Modified perineal stapled rectal resection with Contour Transtar for full-thickness rectal prolapse.

OBJECTIVE: We report a modified technique of perineal proctectomy using a new reloadable curved cutter stapler, the Contour Transtar (Ethicon Endo-Surgery), to treat full-thickness external rectal prolapse. METHOD: Between May and July 2008 three female patients were treated. All had a full-thickness external rectal prolapse up to 10 cm in length. The prolapse was initially divided by a linear cutter in anterior and posterior flaps, and resection of the prolapse was performed with a Contour Transtar stapler. RESULTS: There was no mortality or early or late morbidity. Follow-up was 2-4 months. All patients had a bowel movement within 3 days of the operation, oral feeding started immediately and the hospital stay was 5 days in all cases. All patients reported an improvement of constipation and continence. CONCLUSION: Our procedure may be indicated for full-thickness prolapse with a rectal protrusion up to 10 cm, as it allows a simple resection without any mobilization or dissection of the rectum. The technique is safe, easier and faster to perform than conventional perineal rectosigmoidectomy.

Early recovery after abdominal rectopexy with multimodal rehabilitation.

PURPOSE: Abdominal rectopexy without sigmoid resection is usually associated with a hospital stay of four to ten days. Recent developments have shown that a multimodal rehabilitation program with epidural analgesia and early oral feeding and mobilization will reduce hospital stay after colonic resection. The aim of this study was to describe the results after abdominal rectopexy with a multimodal rehabilitation program. METHODS: Thirty-one consecutive patients with rectal prolapse, median age 69 (range, 24-85) years and including 14 patients of American Society of Anesthesiologists physical status III to IV, were scheduled for abdominal rectopexy with a multimodal rehabilitation program including 48 hours thoracic epidural analgesia or patient-controlled anesthesia (3 patients), early oral nutrition and mobilization, and a planned two-day postoperative hospital stay. Follow-up was done at two months postoperatively. RESULTS: All patients except one tolerated normal diet and were mobilized to the same level as before surgery on the first postoperative day. Bowel movement was reestablished at a median of Day 2, and median postoperative hospital stay was three (mean, 4.4) days. At two months follow-up 16 percent were incontinent vs. 74 percent before surgery. Constipation was noted in 43 percent before surgery vs. 28 percent at two months follow-up. CONCLUSION: Median hospital stay after abdominal rectopexy may be reduced to three days with postoperative multimodal rehabilitation.

Laparoscopic repair of rectal prolapse: a prospective study evaluating surgical outcome and changes in symptoms and bowel function.

BACKGROUND: There have been few large series that have focused on the feasibility of the laparoscopic approach for rectal prolapse. This single-institution study prospectively examines the surgical outcome and changes in symptoms and bowel function following the laparoscopic repair of rectal prolapse. METHODS: In a selected group of 34 patients (total prolapse, 28; intussusception, six), 17 patients underwent laparoscopic-assisted resection rectopexy and 17 patients received a laparoscopic sutured rectopexy. Preoperative and postoperative evaluation at 3, 6, and 12 months included assessment of the severity of anal incontinence, constipation, changes in constipation-related symptoms, and colonic transit time. RESULTS: Median operation time was 255 min (range, 180-360) in the resection rectopexy group and 150 min (range, 90-295) in the rectopexy alone group. Median postoperative hospital stay was 5 days (range, 3-15) and median time off work was 14 days (range, 12-21) in both groups. There were no deaths. Postoperative morbidity was 24%. Incontinence improved significantly regardless of which method was used. The main determinant of constipation was excessive straining at defecation. Constipation was cured in 70% of the patients in the rectopexy group and 64% in the resection rectopexy group. Symptoms of difficult evacuation improved, but the changes were significant only after resection rectopexy. Two patients (7%) developed recurrent total prolapse during a median follow-up of 2 years (range 12-60 months). CONCLUSIONS: Laparoscopic-sutured rectopexy and laparoscopic-assisted resection rectopexy are feasible and carry an acceptable morbidity rate. They eliminate prolapse and cure incontinence in the great majority of patients. Constipation and symptoms of difficult evacuation are alleviated.

[The use of preformed physical factors during the preoperative preparation and rehabilitation of rectocele patients]. / Primenenie preformirovannykh fizicheskikh faktorov v protsesse predoperatsionnoi podgotovki i reabilitatsii bol'nykh rektostsele.

A technique of using preformed physical factors for the treatment of rectocele patients in pre- and postoperative period has been designed. The technique promoted early activation of 36 postoperative females. They recovered functions of the fundus of the pelvis and normal defecation.