INTRODUCTION: The laparoscopic approach in suture rectopexy with sigmoid resection is appealing as surgery is mainly confined to the pelvis. METHODS: The procedure is performed in modified lithotomy position using fiv...INTRODUCTION: The laparoscopic approach in suture rectopexy with sigmoid resection is appealing as surgery is mainly confined to the pelvis. METHODS: The procedure is performed in modified lithotomy position using five trocars. In the case reported, the inferior mesenteric artery is divided distally to the left colic artery branch. The sigmoid colon is mobilized medially and may be mobilized laterally up to the descending colon, depending on the extent of resection. The splenic flexure remains in place. The rectum is mobilized from the presacral fascia down to the pelvic floor, sparing the hypogastric nerves. The rectum is transected in its upper third and the colonic stump pulled outside after enlarging the left lower abdominal incision to a length of 5 cm. The colorectal anastomosis is established intracorporeally in a double- stapling technique. Three 2- 0 braided nonabsorbable sutures are placed to attach the right lateral stalks of the rectum to the presacral fascia. Proctoscopic examination has to ensure that there is no luminal compromise or air leakage. RESULTS: The videotape reports about a 37- year- old male patient with a rectal prolapse of 8 cm in length. First symptoms had occurred in childhood. He reported about temporary constipation and repeated rectal bleeding. During surgery, an elongated sigmoid was found. Laparoscopic sigmoid resection and suture rectopexy were carried out. There were no intraoperative or postoperative complications. The patient was discharged from the hospital on the sixth postoperative day. CONCLUSION: Laparoscopic resection rectopexy is safely feasible as a minimally- invasive treatment option for rectal prolapse.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
PURPOSE:Using meta-analytical techniques, this study was designed to compare open and laparoscopic abdominal procedures used to treat full-thickness rectal prolapse in adults. METHODS: Comparative studies published be...PURPOSE:Using meta-analytical techniques, this study was designed to compare open and laparoscopic abdominal procedures used to treat full-thickness rectal prolapse in adults. METHODS: Comparative studies published between 1995 and 2003, cited in the literature of open abdominal rectopexy vs. laparoscopic abdominal rectopexy, were used. The primary end points were recurrence and morbidity, and the secondary end points assessed were operative time and length of hospital stay. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed. RESULTS: Six studies, consisting of a total of 195 patients (98 open and 97 laparoscopic) were included. Analysis of the data suggested that there is no significant difference in recurrence and morbidity between laparoscopic abdominal rectopexy and open abdominal rectopexy. Length of stay was significantly reduced in the laparoscopic group by 3.5 days (95 percent confidence interval, 3.1-4; P < 0.01), whereas the operative time was significantly longer in this group, by approximately 60 minutes (60.38 minutes; 95 percent confidence interval, 49-71.8). CONCLUSIONS: Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regards to recurrence and morbidity and favorably with length of stay. However large-scale randomized trials, with comparative, sound methodology are still needed to ascertain detailed outcome measures accurately.展开更多
Objective: Axis and support of the vagina can be restored by sacrocolporectopexy with preservation of coital function. We developed a new technique of transvaginal sacrocolporectopexy for patients with prolapse of ute...Objective: Axis and support of the vagina can be restored by sacrocolporectopexy with preservation of coital function. We developed a new technique of transvaginal sacrocolporectopexy for patients with prolapse of uterus and vagina or prolapse of the vaginal vault. Study design: During a 4-year period, 20 patients with vaginal vault prolapse and 83 patients with uterine and vaginal prolapse underwent transvaginal sacrocolporectopexy. Intra-and post-operative complications were recorded. After a mean follow-up period of 24 months (6-48), the result of surgery with respect to prolapse, incontinence, and sexuality was evaluated by patient interviews. Results: No serious perioperative complications occurred with the exception of one patient with bleeding from a presacral vein. Subjectively, 84 patients (82%) were cured of prolapse symptoms. One patient had recurrent grade II vault prolapse and four patients deve-loped a grade II rectocele. Five patients developed urge incontinence grade I. One patient developed fecal incontinence. No patient had coital problems as a sequelae of sacrocolporectopexy. Conclusion: Transvaginal sacrocolporectopexy is a safe procedure with a success rate comparable to sacrospinous fixation.展开更多
目的观察吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)联合直肠黏膜柱状缝合固定术(Block)治疗女性直肠前突的临床疗效。方法选取2019年11月至2022年5月中国中医科学院广安门医院收治的女性直肠前突患者90例,采...目的观察吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)联合直肠黏膜柱状缝合固定术(Block)治疗女性直肠前突的临床疗效。方法选取2019年11月至2022年5月中国中医科学院广安门医院收治的女性直肠前突患者90例,采用随机数字表法分为PPH手术组30例、Block手术组30例、PPH联合Block手术组30例。比较三组患者围术期相关指标、手术前后Longo’s排便梗阻综合征(Longo’s ODS)评分、直肠前突深度及术后并发症发生情况。结果PPH手术组手术时间、术中出血量、术后VAS评分明显低于Block手术组和PPH联合Block手术组,差异有显著性(P<0.05);三组住院时间相近,Block组和PPH联合Block手术组在围术期各项相关指标相近,差异无显著性(P>0.05)。三组术前Longo’s ODS评分及直肠前突深度差异无显著性(P>0.05),三组患者术后3个月Longo’s ODS评分及直肠前突深度明显低于术前,差异有显著性(P<0.05);PPH联合Block手术组术后3个月Longo’s ODS评分及直肠前突深度低于其他两组,差异有显著性(P<0.05);Block手术组与PPH手术组术后Longo’s ODS评分及直肠前突深度差异无显著性(P>0.05)。PPH联合Block手术组显效率明显高于其他两组,差异有显著性(P<0.05),Block手术组与PPH手术组显效率差异无显著性(P>0.05)。三组术后并发症发生率差异无显著性(P>0.05)。结论PPH联合Block手术临床疗效优于单纯行PPH及Block手术,可有效纠正女性直肠前突的解剖异常改变,改善患者便秘症状。展开更多
目的探讨腹腔镜直肠缝线固定术治疗完全性直肠脱垂的临床效果。方法对我院2010年1月至2014年1月采用腹腔镜直肠缝线固定术治疗的36例完全性直肠脱垂病例进行观察,并与同期采用腹腔镜直肠补片固定术治疗的16例同病种病例进行对照。结果...目的探讨腹腔镜直肠缝线固定术治疗完全性直肠脱垂的临床效果。方法对我院2010年1月至2014年1月采用腹腔镜直肠缝线固定术治疗的36例完全性直肠脱垂病例进行观察,并与同期采用腹腔镜直肠补片固定术治疗的16例同病种病例进行对照。结果采用直肠缝线固定术的平均手术时间明显短于直肠补片固定术(110±13 min vs 120±9 min,P<0.05),而且住院费用也较低(16227±845元vs 19143±1163元,P<0.05)。两组在平均术中出血量、平均术后肛门恢复排气时间、平均术后住院时间方面相比均无统计学差异。两组患者均无术后早期并发症。中位随访时间26个月,两组患者在术后1月和术后1年的直肠脱垂复发率、Wexner便秘评分、胃肠生活质量指标GIQLI均无显著性差异(P>0.05)。结论腹腔镜直肠缝线固定术对治疗完全性直肠脱垂具有手术创伤小、恢复快、住院时间短、费用低等优点,而近期和远期随访均具有满意的效果。展开更多
文摘INTRODUCTION: The laparoscopic approach in suture rectopexy with sigmoid resection is appealing as surgery is mainly confined to the pelvis. METHODS: The procedure is performed in modified lithotomy position using five trocars. In the case reported, the inferior mesenteric artery is divided distally to the left colic artery branch. The sigmoid colon is mobilized medially and may be mobilized laterally up to the descending colon, depending on the extent of resection. The splenic flexure remains in place. The rectum is mobilized from the presacral fascia down to the pelvic floor, sparing the hypogastric nerves. The rectum is transected in its upper third and the colonic stump pulled outside after enlarging the left lower abdominal incision to a length of 5 cm. The colorectal anastomosis is established intracorporeally in a double- stapling technique. Three 2- 0 braided nonabsorbable sutures are placed to attach the right lateral stalks of the rectum to the presacral fascia. Proctoscopic examination has to ensure that there is no luminal compromise or air leakage. RESULTS: The videotape reports about a 37- year- old male patient with a rectal prolapse of 8 cm in length. First symptoms had occurred in childhood. He reported about temporary constipation and repeated rectal bleeding. During surgery, an elongated sigmoid was found. Laparoscopic sigmoid resection and suture rectopexy were carried out. There were no intraoperative or postoperative complications. The patient was discharged from the hospital on the sixth postoperative day. CONCLUSION: Laparoscopic resection rectopexy is safely feasible as a minimally- invasive treatment option for rectal prolapse.
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.
文摘PURPOSE:Using meta-analytical techniques, this study was designed to compare open and laparoscopic abdominal procedures used to treat full-thickness rectal prolapse in adults. METHODS: Comparative studies published between 1995 and 2003, cited in the literature of open abdominal rectopexy vs. laparoscopic abdominal rectopexy, were used. The primary end points were recurrence and morbidity, and the secondary end points assessed were operative time and length of hospital stay. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed. RESULTS: Six studies, consisting of a total of 195 patients (98 open and 97 laparoscopic) were included. Analysis of the data suggested that there is no significant difference in recurrence and morbidity between laparoscopic abdominal rectopexy and open abdominal rectopexy. Length of stay was significantly reduced in the laparoscopic group by 3.5 days (95 percent confidence interval, 3.1-4; P < 0.01), whereas the operative time was significantly longer in this group, by approximately 60 minutes (60.38 minutes; 95 percent confidence interval, 49-71.8). CONCLUSIONS: Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regards to recurrence and morbidity and favorably with length of stay. However large-scale randomized trials, with comparative, sound methodology are still needed to ascertain detailed outcome measures accurately.
文摘Objective: Axis and support of the vagina can be restored by sacrocolporectopexy with preservation of coital function. We developed a new technique of transvaginal sacrocolporectopexy for patients with prolapse of uterus and vagina or prolapse of the vaginal vault. Study design: During a 4-year period, 20 patients with vaginal vault prolapse and 83 patients with uterine and vaginal prolapse underwent transvaginal sacrocolporectopexy. Intra-and post-operative complications were recorded. After a mean follow-up period of 24 months (6-48), the result of surgery with respect to prolapse, incontinence, and sexuality was evaluated by patient interviews. Results: No serious perioperative complications occurred with the exception of one patient with bleeding from a presacral vein. Subjectively, 84 patients (82%) were cured of prolapse symptoms. One patient had recurrent grade II vault prolapse and four patients deve-loped a grade II rectocele. Five patients developed urge incontinence grade I. One patient developed fecal incontinence. No patient had coital problems as a sequelae of sacrocolporectopexy. Conclusion: Transvaginal sacrocolporectopexy is a safe procedure with a success rate comparable to sacrospinous fixation.
文摘目的观察吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)联合直肠黏膜柱状缝合固定术(Block)治疗女性直肠前突的临床疗效。方法选取2019年11月至2022年5月中国中医科学院广安门医院收治的女性直肠前突患者90例,采用随机数字表法分为PPH手术组30例、Block手术组30例、PPH联合Block手术组30例。比较三组患者围术期相关指标、手术前后Longo’s排便梗阻综合征(Longo’s ODS)评分、直肠前突深度及术后并发症发生情况。结果PPH手术组手术时间、术中出血量、术后VAS评分明显低于Block手术组和PPH联合Block手术组,差异有显著性(P<0.05);三组住院时间相近,Block组和PPH联合Block手术组在围术期各项相关指标相近,差异无显著性(P>0.05)。三组术前Longo’s ODS评分及直肠前突深度差异无显著性(P>0.05),三组患者术后3个月Longo’s ODS评分及直肠前突深度明显低于术前,差异有显著性(P<0.05);PPH联合Block手术组术后3个月Longo’s ODS评分及直肠前突深度低于其他两组,差异有显著性(P<0.05);Block手术组与PPH手术组术后Longo’s ODS评分及直肠前突深度差异无显著性(P>0.05)。PPH联合Block手术组显效率明显高于其他两组,差异有显著性(P<0.05),Block手术组与PPH手术组显效率差异无显著性(P>0.05)。三组术后并发症发生率差异无显著性(P>0.05)。结论PPH联合Block手术临床疗效优于单纯行PPH及Block手术,可有效纠正女性直肠前突的解剖异常改变,改善患者便秘症状。
文摘目的探讨腹腔镜直肠缝线固定术治疗完全性直肠脱垂的临床效果。方法对我院2010年1月至2014年1月采用腹腔镜直肠缝线固定术治疗的36例完全性直肠脱垂病例进行观察,并与同期采用腹腔镜直肠补片固定术治疗的16例同病种病例进行对照。结果采用直肠缝线固定术的平均手术时间明显短于直肠补片固定术(110±13 min vs 120±9 min,P<0.05),而且住院费用也较低(16227±845元vs 19143±1163元,P<0.05)。两组在平均术中出血量、平均术后肛门恢复排气时间、平均术后住院时间方面相比均无统计学差异。两组患者均无术后早期并发症。中位随访时间26个月,两组患者在术后1月和术后1年的直肠脱垂复发率、Wexner便秘评分、胃肠生活质量指标GIQLI均无显著性差异(P>0.05)。结论腹腔镜直肠缝线固定术对治疗完全性直肠脱垂具有手术创伤小、恢复快、住院时间短、费用低等优点,而近期和远期随访均具有满意的效果。
