Introduction-Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using...Introduction-Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using artificial sphincters. Preliminary results are disclosed. Patients-In 3 female patients, 45, 59 and 68 years old, curative APR and perineal colostomy were performed after radiotherapy in 2, for T1-2N0 cancer of the lower rectum. Due to occasional leaks, need for strict diet and fear of incontinence,an Acticon Neosphincter(r) (AMS)was implanted consecutively at a mean 4.5 years after APR. Results-Device implantation was feasible and uneventful. In one case, a superficial hematoma was drained and healed by second intention. Devices were activated 3 months after implantation. At a mean 2.5 years follow-up, the 3 patients had an activated and functional artificial sphincter. Leaks and fecal urgency significantly decreased but colonic enemas were maintained. Dietary restrictions were less and quality of life improved. All 3 considered the device as a useful adjunct. Conclusion-In this limited experience, implantation of artificial sphincter around a perineal colostomy following APR for rectal cancer appeared feasible and safe even in case or previous radiotherapy. Midterm tolerance was satisfactory. Continence and quality of life significantly improved.展开更多
PURPOSE: The aim of this study was to assess long- term outcome of Orr- Loygue rectopexy and Delorme’ s procedures in total rectal prolapse management. METHODS: Data were collected retrospectively from 1978 to 2001. ...PURPOSE: The aim of this study was to assess long- term outcome of Orr- Loygue rectopexy and Delorme’ s procedures in total rectal prolapse management. METHODS: Data were collected retrospectively from 1978 to 2001. Statistical analysis was performed by chi- squared test and Student’ s t - test. RESULTS: One hundred nine patients underwent either a Orr- Loygue rectopexy (49 patients) or a Delorme’ s procedure (60 patients). Mean follow- up was 88 (range, 1- 300) months. In the rectopexy group, the overall complication rate and the recurrence rate were 33 percent and 4 percent, respectively. In patients with preoperative constipation, this symptom was improved or completely resolved in 33 percent and worsened in 58 percent postoperatively. Seventy- three percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. In Delorme’ s group, overall complication and recurrence rates were 15 percent and 23 percent, respectively. Mortality was 7 percent. In patients with preoperative constipation, this symtom was improved or completely resolved in 54 percent and worsened in 12.5 percent of patients postoperatively. Forty- two percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. CONCLUSIONS: In this study, Orr- Loygue rectopexy had a lower long- term recurrence rate. However, this surgical procedure is associated with a higher complication rate. We believe that Delorme’ s procedure is still a valuable option in selected patients with postoperative minimal morbidity but higher recurrence rate.展开更多
文摘Introduction-Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using artificial sphincters. Preliminary results are disclosed. Patients-In 3 female patients, 45, 59 and 68 years old, curative APR and perineal colostomy were performed after radiotherapy in 2, for T1-2N0 cancer of the lower rectum. Due to occasional leaks, need for strict diet and fear of incontinence,an Acticon Neosphincter(r) (AMS)was implanted consecutively at a mean 4.5 years after APR. Results-Device implantation was feasible and uneventful. In one case, a superficial hematoma was drained and healed by second intention. Devices were activated 3 months after implantation. At a mean 2.5 years follow-up, the 3 patients had an activated and functional artificial sphincter. Leaks and fecal urgency significantly decreased but colonic enemas were maintained. Dietary restrictions were less and quality of life improved. All 3 considered the device as a useful adjunct. Conclusion-In this limited experience, implantation of artificial sphincter around a perineal colostomy following APR for rectal cancer appeared feasible and safe even in case or previous radiotherapy. Midterm tolerance was satisfactory. Continence and quality of life significantly improved.
文摘PURPOSE: The aim of this study was to assess long- term outcome of Orr- Loygue rectopexy and Delorme’ s procedures in total rectal prolapse management. METHODS: Data were collected retrospectively from 1978 to 2001. Statistical analysis was performed by chi- squared test and Student’ s t - test. RESULTS: One hundred nine patients underwent either a Orr- Loygue rectopexy (49 patients) or a Delorme’ s procedure (60 patients). Mean follow- up was 88 (range, 1- 300) months. In the rectopexy group, the overall complication rate and the recurrence rate were 33 percent and 4 percent, respectively. In patients with preoperative constipation, this symptom was improved or completely resolved in 33 percent and worsened in 58 percent postoperatively. Seventy- three percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. In Delorme’ s group, overall complication and recurrence rates were 15 percent and 23 percent, respectively. Mortality was 7 percent. In patients with preoperative constipation, this symtom was improved or completely resolved in 54 percent and worsened in 12.5 percent of patients postoperatively. Forty- two percent of patients with preoperative incontinence were continent or had continence improvement postoperatively. CONCLUSIONS: In this study, Orr- Loygue rectopexy had a lower long- term recurrence rate. However, this surgical procedure is associated with a higher complication rate. We believe that Delorme’ s procedure is still a valuable option in selected patients with postoperative minimal morbidity but higher recurrence rate.
