexy for internal rectal intussusception.

Background and Aims. The optimal treatment of patients with internal rectal intussusception (IRI) is unresolved. The aim was to study the short- and long-term outcome of resection rectopexy in these patients. Methods. An observational and mainly prospective study of 48 patients (44 women) with IRI who had ligament-preserving suture rectopexy by laparoscopic (n = 25) or open (n = 23) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report, and health-related quality of life (HRQoL). Results. From preoperatively to a median of 6 months and 76 months postoperatively, constipation scores were reduced from a mean of (95% CI) 13.20 (11.41 to 15.00) to 6.91 (5.29 to 8.54) and 6.35 (4.94 to 7.76) (P < 0.0001). The number of constipated patients was reduced from 35 to eleven and eight, respectively, and none became constipated. Nine of ten symptoms of constipation improved. Corresponding scores for anal incontinence were 4.7 (2.4-7.0), 4.0 (2.4-5.7), and 4.1 (2.3-5.8), respectively. HRQoL at long-term followup compared to the general Norwegian population was reduced in four out of eight dimensions concerning physical factors. The patient-reported outcome at short- and long-term followup was improved by 85.4% and 75.0%, respectively. Conclusions. Resection rectopexy for IRI improved the outcome. HRQoL was reduced compared with the general population.

[Diagnosis and staging of colorectal cancer]. / Diagnostikk og stadieinndeling av kolorektal kreft.

BACKGROUND: Colorectal cancer is a frequent disease in Norway. New and improved surgical techniques and the implementation of adjuvant and neoadjuvant therapy have improved 5-year survival rates significantly. Accurate preoperative assessment of tumour extent is essential for choosing the appropriate therapeutic strategy, and thus for patient prognosis. Both established and recent imaging methods are presented and discussed. MATERIAL AND METHODS: This review is based on a selection of articles from Pub-Med, with an emphasis on meta-analyses and prospective investigations, and on the clinical experiences of the authors. RESULTS AND INTERPRETATION: Recto-/colonoscopy with biopsy is still the most common approach for diagnosis. In Norway, magnetic resonance imaging (MRI) is the preferred imaging modality for rectal cancer. With optimal technique MRI provides a good visualisation of important local prognostic factors. Endoscopic ultrasound is the modality of choice for small, superficial tumours. The role of multidetector computer tomography (MDCT) in the local evaluation of rectal cancer is not entirely established. The evaluation of metastases of regional lymph nodes is a challenge with all the available imaging modalities. CT-colonography is a recent method for imaging of the colon. It provides an accurate evaluation of the bowel, of tumour invasion outside the bowel wall and of extracolonic (glandula- and liver-) metastases. Double-contrast barium enema, or abdominal and pelvic CT are alternative methods for evaluation of colon cancer. CT of the thorax and abdomen is recommended for screening of distant metastasis.

Survival and complications after insertion of self-expandable metal stents for malignant oesophageal stenosis.

OBJECTIVE: To report on survival and complications after insertion of self-expandable stents in patients with malignant oesophageal stenosis. MATERIAL AND METHODS: Data were gathered retrospectively from the medical records of 92 consecutive patients in the period 1994-2003. The study comprised 68 men and 24 women (median age 72 years, range 46-93 years) with stenosis from cancer of the oesophagus (n=61), the gastric cardia (n=26) and the lung (n=5), located mainly above (n=4) or below (n=62) the carina, or at the gastro-oesophageal junction (n=26). One uncovered stent and six different covered stents were used. RESULTS: Median and mean survival times after stenting (n=92) were 83 (range 4-1102) and 125 days, respectively. Thirty-day mortality was 19% (n=17), and 7% (n=6) survived more than one year. Survival was neither significantly influenced by division of the patients into diagnostic subgroups nor by comparison of the three most frequently used stents. One, two, three and four stents were received by 76, 11, 4 and 1 patient(s), respectively. There was no stent-related mortality, and complications were bleeding 1 (1%), stent migration 7 (8%), recurrent stenosis 8 (9%) from both tumour overgrowth (n=8) and tumour ingrowth (n=2) when using uncovered stents. Thirteen (14%) patients were re-stented because of recurrent stenosis (n=8) including fistula formation to the left main bronchus (n=2) and stent migration (n=5). CONCLUSIONS: Use of self-expandable stents in patients with inoperable malignant oesophageal stenosis carried few complications and resulted in relatively long survival in comparison with similar studies.

[Pelvimetry with compute tomography]. / Bekkenmåling med computertomografi.

BACKGROUND: In 1993, Ullevaal University Hospital started CT pelvimetry. The accuracy of CT pelvimetric measurements and a low fetal dose are very important. In our study we tested the accuracy of CT pelvimetry and measured the fetal dose and the effective dose to the mother. METHOD: A lead scalar was exposed in different heights compared to the isocentre. Measurements were done at front and side scout views and compared to the real scale. Dose estimates were done in CT dosimetry (NRPB). Effective doses to patient as well as fetal doses were measured in this study. Fetal dose was estimated as uterus dose. RESULTS: Our results show that the measurements are overestimates when the table is moved away from the isocentre against the tube. If the table is moved away from the tube and against the detector, the measurements are underestimates. The measurements in the isocentre are accurate. This means that CT pelvimetric measurements are accurate if the patient is placed in the isocentre. In our study the estimated fetal dose was 0.74 mGy and mother's effective dose was 0.3 mSv. INTERPRETATION: Our results show that the fetal dose is as low or lower than with conventional pelvimetry. The CT pelvimetric measurements are accurate if they are performed on patients in the isocentre. We recommend that CT pelvimetry replace conventional pelvimetry.

[Surgery and stenting for oesophageal cancer]. / Kirurgi og stenting for cancer oesophagi.

BACKGROUND: The purpose of this study was to evaluate the results of surgery and stenting for operable and inoperable oesophageal cancer. MATERIAL AND METHODS: Retrospective patient materials with resection (n = 65, 1983-2002) or stenting (n = 59, 1994-2003) for primary oesophageal cancer. RESULTS: Mortality after surgery was 11% and 15% of the patients were re-operated. 36 (55%) had complications such as respiratory failure (n = 33), anastomotic dehiscence/perforation (n = 4), chylothorax (n = 1), haemorrhage (n = 3), wound rupture (n = 1), septicaemia (n = 2), arrhythmia (n = 4) and wound infection (n = 5). Median survival after surgery was 11 months. Survival after three years was 17%, after five years 8%. The stent procedure was without mortality but haemorrhage (n = 1) and stent dislocation (n = 2) occurred. 8 patients (14%) were re-stented for tumour stenosis (n = 6), fistula (n = 2) and dislocation (n = 1). Median survival after stenting was 78 days. Survival after 30 days was 80%, after one year 7%. INTERPRETATION: Resectable oesophageal cancer should be operated in fit patients, as survival is improved and some patients can be cured. Stenting is the main option in inoperable patients.

Low-renin status in therapy-resistant hypertension: a clue to efficient treatment.

OBJECTIVE: Therapy resistance is an enduring problem in clinical hypertension. Our aims were to estimate: (1) the contribution of a low-renin status in therapy resistance; (2) whether such status could give a clue to more successful treatment; and (3) the contribution by adrenal cortical adenomas and by primary aldosteronism. SETTING: Patients were referred from general and internal medicine practices following written invitations and included consecutively. Participants were examined and followed-up on an outpatient basis. DESIGN AND INTERVENTIONS: Patients were divided according to renin status. Low-renin patients were treated with an aldosterone inhibitor in a prospective, randomized, placebo-controlled, double-blind, cross-over study. MAIN OUTCOME MEASURES: Prevalence of low-renin status in therapy resistance. Blood pressure and hormonal responses to specific treatment. Numbers of adrenocortical adenomas and primary aldosteronism. RESULTS: In 90 treatment-resistant hypertensive, 67% had plasma renin activity (PRA) below 0.5 nmol/l per hour. Of the 60 low-renin patients, 38 were studied on a fixed combination of amiloride and hydrochlorothiazide. Three weeks' treatment reduced blood pressure by 31/15 mmHg compared to placebo (P < or = 0.0001). Serum aldosterone and plasma renin activity increased substantially during active treatment. Through the subsequent 6-12 months of open treatment, seven patients (18%) showing an escape phenomenon had their high blood pressure effectively treated by extra amiloride. Of the 60 low-renin patients, eight had adrenal adenoma. CONCLUSION: A low-renin status characterized two-thirds of patients with treatment-resistant hypertension, who could be treated efficiently by aldosterone inhibition. Patients with an escape phenomenon (18%) could effectively be treated by increasing the aldosterone inhibitor. Low-renin hypertensives had high prevalence of adrenocortical adenomas and primary aldosteronism.

Deep vein thrombosis after elective cesarean section.

INTRODUCTION: Pregnancy is associated with an overall 5-10 fold increased risk of venous thromboembolism (VTE). The absolute risk is highest during and shortly after delivery. Although operative delivery further increases the risk of VTE, there is no consensus on thromboprophylaxis after an elective cesarean. The aim of the present study was to investigate the frequency of symptomatic and asymptomatic deep venous thrombosis (DVT) in a low risk cesarean section population. MATERIALS AND METHODS: Fifty-nine women undergoing elective cesarean section were screened for DVT using triplex Doppler sonography 3-5 days after delivery. Markers of activated coagulation were also followed and all women were screened for thrombophilia. Postoperative thromboprophylaxis was not given. During the same period all cases of symptomatic VTE were also recorded. RESULTS: No DVT was detected by ultrasonography and no women developed symptomatic VTE during the six weeks follow-up period after delivery. Six women had thrombophilia. During the study period, a cesarean section was performed in 1067/5364 (20%) deliveries. Five of these women (0.47%) developed symptomatic pulmonary embolism, and all of these women had additional risk factors for VTE. CONCLUSION: The risk of DVT among healthy pregnant women undergoing elective cesarean section is low, and general medical thromboprophylaxis is probably not justified.

[Internal rectal invagination treated with rectopexy and sigmoid resection]. / Intern invaginasjon i rectum behandlet med rektopeksi og sigmoideumreseksjon.

BACKGROUND: Internal rectal intussusception, usually occurring in women, causes constipation and incomplete evacuation of stool. MATERIALS AND METHODS: Twenty-one women and one man (median age 48) were operated with suture rectopexy and sigmoid resection. The patients were examined with anoscopy and defecography, and symptomatic outcome, patients' satisfaction and morbidity were evaluated. Outcome was based mainly on the validated KESS score for constipation. RESULTS: There was a significant reduction in all ten symptoms. Faecal incontinence improved in the two afflicted patients after operation. The number of patients with constipation was reduced from 20 to 8 (p < 0.01); none became constipated. Mean (95 % CI) colonic transit times in ten constipated patients was reduced from 5.3 (4.1-6.4) to 4.0 (2.6-5.4) days (p = 0.08); seven of these patients had a reduction of transit time as well as constipation score. INTERPRETATION: Rectopexy with sigmoid resection improved symptoms, including constipation and feeling of incomplete rectal emptying.

Resection rectopexy for internal rectal intussusception reduces constipation and incomplete evacuation of stool.

OBJECTIVE: To study the effect of rectopexy and sigmoid resection (resection rectopexy) on symptoms in patients with internal rectal intussusception. DESIGN: Retrospective and prospective study. SETTING: University hospital, Norway. PATIENTS: 22 patients with internal rectal intussusception. INTERVENTIONS: Resection rectopexy by an open (n = 13) or laparoscopically-assisted (n = 9) technique. MAIN OUTCOME MEASURES: Symptomatic outcome, patients' satisfaction, and morbidity. Outcome was based mainly on the validated KESS score, which covers 10 symptoms included in the definiton of constipation. RESULTS: There was a significant reduction in all 10 symptoms. Two patients complained of incontinence which improved after operation. The number of patients with constipation was reduced from 20 to 8 (p = 0.000) and none became constipated. Mean (95% CI) colonic transit times before and after operation in 10 patients with constipation were 5.3 (4.1 to 6.4) and 4.0 (2.6 to 5.4) days (p = 0.083). Seven of these 10 patients had a reduction of both transit time and constipation score. Six patients had complications after open operations. These included one damaged ureter, reoperations for bleeding, incomplete intestinal obstruction, and 2 wound infections. CONCLUSION: Rectopexy with sigmoid resection resulted in improvement in symptoms, including constipation and feeling of incomplete rectal evacuation, and acceptable morbidity.