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.

Tannic acid-loaded hydrogel coating endues polypropylene mesh with hemostatic and antiinflammatory capacity for facilitating pelvic floor repair

The application of polypropylene mesh(PPM)in pelvic organ prolapse(POP)treatment was severely limited by the complications associated with PPM,such as mesh exposure,chronic inflammatory reactions and postoperative hematoma.This study applied a method of fabricating a hydrogel-mesh complex(PPM+TA@GelMA)to cross-link tannic acid(TA)directly with Methacrylate Gelatin(GelMA)hydrogel and thus to form a coating for PPM.This one-step coating modification improved the hydrophilicity and cyto-compatibility of PPM.The hemostatic effect of PPMtTA@GelMA was confirmed through tail amputation test.Through the defect tissue repair experiments in vivo,it was proved that PPMtTA@GelMA had effects of anti-inflammation and promoting tissue repair and regulated the M2 subtype macrophages polarization for tissue repair.The TAloaded hydrogel coating endued PPM with multiple functions.It is believed that the novel hydrogel-mesh complex and its fabrication method will have great significance in basic research and clinical application.

A novel antibacterial biomaterial mesh coated by chitosan and tigecycline for pelvic floor repair and its biological performance

The biomaterials composed of mammalian extracellular matrix(ECM)have a great potential in pelvic floor tissue repair and functional reconstruction.However,bacterial infection does cause great damage to the repair function of biomaterials which is the major problem in clinical utilization.Therefore,the development of biological materials with antimicrobial effect is of great clinical significance for pelvic floor repair.Chitosan/tigecycline(CS/TGC)antibacterial biofilm was prepared by coating CS/TGC nanoparticles on mammalian-derived ECM.Infrared spectroscopy,scanning electron microscopy,bacteriostasis circle assay and static dialysis methods were used to characterize the membrane.MTS assay kit and DAPI fluorescence staining were used to evaluate cytotoxicity and cell adhesion.The biocompatibility was assessed by subabdominal implantation model in goats.Subcutaneous antimicrobial test in rabbit back was used to evaluate the antimicrobial and repairing effects on the infected wounds in vivo.Infrared spectroscopy showed that the composite coating had been successfully modified.The antibacterial membrane retained the main structure of ECM multilayer fibers.In vitro release of biomaterials showed sustained release and stability.In vivo studies showed that the antibacterial biological membrane had low cytotoxicity,fast degradation,good compatibility,anti-infection and excellent repair ability.

Sphincteroplasty for anal incontinence

Sphincteroplasty(SP)is the operation most frequently performed in patients suffering from moderate-to-severe anal incontinence(AI)who do not respond to conservative treatment.Other costly surgeries,such as artificial bowel sphincter(ABS)and electro-stimulated graciloplasty,have been more or less abandoned due to their high morbidity rate.Minimally invasive procedures are widely used,such as sacral neuromodulation and injection of bulking agents,but both are costly and the latter may cure only mild incontinence.The early outcome of SP is usually good if the sphincters are not markedly denervated,but its effect diminishes over time.SP is more often performed for post-traumatic than for idiopathic AI.It may also be associated to the Altemeier procedure,aimed at reducing the recurrence rate of rectal prolapse,and may be useful when AI is due either to injury to the sphincter,or to a narrowed rectum following the procedure for prolapse and haemorrhoids(PPH)and stapled transanal rectal resection(STARR).The outcome of SP is likely to be improved with biological meshes and post-operative pelvic floor rehabilitation.SP is more effective in males than in multiparous women,whose sphincters are often denervated,and its post-operative morbidity is low.In conclusion,SP,being both low-cost and safe,remains a good option in the treatment of selected patients with AI.