Functionality-packed additively manufactured porous titanium implants.

The holy grail of orthopedic implant design is to ward off both aseptic and septic loosening for long enough that the implant outlives the patient. Questing this holy grail is feasible only if orthopedic biomaterials possess a long list of functionalities that enable them to discharge the onerous task of permanently replacing the native bone tissue. Here, we present a rationally designed and additive manufacturing (AM) topologically ordered porous metallic biomaterial that is made from Ti-6Al-4V using selective laser melting and packs most (if not all) of the required functionalities into a single implant. In addition to presenting a fully interconnected porous structure and form-freedom that enables realization of patient-specific implants, the biomaterials developed here were biofunctionalized using plasma electrolytic oxidation to locally release both osteogenic (i.e. strontium) and antibacterial (i.e. silver ions) agents. The same single-step biofunctionalization process also incorporated hydroxyapatite into the surface of the implants. Our measurements verified the continued release of both types of active agents up to 28 days. Assessment of the antibacterial activity in vitro and in an ex vivo murine model demonstrated extraordinarily high levels of bactericidal effects against a highly virulent and multidrug-resistant Staphylococcus aureus strain (i.e. USA300) with total eradication of both planktonic and adherent bacteria. This strong antibacterial behavior was combined with a significantly enhanced osteogenic behavior, as evidenced by significantly higher levels of alkaline phosphatase (ALP) activity compared with non-biofunctionalized implants. Finally, we discovered synergistic antibacterial behavior between strontium and silver ions, meaning that 4-32 folds lower concentrations of silver ions were required to achieve growth inhibition and total killing of bacteria. The functionality-packed biomaterial presented here demonstrates a unique combination of functionalities that make it an advanced prototype of future orthopedic biomaterials where implants will outlive patients.

A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures.

BACKGROUND: Anal fissure is a common painful condition affecting the anal canal. The majority of acute fissures heal spontaneously. However, some of these acute fissures do not resolve but become chronic. Chronic anal fissures were traditionally treated by anal dilation or by lateral sphincterotomy. However, both of these surgical treatments may cause a degree of incontinence in up to 30% of patients. Several recent trials have shown that nitric oxide donors such as glyceryl trinitrate (GTN) can reduce sphincter pressure and heal up to 70% of chronic fissures. AIM: This study addressed the dose-response to three different concentrations of GTN ointment compared with placebo in a double blind randomised controlled trial. METHOD: A double blind, multicentre, randomised controlled trial was set up to compare placebo ointment against three active treatment arms (0.1%, 0.2%, and 0.4% GTN ointment applied at a dose of 220 mg twice daily) in chronic anal fissures. The primary end point was complete healing of the fissure. RESULTS: Two hundred patients were recruited over an eight month period from 18 centres. After eight weeks of treatment the healing rate in the placebo group was 37.5% compared with 46.9% for 0.1%, 40.4% for 0.2%, and 54.1% for 0.4% GTN. None was significantly better than the placebo response. A secondary analysis excluded fissures without secondary criteria for chronicity. Healing rates were then found to be 24% in the placebo group compared with 50% in the 0.1% GTN group, 36% in the 0.2% group, and 57% in the 0.4% GTN group. These values were statistically significantly different for the placebo group compared with 0.1% GTN, 0.4% GTN, and for the GTN treated group as a whole. CONCLUSIONS: The results of this study have demonstrated the significant benefit of topical GTN when applied to patients suffering from chronic anal fissures but acute fissures showed a tendency to resolve spontaneously. The high proportion of fissures which healed in the placebo group suggests that the definition of "chronicity" needs to be reassessed. Further studies are required to confirm the optimal therapeutic strategy.

The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse--a clinical and manometric study.

BACKGROUND: When treating a complete rectal prolapse, the most important objective is elimination of the prolapse. In addition, restoration of sufficient anorectal continence is extremely important for the patients. We examined the value of posterior levator repair with respect to stabilization of the pelvic floor and to improvement in anorectal incontinence. METHODS: In patients with disabling anorectal incontinence, a posterior levatorplasty can be concomitantly performed during operative removal of the prolapse. To facilitate evaluation of the operative results, we implemented a scoring system to judge the patients' subjective symptoms of incontinence; in addition, we performed manometric measurements of resting and squeezing pressures of the anal sphincter to objectify the anorectal incontinence. RESULTS: From 1991 to 1997, 84 patients (mean age 65+/-10 years, 38-91 years; 79 women, 5 men) with complete rectal prolapse and severe incontinence were operatively treated; corresponding follow-ups were done. The following procedures were performed: Frykmann-Goldberg, 28 patients; Wells, 18 patients; Ripstein, 22 patients; and perineal proctectomy, 16 patients. Incontinence for liquid and solid stools was present in all of these patients. Posterior levatorplasty was implemented in 38 patients, and in this group we found significantly better postoperative results, both clinically and in the manometric measurements. Continence was improved by 84% in the group with levatorplasty, but improvement was only 67% in the other group (P<0.05). The incontinence score decreased significantly in the group with levatorplasty (preoperative 16.4+/-3.1, postoperative 9.3+/-4.5, P<0.05, vs the other group with preoperative 15.6+/-4.2, postoperative 11.5+/-5.1). Manometric observations in the group with levatorplasty demonstrated 55% improvement in resting pressure (preoperative 29+/-17 cm H2O, postoperative 45+/-21 cm H2O, P<0.05) and 40% improvement in squeezing pressure (preoperative 61+/-25 cm H2O, postoperative 85+/-31 cm H2O, P<0.05). In the group without levatorplasty, resting and squeezing pressure improved only by 20% (resting pressure: preoperative 32+/-16 cm H2O, postoperative 38+/-18 cm H2O; squeezing pressure: preoperative 64+/-29 cm H2O, postoperative 75+/-26 cm H2O). CONCLUSIONS: Posterior levatorplasty is an easy and efficient operative procedure which facilitates an improvement in anorectal continence. There are no apparent disadvantages. For this reason, levatorplasty can be part of operative procedures implemented in the treatment of a complete rectal prolapse accompanied by disabling anorectal incontinence.

Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients.

INTRODUCTION: Between 1985 and 1996, 190 patients underwent a low anterior rectal resection with coloanal anastomosis for adenocarcinoma of the lower one-third of the rectum. METHODS: This article reports on 31 (17 males) of these patients with a very low localization of the tumor (distal tumor margin 1.3 +/- 0.9 cm above the dentate line). If the function of the sphincter was acceptable and we could exclude tumor infiltration into the sphincter through endosonography, we relocated the resection plane distally into the intersphincteric region to attain an acceptable margin of safety. In all of these cases, it was impossible for us to perform the usual surgical procedure of a mechanical anastomosis by means of a circular stapler. After intersphincteric rectal resection, the anastomosis was handsewn, using interrupted sutures from the perineal approach, 2.5 to 3 cm above the anal verge, implementing Parks' retractor. A protective stoma was performed in all cases. All data were documented prospectively. COMPLICATIONS: Postoperative mortality was 0 percent. Postoperatively, none of the patients showed an indication for relaparotomy. The leakage rate was 48 percent. Only 16 percent later needed additional surgery for anastomotic strictures or for rectovaginal fistulas. Long-term observations showed that the anastomosis healed well in 27 patients (87.1 percent). Four patients (12.9 percent) decided to have a terminal colostomy performed (anastomotic stricture, 3 patients; anorectal incontinence, 1 patient). FOLLOW-UP: During the follow-up period of 6.8 +/- 3.7 years, six patients (19.4 percent) developed a tumor progression (9.7 percent local recurrences and 12.9 percent distant spread). The five-year survival rate was 79 percent (Dukes A, 100 percent (n = 18); Dukes B, 67 percent (n = 4); and Dukes C, 44 percent (n = 9)). Continence: One-third of patients developed anorectal incontinence for liquid (29.6 percent) or solid stool (3.7 percent). Average stool frequency was 3.3 times per day. Resting pressure decreased significantly by 29 percent (preoperative, 105 +/- 37 cm H2O and postoperative, 75 +/- 19 cm H2O; P < 0.05), whereas squeeze pressure did not change. CONCLUSION: In selected patients with tumors close to the dentate line, an intersphincteric resection of the rectum may help to avoid an abdominoperineal excision of the rectum with a terminal stoma, without any curtailment of oncologic standards. A protective stoma for three months is advantageous.

[Management of primary non-classifiable anal fistulas]. / Vorgehen bei primär nicht klassifizierbaren Analfisteln.

UNLABELLED: In the surgery of anal fistulae, very demanding problems warranting special consideration are caused by the non-classifiable fistulae in ano. RESULTS: Of 823 patients who underwent surgery for anal fistulae between 1993 and 1996, 38 (4.5%) were, according to Parks' classification, non-classifiable; the anal canal was intact. There was no internal opening. All patients had already undergone operations, some of them multiple. In 53%, complete healing of the fistula was achieved by using a single excision. In 47% a recurrence developed. During a second revision we explored the intersphincteric space and were able to reclassify the fistulae in 50% of the cases. A continent fistulectomy led to complete healing in these patients. CONCLUSION: Non-classifiable fistulae in ano, in which an internal opening of the fistula cannot be found, can primarily be treated by a single excision of the fistula. If recurrence does occur, the patient should undergo exploration of the intersphincteric space in the region, where the cryptoglandular infection is suspected.

[Results of transperineal levator-plasty in treatment of symptomatic rectocele]. / Ergebnisse der transperinealen Levatorplastik bei der Behandlung der symptomatischen Rectocele.

A rectocele is a herniation of the anterior rectal wall through the rectovaginal septum into the vagina. The most important risk factors are a previous hysterectomy, obstetic injuries and the descending perineum syndrome. In some patients the rectocele becomes symptomatical because of defecation disorders. The patients have to give manual vaginal or perineal help during defecation. Radiological parameters like the size of the rectocele or retention of barium only have limited value for the clinical evaluation. In a high percentage we find simultaneous symptoms of fecal incontinence. Transperineal anterior levatorplasty makes it possible to close the rectocele. This procedure has a positive influence on defecation and continence. In a prospective study we performed anterior levatorplasty in 35 female patients having a rectocele in combination with rectal outlet obstruction. Subjective improvement of the defecation disorder was found in 74%. Only 1 patient complained of deterioration. No patient needed manual vaginal help postoperatively. Patients who needed perineal help preoperatively had worse results. Patients who did not need any manual help preoperatively nevertheless reported an improvement postoperatively. Fifteen of 20 patients, who suffered from fecal incontinence preoperatively, reported a better continence postoperatively (75%). Even in patients with incontinence the anterior levatorplasty is a good method for rectocele repair, as it improves rectal emptying and simultaneously provides therapy for fecal incontinence.

[Evacuation defecography and defecoflometry in diagnosis of chronic constipation. A prospective comparative study of 49 patients]. / Die Entleerungsdefäkographie und die Defäkoflowmetrie in der Diagnostik der chronischen Obstipation. Eine prospektiv vergleichende Studie bei 49 Patienten.

Chronic constipation can be divided in two large groups: slow-transit constipation, caused by pathological intestinal transit, and obstructive defecation disorder, caused by pelvic and rectal wall abnormalities. Videodefecography and defecoflowmetry are methods used to study dynamic evacuation of the rectum. Videodefecography also enables visual estimation of rectal evacuation. Defecoflowmetry allows analysis of anal and rectal pressures. Within this prospective study we utilized and compared these methods in 19 patients with slow transit and 30 patients with obstructive disease. In patients with slow transit, both investigations demonstrated a significantly higher defecation rate than in obstructive defecation disorder (slow transit: defecoflowmetry 65%, videodefecography 80%; obstructive defecation disorder: 50% and 58%). The evacuation time was pathologically prolonged in both types of constipation, with a range of 43-55 s. Rectoceles are demonstrated in 94% of cases with slow transit and in 72% with obstructive defecation disorder. Also, we often found obstructive components in slow-transit constipation patients. Normal defecography or defecoflowmetry can rule out obstructive defecation disorder. We conclude that videodefecography and defecoflowmetry are important items in the complex diagnostic regimen needed in evaluation of chronic constipation.

[Dynamic gracilis-plasty as final therapeutic possibility in anorectal incontinence]. / Die dynamische Gracilisplastik als letzte therapeutische Möglichkeit bei anorektaler Inkontinenz.

UNLABELLED: Six patients (five women, one man with an average age of 63 years) underwent a dynamic graciloplasty. Three patients had a three- or two-stage procedure; the past three patients were treated by a one-stage procedure without any negative consequences. None of the patients received a protective stoma. COMPLICATIONS: COMPLICATIONS, needing surgical intervention occurred in two patients. In one of these patients a positive final result may still fail. RESULTS: Five patients are subjectively continent and satisfied. Four are able to retain a clysma without any problem. As a result of stimulation, three patients developed optimal anal pressures. In two patients the pressure values are satisfactory. Three patients developed evacuation problems, which up to now have been managed by laxatives. CONCLUSION: The dynamic graciloplasty is a new hope for carefully chosen patients, in whom other methods have failed.

[Anodermal advancement flap-plasty as alternative treatment method to endorectal closure techniques in therapy of high anal fistulas. A prospective study of 31 patients]. / Die anodermale Verschiebelappenplastik als alternative Behandlungsmethode zu den endorectalen Verschlusstechniken bei der Therapie hoher Analfisteln. Eine prospektive Studie bei 31 Patienten.

From January 1992 until April 1995, 31 patients with trans- and suprasphincteric anal fistulae (transsphincteric n = 21; suprasphincteric n = 4; transsphincteric in Crohn's disease n = 6) underwent a fistulectomy followed by closure of the internal opening by suture and anocutaneous flap. All patients had undergone previous operations, some several times. The recurrence rate of 13% appeared to be low after a short follow-up. Continence was only negligibly impaired, although the anal resting pressure and contraction pressure were significantly reduced. In five patients a shortened prewarning period was noticed. Also in Crohn's fistulae the results were equivalent when the surgical treatment was performed in a non-inflammatory period.

[Surgery of primary sphincter incontinence]. / Chirurgie der primären Sphincterinkontinenz.

A thorough functional analysis of the anorectal continence organ and the pelvic floor is a prerequisite for adequate treatment of incontinence. If conservative therapy has failed, corrective surgery on the basis of careful patient selection may well lead to improvement of continence. In our experience, plastic surgery of both the anterior levator ani muscle and the sphincter ani externus muscle is the treatment of choice for idiopathic incontinence.

[Endo-anal and transperineal continence preserving closure techniques in surgical treatment of Crohn fistulas. A prospective long-term study of 186 patients]. / Endoanale und transperineale kontinenzschonende Verschlusstechniken bei der chirurgischen Behandlung der Crohn-Fisteln: Eine prospektive Langzeitstudie bei 186 Patienten.

UNLABELLED: Our aim was to review the results and to investigate the prognosis in a prospective study of aggressive surgical treatment in 186 patients (59% women, 41% men, age 18 to 65 years) treated during the past 9 1/2 years by conventional laying open of the fistula (n = 71), endorectal advancement flap repair (n = 89) and by fistulectomy without internal sphincterotomy (n = 37). 54 (29%) patients had intersphincteric, 57 (30.5%) transsphincteric, 10 (5.5%) suprasphincteric, 37 (20%) low rectovaginal and 28 (15%) had complex fistulas without internal opening. Four sphincter saving techniques were performed by the high and fistulas (n = 89) with primary occlusion of the intraanal ostium and endorectal mucosal flap (n = 29), endorectal advancement flap (n = 41), anodermal flap (n = 8) and transperineal repair with levator interposition (n = 11). Postoperatively 18 cases (20.2%) of suture leakage occurred, 27% in the mucosal flap group, 17.6% in the advancement flap group, 12.5% in the anodermal group, and 27% in the transperineal group. A complete primary healing of perianal wounds was noted in 73% of the patients within 6 months. The presence of rectal disease (n = 77) did not adversely influence the rate and duration of healing. Persistent or recurrent fistula occurs in 29 patients (15.6%), 22% in the sphincter saving group, 4% in the intersphincteric group and 32% in the complex type of fistulas. Disturbance of continence was observed in 9 patients (4.8%). Postoperatively, there was no significant change in resting anal pressure and maximum voluntary conctraction pressure in any fistula group (n = 104). CONCLUSION: The presented clinical and functional long term results of patients with Crohn's fistulas underline the importance of experience in the treatment of perianal fistula disease. A successful treatment depends primarily on an aggressive therapeutic strategy and the appropriate method of operation.

[Defecation flowmetry. A new study technique for evaluating the evacuation function of the rectum]. / Defäkoflowmetrie. Eine neue Untersuchungstechnik zur Beurteilung der Entleerungsfunktion des Rektums.

In a prospective study carried out on 78 patients with chronic constipation (31, with slow transit, 47 with obstructive defecation disorders) the evacuation function of the rectum during defecation was assessed by defecoflowmetry. These patients were compared to a control group of normal volunteers (n = 32). The following parameters were evaluated: defecation and retention volume, defecation fraction, defecation time, maximum flow, mean flow rate and time to maximum flow. As expected, there was no difference in evacuation function between the group of patients with slow transit and the control group. Significant differences, however, existed between the two types of constipation, as well as between obstructive defecation disease and controls, regarding all parameters mentioned above. Evacuation function depends neither on rectal neck pressure nor on intrarectal pressure. In patients with obstructive defecation disorders, three subgroups were discernable: one with prolonged time of defecation and satisfactory evacuation, one with prolonged time of defecation and poor evacuation, and one small group of patients who were not able to defecate. Each group is based on a different underlying pathomechanism. We conclude that changes in evacuation function of the rectum refer either to volume or to time of defecation, or to both. Changes are found only in obstructive type constipation, not in slow transit constipation. Therefore, defeconflowmetry as a dynamic procedure can be used in screening for the classification of chronic constipation.

The risk of infection of three synthetic materials used in rectopexy with or without colonic resection for rectal prolapse.

The incidence of infection was compared after the use of synthetic implants in abdominal rectopexy with (145 patients) and without (77 patients) synchronous colon resection. Three different materials were used, including polyvinyl alcohol (Ivalon) (n = 87), polyglactin (Vicryl) mesh (n = 109), and Gore-Tex (n = 26). In patients have colonic resection two (3.7%) pelvic infections occurred in the polyvinyl alcohol (Ivalon) group, one abdominal infection with polyglactin (Vicryl) and none with Gore-Tex. In the group without colonic resection, two patients (3.0%) developed infection after polyvinyl alcohol (Ivalon) insertion with one occurring after polyglactin (Vicryl) or Gore-Tex. Overall mortality was 0.4%. Follow-up ranged from 3 to 120 months. There were 3 (1.9%) cases of recurrent prolapse in 151 patients with full-thickness rectal prolapse.

[What is the role of the pubococcygeal and puborectal muscles in patients with obstructive defecation disorders? An electromyography study]. / Welche Rolle spielen der M. pubococcygeus und M. puborectalis bei Patienten mit obstruktiven Defäkationsstörungen? Eine elektromyographische Studie.

BACKGROUND: We believe that the M. levator ani plays little or no role in obstructed defaecation, and that the concept of "paradoxical" puborectalis muscle activity is misleading. The main aim of the study was to investigate the function of the pubococcygeal muscle during simulated defaecation and to compare this with the electromyographic activity of the puborectal muscle. METHODS AND RESULTS: In a prospective electromyographic study of 18 women (average age 53 years) with obstructive defecation disorder the activity of the pubococcygeal muscle and the puborectal muscle was investigated at rest, during contraction and straining. The control group consisted of 18 healthy women with an average age of 54 years. The function of the pubococcygeal muscle and the puborectal muscle was largely the same in both, study and control group. No statistically significant differences in the amplitude were found between the two groups at rest during contraction and maximum strain. CONCLUSION: We therefore conclude that the increase in activity of the voluntary muscle of the pelvic floor observed on electromyography during defaecation does not indicate automatically a pathologic condition but is a possible functional state at this moment.

[Endorectal advancement flap-plasty vs. transperineal closure in surgical treatment of rectovaginal fistulas. A prospective long-term study of 88 patients]. / Endorectale Verschiebelappenplastik vs. transperinealer Verschluss bei der chirurgischen Behandlung der rectovaginalen Fisteln. Eine prospektive Langzeitstudie bei 88 Patientinnen.

UNLABELLED: A prospective study was carried out on 88 patients with rectovaginal fistulae to evaluate the value of two sphincter-saving techniques: primary occlusion of the intraanal ostium and endorectal advancement flap (n = 37) or transperineal repair with levator interposition (n = 34). Causes were Crohn's disease 35, obstetric injury 31, proctological-gynecological operation 11, cryptoglandular 11. Perineal group: 11 patients underwent concomitant anterior sphincter plication. Crohn group (n = 35): endorectal advancement flap was performed in 8 patients only, and 10 with intra- or supraanal stenosis were treated by transperineal approach, 12 (34%) with extended perianal fistula complaints required primary proctectomy, and operative therapy was not possible in 5 with persistent rectal inflammation. No deaths occurred. Postoperatively 12 cases (17%) of suture leakage occurred (flap group (FG): 16.2%, transperineal group (TPG): 17.6%). Persistent or recurrent fistula occurred in 8 patients (11%), 5.4% FG, 17.6% TPG. Disturbance of continence was observed in one patient after endorectal approach. Postoperatively there were no significant changes in the resting anal pressure and maximum voluntary contraction pressure. A complete primary healing with no further recurrence (follow-up 3 months to 9.5 years) was noted in 78.4% FG and 64.7% TPG. One patient with postoperative incontinence after the endorectal flap, had undergone anterior levator plication with perineal body reconstruction. CONCLUSIONS: Endorectal advancement flap allows preservation of the sphincter and is an effective method for repair of rectovaginal fistulae. The endorectal advancement flap proved to result in a better primary healing rate with 85% than the mucosal advancement flap with 65%. Perineal procedures are indicated in selected patients with simultaneous sphincter plication and in Crohn's fistulae associated to intra- or supraanal stenosis.

[Long-term follow-up of Parks posterior repair. An electromyographic, manometric and radiologic study of 31 patients]. / Langzeitergebnisse der posterioren Raffung nach Parks. Eine elektromyographische, manometrische und radiologische Studie bei 31 Patienten.

This study was carried out to document the long-term results of postanal repair for idiopathic faecal incontinence. Thirty-one patients (mean age 65.6 years) were followed up for 2-7.5 years (median 4.2 years). Continence was improved in 16 (52%) patients, only 2 (6%) of whom regained normal continence. No significant change in resting and pressure, maximum squeeze pressure, pelvic descent or anorectal angle was seen postoperatively. The electromyographical signs, e.g. duration and amplitude of action potentials, average amplitude, and integrals of the curves did not change significantly after the operation. The mean right pudendal nerve terminal motor latency (PNTML) increased from 2.38 ms before to 2.59 ms after surgery (P > 0.05). No significant change in the continence and defaecation index was seen postoperatively.

[Transanal rectal advancement flap versus mucosa flap with internal suture in management of complicated fistulas of the anorectum]. / Transanaler rektaler Verschiebelappen (rectal advancement flap) versus Mukosaflap mit Internusnaht im Management komplizierter Fisteln des Anorektums.

A prospective study was carried out on 55 patients with complicated anal fistulas (41 transsphincteric, 5 suprasphincteric and 9 rectovaginal) to evaluate the value of two sphincter-conserving techniques with primary occlusion of the internal ostium and endorectal advancement flap (group A, n = 34) or mucosal flap (group B, n = 21). Ten of the patients had Crohn's disease. Both techniques consist in one-stage fistulectomy without drainage of the intersphincteric space. The inflamed proctodeal and granulation tissue was carefully cleared. The site of the former primary orifice of the fistula was adapted by means of two or three peranally performed single stitches. The peranally applied suture included the layers of the internal anal sphincter muscle only. A mobilized flap of rectal wall (group A) and rectal mucosa and submucosa (group B) about 4 cm x 3 cm in size was stitched below the muscular sphincter. The perianal part of the wound was left to heal by second intention. Postoperatively there were 16 cases of suture leakage (23.5% in group A, and 38% in group B), and 19 patients (26% or 47% in both groups) had to have revision surgery because of recurrent fistula or sutur leakage; 2 patients (3.6%) developed incontinence with intermittent fecal soiling. Complete incontinence was not observed in any patient. No significant difference in clinical and functional results was determined between the two groups.

[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]. / Chirurgische Therapie des Rectumprolapses mittels Rectopexie und Resektion. Einfluss der Resektionsbehandlung auf postoperative Obstipation und Schliessmuskelfunktion--eine Follow-up-Studie bei 112 Patienten.

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.