Adult sigmoid intussusception resembling rectal prolapse:A case report

BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial to recognize and differentiate rectal prolapse from internal intussusception because the two diagnoses have different prognoses.Here,we describe a case of adult sigmoid intussusception presenting as rectal prolapse.CASE SUMMARY A 64-year-old woman with no known medical history visited a gastrointestinal outpatient department due to hard bloody stool defecation for 1 wk followed by constipation for 3 d.Colonoscopy revealed a huge polypoid ulcerated tumor at the sigmoid colon with lumen stenosis.The patient was admitted due to postprocedural dull abdominal pain.Due to failed colonoscopy reduction and stent insertion,the patient underwent sigmoid colon resection with primary end-to-end anastomosis,with the transverse colostomy pathological report showing adenocarcinoma,pT3N0M0.She recovered well from the operation and was discharged with regular outpatient clinic follow-up.CONCLUSION Presentation and manifestation of sigmoid intussusception may resemble that of rectal prolapse,necessitating careful observation due to distinct prognostic implications.

Exosomes from umbilical cord mesenchymal stromal cells promote the collagen production of fibroblasts from pelvic organ prolapse

BACKGROUND Pelvic organ prolapse(POP)involves pelvic organ herniation into the vagina due to pelvic floor tissue laxity,and vaginal structure is an essential factor.In POP,the vaginal walls exhibit abnormal collagen distribution and decreased fibroblast levels and functions.The intricate etiology of POP and the prohibition of trans-vaginal meshes in pelvic reconstruction surgery present challenges in targeted therapy development.Human umbilical cord mesenchymal stromal cells(hucMSCs)present limitations,but their exosomes(hucMSC-Exo)are promising therapeutic tools for promoting fibroblast proliferation and extracellular matrix remodeling.suppressed inflammation in POP group fibroblasts,stimulated primary fibroblast growth,and elevated collagen I(Col1)production in vitro.High-throughput RNA-seq of fibroblasts treated with hucMSC-Exo and miRNA sequencing of hucMSC-Exo revealed that abundant exosomal miRNAs downregulated matrix metalloproteinase 11(MMP11)expression.CONCLUSION HucMSC-Exo normalized the growth and function of primary fibroblasts from patients with POP by promoting cell growth and Col1 expression in vitro.Abundant miRNAs in hucMSC-Exo targeted and downregulated MMP11 expression.HucMSC-Exo-based therapy may be ideal for safely and effectively treating POP.

Advancing the predictive accuracy of PNTML in rectal prolapse:An ongoing quest

Fecal incontinence is a common symptom among patients with rectal prolapse.Pudendal nerve terminal motor latency(PNTML)testing can serve as a reference indicator for predicting the outcomes of rectal prolapse surgery,thereby assisting surgeons in formulating more appropriate surgical plans.The direct correlation between preoperative PNTML testing results and postoperative fecal incontinence in patients with rectal prolapse remains a contentious issue,necessitating further clarification.Thus,we analyze the existing publications from both clinical and statistical perspectives to comprehensively evaluate the accuracy of preoperative PNTML testing in rectal prolapse and provide some feasible statistical solutions.

Combined laparoscopic and thoracoscopic repair of adult right-sided Bochdalek hernia with massive liver prolapse: A case report

BACKGROUND A Bochdalek hernia(BH)is a congenital diaphragmatic hernia that often develops in the neonatal period.BH typically occurs on the left side of the diaphragm.A right-sided BH in an adult is rare.CASE SUMMARY A 45-year-old man was referred to our hospital because of an abnormal shadow seen on chest radiography during a medical check-up.A chest radiograph showed elevation of the right hemidiaphragm.Computed tomography showed prolapse of multiple intraabdominal organs into the right thoracic cavity,corresponding to a right-sided BH.The herniated contents included the stomach,transverse colon,and left lobe of the liver.The left lobe of the liver was enlarged,particularly the medial segment.Laparoscopic surgery was performed.However,the left lobe of the liver was completely trapped in the thoracic cavity.Therefore,thoracoscopic manipulation had to be performed to return the liver to the abdominal cavity.The hernia was repaired with interrupted nonabsorbable sutures and reinforced with mesh.CONCLUSION Combined laparoscopic and thoracoscopic surgery was successfully performed for right-sided BH with massive liver prolapse and abnormal liver morphology.

Clinically significant changes in anal sphincter hiatal area in patients with gestational diabetes mellitus and pelvic organ prolapse

BACKGROUND The prevalence of pelvic organ prolapse(POP)increases with age and parity.Specifically,the prevalence of POP among women aged 20 to 39 is 9.7%,while it rises to 49%among women over 80 years old.Additionally,as the number of deliveries increases,the prevalence of POP also rises accordingly,with a rate of 12.8%for women with one delivery history,18.7%for those with two deliveries,and 24.6%for women with three or more deliveries.It causes immense suffering for pregnant women.AIM To evaluate the relationship between the levator ani muscle’s hiatus(LH)area and POP in patients with gestational diabetes mellitus(GDM)using perineal ultrasound.METHODS The study cohort comprised 104 patients aged 29.8±3.7 years who sought medical care at our institution between January 2021 and June 2023.All were singleton pregnancies consisting of 75 primiparas and 29 multiparas,with an average parity of 1.7±0.5.According to the POP diagnostic criteria,the 104 subjects were divided into two groups with 52 members each:POP group(patients with GDM combined with POP)and non-POP group(patients with GDM without POP).Perineal ultrasound was used to measure differences in the anteroposterior diameter,transverse diameter,and LH area.Receiver operating characteristic curves were drawn to determine the optimal cutoff values for the LH anteroposterior diameter,transverse diameter,and area for diagnosing POP.RESULTS Statistically significant increase in the LH area,anteroposterior diameter,and lateral diameter were observed in the POP group compared with the non-POP group(P<0.05).Both groups exhibited markedly elevated incidence rates of macrosomia and stress urinary incontinence.For the POP group,the area under the curve(AUC)for the LH area was 0.906 with a 95%confidence interval(CI):0.824-0.988.The optimal cutoff was 13.54cm²,demonstrating a sensitivity of 83.2%and a specificity of 64.4%.The AUC for the anteroposterior diameter reached 0.836 with a 95%CI:0.729-0.943.The optimal cutoff was 5.53 cm with a sensitivity of 64.2%and a specificity of 73.4%.For the lateral diameter,its AUC was 0.568 with a 95%CI:0.407-0.729.The optimal cutoff was 4.67 cm,displaying a sensitivity of 65.9%and a specificity of 69.3%.Logistic regression analysis unveiled that age,body weight,number of childbirths,total number of pregnancies,and gestational weight gain constituted the independent risk factors for the cooccurrence of GDM and POP.CONCLUSION Three-dimensional perineal ultrasonography of LH size and shape changes can effectively diagnose POP.Age,weight,number of births,number of pregnancies,and weight gain during pregnancy are independent risk factors affecting the cooccurrence of GDM and POP.GDM can increase the LH area in patients,and an enlarged LH leads to an increased incidence of POP.

Clinical Presentation, Therapeutic Aspects and Results of Urogental Prolapse in Yaounde

Introduction: Urogenital prolapse is the descent of one or more elements of the abdominal-pelvic contents into the vaginal cavity. The anterior, middle and posterior anatomical compartments may be involved giving rise to several types of genital prolapse. However, there are various therapeutic modalities ranging from observational procedures to surgery. In Yaounde, urogenital prolapse appears to be a rare clinical entity, and its treatment has not been clearly stated. There is limited data about this subject in our context. Our aim was to study the clinical and therapeutic aspects of urogenital prolapse in Yaounde. Methods: We conducted a descriptive cross-sectional study with retrospective data collection at the Yaounde Gynaecological Obstetric and Pediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH) over a period of 05 months (from February 2022 to June 2022). All women aged ≥30 years and all women with documented urogenital prolapse admitted to the maternity and urology departments of these two health facilities were included. Data were collected using a structured questionnaire. Data was analyzed using IBM SPSS (statistical package for social sciences) software version 23.0 and the data were reported as mean, standard deviation, frequencies and percentages. Results: A total of 50 patients were recruited;the mean age was 45.8 ± 17 years. The age range was from 21 to 72 years. Majority of the patients were aged more than 55 years (32%). Most of the patients attended primary education (48%). Forty percent of the patients were housewives. The majority of the patients were from West Cameroon (26%). The most common reason for consultation was pelvic heaviness (54%). The most prevalent clinical sign was cystocele (56%), followed by hysterocele (54%). According to the Baden Walker classification, one-third of the patients were classified as first degree (36%). More than half (58%) of patients had the condition located at the first stage. Surgery was performed in 68% of cases while 48% received medical treatment. The average length of inpatient stay was 7.9 ± 3.7 days and the average length of transurethral catheterization was 3.02 ± 2.9 days. Most patients had a good short-term outcome, and the main postoperative complications were infection (8.8%) and hemorrhage (5.9%). Conclusion: Urogenital prolapse is a rare condition in our population. Diagnosis is essentially clinical. Cystocele and hysterocele are the predominant clinical forms. Surgery is the mainstay of treatment. Outcomes are satisfactory.

Umbilical Cord Prolapse Managed by Assisted Vacuum Delivery

G4P3L3 was at 40 weeks of gestation who was admitted in active stage of labor with normal fetal heart rate. At 8 cm cervical dilatation she experienced spontaneous rupture of membrane with clear liquor. Cord prolapse was detected and was prepared for caesarian section meanwhile she was kept in knee chest position and bladder was filled with normal saline 0.9%. 30 min before operation she was fully dilated with signs of Non reassuring fetal status, vacuum extraction was done to assist delivery as soon as possible. The APGAR score was 6 and 10 in the first and fifth minutes respectively. Mother and the baby were discharged the next day in good condition.

Evaluation of the Clinical Advantages of Laparoscopic Transverse Abdominal Wall Suspension in the Treatment of Pelvic Organ Prolapse

Objective:To evaluate the clinical advantages of laparoscopic transverse abdominal wall suspension in treating pelvic organ prolapse.Methods:Sixty patients diagnosed with moderate to severe pelvic organ prolapse and underwent surgical treatment in our hospital between January 2022 and December 2023 were selected.According to different surgical methods,they were divided into an observation group(given laparoscopic transverse abdominal wall suspension)and a control group(given transvaginal mesh implantation),with 30 subjects/group.The data on perioperative-related indicators,quality of life scores,postoperative recurrence,and complications of the two groups of patients were collected.Results:The postoperative hospitalization days and intraoperative bleeding volume of the observation group were significantly lower than those of the control group,but had longer operation time than that of the control group(P<0.05).The differences between the two groups were statistically significant 6 months after surgery,and the Pelvic Floor Disease Quality of Life Impact Questionnaire(PFIQ-7)score of the observation group was significantly higher than the control group(P<0.05).Both groups of patients completed 12 months of follow-up without any postoperative recurrence.The number of complications in the observation group was slightly lower than that of the control group(P>0.05).Conclusion:Laparoscopic transverse abdominal wall suspension was more effective in treating pelvic organ prolapse and is an ideal surgical procedure.

Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse

External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.

Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females

BACKGROUND Internal rectal prolapse(IRP)is one of the most common causes of obstructive constipation.The incidence of IRP in women is approximately three times that in men.IRP is mainly treated by surgery,which can be divided into two categories:Abdominal procedures and perineal procedures.This study offers a better procedure for the treatment of IRP.AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair(IPFLR)combined with a procedure for prolapse and hemorrhoids(PPH)and the laparoscopic IPFLR alone in the treatment of IRP in women.METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014.The patients were divided into groups A and B.Group A had 63 patients who underwent laparoscopic IPFLR alone,and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH.The degree of internal rectal prolapse(DIRP),Wexner constipation scale(WCS)score,Wexner incontinence scale(WIS)score,and Gastrointestinal Quality of Life Index(GIQLI)score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.RESULTS All laparoscopic surgeries were successful.The general information,number of bowel movements before surgery,DIRP,GIQLI score,WIS score,and WCS score before surgery were not significantly different between the two groups(all P>0.05).The WCS score,WIS score,GIQLI score,and DIRP in each group 6 mo,and 2 years after surgery were significantly better than before surgery(P<0.001).In group A,the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery(P<0.001),and the GIQLI score progressively improved from 6 mo to 2 years after surgery(P<0.05).In group B,the DIRP,WCS score and WIS score significantly improved from 6 mo to 2 years after surgery(P<0.05),and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery(P<0.05).The WCS score,WIS score,GIQLI score,and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery(all P<0.001,Bonferroni)except DIRP at 2 years after surgery.There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery(P=0.011).There was no significant difference in postoperative grade I-III complications between the two groups(P=0.822).CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.

Evaluation of the clinical efficacy and safety of TST33 mega hemorrhoidectomy for severe prolapsed hemorrhoids

BACKGROUND The pathogenesis of hemorrhoids is mainly anal cushion prolapse.Although the traditional treatment has a certain curative effect,it is not ideal.The remission rate of postoperative symptoms is low.Even if temporary remission is achieved,patients with hemorrhoids easily relapse after 1-2 years.The new technique of using staplers to treat prolapsed hemorrhoids has good therapeutic effects in clinical practice.AIM To explore the effect of TST33 mega stapler prolapse and hemorrhoid mucosal resection in the treatment of patients with severe prolapsed hemorrhoids.METHODS A total of 204 patients with severe prolapse hemorrhoids who were admitted to the department of anorectal in our hospital from April 2018 to June 2020 were selected,and the patients were randomly divided into group A and group B with 102 cases in each group using a randomized controlled clinical research program.Patients in Group A were treated with a TST33 mega stapler and hemorrhoid mucosal resection to treat prolapse,and patients in Group B were treated according to the Procedure for Prolapse and Hemorrhoids;the operation time,intraoperative blood loss,hospital stay,the difference in operation time,intraoperative blood loss,hospitalization time,pain degree before and after operation,degree of anal edema,anal Wexner score,and surgical complications were compared between the two groups of patients.RESULTS The operation time,intraoperative blood loss and hospitalization time in Group A were significantly lower than those in Group B(P<0.05).The cure rate of Group A was 98.04%,compared with 95.10%cure rate of Group B,and the difference was not statistically significant(P>0.05).The visual analogue scale(VAS)at 12 h and 24 h postoperatively in Group A were significantly lower than those in Group B(P<0.05).The comparison of the VAS scores between Group A and Group B at 48 h,72 h and 96 h postoperatively revealed that the difference was not statistically significant(P>0.05).One day postoperatively,the degree of perianal edema in Group A was compared with that in Group B,and the difference was not statistically significant(P>0.05).Seven days postoperatively,the degree of perianal edema in Group A was significantly lower than that in Group B(P<0.05).The comparison of anal Wexner scores between the two groups preoperatively and at 1 mo,3 mo and 6 mo postoperatively showed that the difference was not statistically significant(P>0.05).The Wexner scores of the two groups at 1 mo,3 mo and 6 mo postoperatively were significantly lower than the scores preoperatively(P<0.05).The postoperative complication rate of Group A was 2.94%lower than that of Group B(11.76%),which was statistically significant(P<0.05).CONCLUSION TST33 mega anastomotic hemorrhoidectomy treatment for patients with severe prolapse hemorrhoids,leads to less postoperative pain,the rapid recovery of perianal edema and has fewer complications.

Prevalence of Female Sexual Dysfunction among Women with Pelvic Organ Prolapse Diagnosed by Pisq-12 and Related Factors in Hung Vuong Hospital, Vietnam

Pelvic organ prolapsed is a common problem today, and it has been gradually increasing because of the longevity of women. Pelvic organ prolapse can result in negative psychological feelings that affect on women’s sexual activity. Methods: There is a cross-sectional study on sexual dysfunction in 296 women with pelvic organ prolapse grade II and III followed up at gynecological-pelvic floor unit of Hung Vuong hospital from 09/2017 to 06/2018. Results: The prevalence of female sexual dysfunction in PISQ-12 was 76.4% and 95% CI [71.6 - 81.2]. The rate of female sexual dysfunction in turn is: 1) Behavioral-Emotional: 93.6% 95% CI [90.8 - 96.4]. 2) Physiology: 62.2% CI 95% [56.7 - 67.7]. 3) Relationship to partner: 89.5% 95% CI [86.0 - 93.0]. Factor related to sexual dysfunction in women with pelvic organs (p < 0.05) is general sexual dysfunction: 1) Age group: women over age 55 increased generally the risk of sexual dysfunction, OR = 5.89, 95% CI [1.38 - 25.20]. 2) Diabetes mellitus increased the risk of sexual dysfunction with OR = 5.03, 95% CI [1.42 - 17.82]. 3) Patients with previous abortions reduced the risk of sexual dysfunction with OR = 0.49 95% CI [0.27 - 0.90]. Conclusion: Research on quality of life in pelvic organ prolapse should be considered more in the future.

Clinical analysis of laparoscopic lateral peritoneal suspension in the treatment of severe pelvic organ prolapse

Objective:To investigate the clinical effects of laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse(POP).Methods:Thirty-eight patients who underwent laparoscopic lateral peritoneal suspension for pelvic organ prolapse in the gynecology department of our hospital from January 2019 to January 2020 were selected for retrospective analysis.Postoperative outcomes were recorded for patients at 3,6,and 12 months postoperatively.Results:All 38 patients completed the surgery safely,and the duration of surgery was 85-190 min,with a mean of(138±40.75)min;surgical bleeding was 30-80 ml,with a mean of(57±35.4)ml;the duration of postoperative catheterization was 4-6 days,with a mean of(5±0.73)days;postoperative hospitalization was 6-12 days,with a mean of(8.49±2.18)days.2.18)days.At 3,6,and 12 months after the end of surgery,all follow-up patients had their uterus and anterior vaginal wall restored to normal position without prolapse.The pelvic floor rehabilitation of the patients after surgery was good and their sexual life was significantly improved in all cases.Conclusion:Laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse is safe,efficacious,minimally traumatic,less painful,with short hospital stay,fast postoperative recovery,greater choice of uterine de-positioning,with the advantages of permanence and good pelvic floor anatomical recovery,and this procedure can maintain a certain vaginal length with 100%efficiency,which is worthy of clinical promotion.

Rectal prolapse: Diagnosis and clinical management

The exact cause of rectal prolapse is not well addressed,but it is often associated with long standing constipation,advanced age,chronic obstructive pulmonary disease and some neurological disorders.Rectal prolapse is usually only a symptom,which needs a focus on discovery of the underlying pathology or disorder.Three different clinical presentations are often combined and called rectal prolapse.Rectal prolapse can be divided into full thickness rectal prolapse where the entire rectum protrudes beyond the anus,mucosal prolapse where only the rectal mucosa (not the entire wall) prolapses,and internal intussuception wherein the rectum collapses but does not exit the anus.Although constipation and straining may contribute to the development of rectal prolapse,simply correcting these problems may not improve the prolapse once it has developed.There are many different approaches to surgical correction of rectal prolapse.

Modified Gant procedure for treatment of internal rectal prolapse in elderly women

BACKGROUND Although rectal prolapse is not a life-threatening condition,it can cause defecation disorders,anal incontinence,sensory abnormalities,and other problems that can seriously affect quality of life.AIM To study the efficacy of the modified Gant procedure for elderly women with internal rectal prolapse.METHODS Sixty-three elderly female patients with internal rectal prolapse underwent the modified Gant procedure.The preoperative and postoperative anal symptoms,Patient Assessment of Constipation Quality of Life(PAC-QOL),Wexner incontinence score,incontinence quality of life score,and complications(massive hemorrhage,infection,anorectal stenosis,and anorectal fistula)were compared.RESULTS The improvement rates of postoperative symptoms were defecation disorders(84.5%),anal distention(69.6%),defecation sensation(81.4%),frequent defecation(88.7%),and anal incontinence(42.9%)(P<0.05).All dimensions and total scores of the PAC-QOL after the procedure were lower than those before the operation(P<0.05).The postoperative anal incontinence score and Wexner score were significantly lower than those before the procedure(P<0.05).The quality of life and total scores of postoperative anal incontinence were significantly higher than those before the procedure(P<0.05).There were no serious complications and no deaths.CONCLUSION The modified Gant procedure has significant advantages in the treatment of elderly women with internal rectal prolapse.

Plasma Levels of Transforming Growth Factor-Beta 1 in Women with Pelvic Organ Prolapse

Objective: In women with pelvic organ prolapse (POP), decreased expression of transforming growth factor-beta 1 (TGF-β1) has been shown in POP tissues. However, no studies have evaluated plasma TGF-β1 levels in patients with POP, so it is unknown whether they are also changed or not. Therefore, we compared plasma TGF-β1 levels in women with and without POP. Methods: Participants were 49 women with POP and 23 healthy control women. All participants were postmenopausal. We measured plasma TGF-β1 and compared data between patients with POP and controls, and between patients with uterine prolapse (UP, n = 19) and those with a cystocele (CC, n = 30). In addition, in patients, we assessed the POP quantification system (POP-Q) stage. Results: Plasma TGF-β1 levels were significantly lower in patients than in healthy controls. POP-Q stage was not significantly different between the UP and CC subgroups, but POP-Q stage IV was diagnosed in 63% of patients with UP and 7% of those with CC. Plasma TGF-β1 levels were significantly lower in the CC subgroup than in the UP subgroup. Conclusion: Plasma TGF-β1 is decreased in POP. It remains unclear whether the lower levels indicate a reduction in systemic TGF-β1 activity, but they can be assumed to reflect reduced TGF-β1 expression in POP tissues.

Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation

AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.

Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results

AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant database were searched to identify studies.Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.RESULTS:Twelve non-randomized case series studies with 574 patients were included in the review.No surgical mortality was described.Conversion was needed in 17 cases(2.9%), most often due to difficult adhesiolysis.Twenty eight patients(4.8%) presented with major complications.Seven(1.2%) mesh-related complications were reported.Most frequent complications were urinary tract infection and urinary retention.Mean recurrence rate was 4.7% with a median follow-up of 23 mo.Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%.Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages.Evaluation of functional score was disparate between studies.CONCLUSION:Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.

Transcatheter closure of ventricular septal defect in patients with aortic valve prolapse and mild aortic regurgitation:feasibility and preliminary outcome

Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January 2008 and July 2014,transcatheter closure of VSD was attempted in 65 patients.Results:The total intermediate closure successful rate in all subjects was 96.9%.During the perioperative period,no death,major bleeding,pericardial tamponade,occluder dislodgement,residual shunt or hemolysis occurred.Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation,three cases of transient complete left bundle branch block occurred but did not sustain.At 1-year followup,no patients had residual shunts and complications.Furthermore,grade of residual AR were relieved in 61.9%(39/63)cases and degree of AVP were ameliorated in 36.5%(23/63)patients;Conclusions:Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective.Long term safety and efficacy needs to be assessed.

Endometrial mesenchymal stem cells as a cell based therapy for pelvic organ prolapse

Pelvic organ prolapse(POP) occurs when the pelvic organs(bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman's quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells(MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.