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.

[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.

[Abscess excision and primary fistulectomy as initial therapy of peri-proctal abscess. A prospective analysis of 122 patients]. / Abscessexcision und primäre Fistulektomie als Initialtherapie des periproktitischen Abscesses. Eine prospektive Analyse bei 122 Patienten.

A prospective study of 122 patients with anorectal abscesses was carried out to elucidate the value of abscess drainage with primary fistulectomy, when fistulas were identified. Patients were followed from 2 1/2 to 3 1/2 years with a mean follow-up of three years. In 52 patients (Group A) a primary fistula was present (42.6%), in 47 patients simultaneous excision of abscess and drainage of the intersphincteric space combined with partial sphincterotomy was performed. Recidives occurred in 17.3%. In 5 patients with a high transsphincteric or suprasphincteric fistula, a two-stage fistulectomy was done. In all 70 patients of group B no fistula was found at drainage operation. The incidence of recurrent anorectal abscess was 21.4%. In this group it is shown that the rate of recurrence was not related to a simultaneous excision of abscess and drainage of the intersphincteric space.