Laparoscopic surgery and rectal prolapse: Personal experience
ABSTRACT Laparoscopy is gaining an important role in the treatment of benign colorectal disorders. The aim of this study is to evaluate
clinical and functional results in 4 patients subjected to laparoscopic rectopexy according to Wells. From 1993 through 1995,
4 females (mean age 53.7 years, range 22 to 76 years) affected from complete rectal prolapse with faecal incontinence underwent
this procedure. Six months after surgery, at the end of a rehabilitation program consisting of kinesitherapy, biofeedback
and electrostimulation, all patients were re-evaluated by means of a clinical examination, anorectal manometry and defecography.
Preliminary results seem satisfactory and may allow this approach to be used instead of the traditional open surgery.
Die Laparoskopie gewinnt bei der Behandlung benigner kolorektaler Affektionen immer mehr an Bedeutung. Ziel unserer Untersuchung
war die Bewertung der klinischen und funktionellen Ergebnisse bei vier Patientinnen, die sich einer laparoskopischen Rektopexie
nach Wells unterziehen mußten. Zwischen 1993 und 1995 wurden vier Frauen (Durchschnittsalter 53,7 Jahre [22 bis 76 Jahre])
mit einem kompletten Rektumprolaps mit fäkaler Inkontinenz auf diese Weise operiert. Sechs Monate post-operativ, nach Beendigung
eines Rehabilitationsprogrammes mit Kinesiotherapie, Biofeedback und Elektrostimulation, wurde bei allen Patientinnen eine
klinische Untersuchung durchgeführt. Die ersten Ergebnisse sind zufriedenstellend und sprechen für den Einsatz dieser Vorgehensweise
anstelle der bisherigen traditionellen offenen Operationsmethode.
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ABSTRACT: A simple technique for measuring gastrointestinal transit times using radioopaque pellets of barium-impregnated polythene has been developed and validated. A normal range has been established by studying 25 normal subjects; all passed the first marker within three days and most passed 80% of the markers within five days.Gut 11/1969; 10(10):842-7. DOI:10.1136/gut.10.10.842 · 13.32 Impact Factor
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ABSTRACT: Twenty-three patients with rectal prolapse or intussusception were studied to specifically focus on the effect of posterior rectopexy on fecal continence, anal pressure, and rectal capacity. Before operation, five patients were fully continent (A), 10 were continent for solid stools (B) and eight patients were fully incontinent (C). Group A remained fully continent; continence was regained nine times in group B and in group C, three patients regained full continence, two became continent for solid stools, three patients remained incontinent. Other symptoms such as constipation, false urgency, and a feeling of incomplete evacuation were not beneficially influenced by rectopexy. The patients' continence status was correlated to anorectal manometry and rectal capacity measurement. In group B, incremental pressure (P = squeeze - basal P) increased significantly (P less than 0.02) as well as incremental volume (V = maximum tolerated volume - volume of first sensation) (P less than 0.05). We conclude that, by an increase of incremental anal pressure and incremental rectal volume, posterior rectopexy offers an 83 percent chance of regaining full continence, or a major improvement, and a 17 percent chance of stabilization of fecal incontinence.Diseases of the Colon & Rectum 05/1991; 34(4):311-6. DOI:10.1007/BF02050590 · 3.20 Impact Factor
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ABSTRACT: Biopsies of the external anal sphincter, puborectalis, and levator ani muscles have been examined in 24 women and one man with long-standing anorectal incontinence, 18 of whom also had rectal prolapse, and in two men with rectal prolapse alone. In 16 of the women anorectal incontinence was of unknown cause, but in eight there was a history of difficult labour. Similar biopsies were examined in six control subjects. In all the incontinent patients there was histological evidence of denervation, which was most prominent in the external anal sphincter muscle biopsies, and least prominent in the levator ani muscles. Myopathic features, which were thought to be secondary, were present in the more abnormal biopsies. There were severe histological abnormalities in small nerves supplying the external anal sphincter muscle in the three cases in which material was available for study. We suggest that idiopathic anorectal incontinence may be the result of denervation of the muscles of the anorectal sling, and of the anal sphincter mechanism. This could result from entrapment or stretch injury of the pudendal or perineal nerves occurring as a consequence of rectal descent induced during repeated defaecation straining, or from injuries to these nerves associated with childbirth.Gut 09/1977; 18(8):656-65. DOI:10.1136/gut.18.8.656 · 13.32 Impact Factor