Mikulicz’S Procedure with Levator Muscle and External Anal Sphincter Plasty in the Treatment of Rectal Prolapse
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Rectal prolapse is the partial or complete protrusion of the rectal wall into the anal canal. The most common etiology consists in the insufficiency of the diaphragm of the lesser pelvis and anal sphincter apparatus. Methods of surgical treatment involve perineal or abdominal approach surgical procedures.The aim of the study was to present the method of surgical rectal prolapse treatment, according to Mikulicz’s procedure by means of the perineal approach, based on our own experience and literature review.Material and methods. The study group comprised 16 patients, including 14 women and 2 men, aged between 38 and 82 years admitted to the department, due to rectal prolapse, during the period between 2000 and 2012. Nine female patients, aged between 68 and 82 years (mean age-76.3 years) with fullthickness rectal prolapse underwent surgery by means of Mikulicz’s method with levator muscle and external anal sphincter plasty. The most common comorbidities amongst patients operated by means of Mikulicz’s method included cardiovascular and metabolic diseases.Results. Mean hospitalization was 14.4 days (ranging between 12 and 17 days). Despite advanced age and poor general condition of the patients, complications during the perioperative period were not observed. Good early and late functional results were achieved. The degree of anal sphincter continence was determined 6-8 weeks after surgery showing significant improvement, as compared to results obtained prior to surgery. One case of recurrence consisting in mucosal prolapse was noted, being treated surgically by means of Whitehead’s method. Good treatment results were observed.Conclusion. Transperineal rectosigmoidectomy using Mikulicz’s method with levator muscle and external anal sphincter plasty seems to be an effective, minimally invasive and relatively safe procedure that does not require general anesthesia. It is recommended in case of patients with significant comorbidities and high surgical risk.
1 - 12 - 2012
09 - 02 - 2013
- 1. Kim M, Reibetanz J, Boenicke L et al.: Quality of life after transperineal rectosigmoidectomy. BrJ Surg 2010; 97(2): 269-72.[Crossref]
- 2. Kościński T, Stadnik H, Sękowska M: Etiopathogenesis of the rectal prolapse. Gastroenterol Pol 2005; 12(2): 127-31.
- 3. Altemeier WA, Culbertson WR, Schowengerdt C et al.: Nineteen years’ experience with the onestage perineal repair of rectal prolapse. Ann Surg 1971; 173: 993-1006.[Crossref]
- 4. Beahrs OH, Theuerkauf FJ Jr, Hill JR: Procidentia: surgical treatment. Dis Colon Rectum 1972; 15: 337-46.[PubMed][Crossref][WoS]
- 5. Goldberg SM: Choosing the best operation for rectal prolapse in 2005. Proktologia 2005; 6(2): 121-31.
- 6. Madiba TE, Baig MK, Wexner SD: Surgical management of rectal prolapse. Arch Surg 2005; 140(1): 63-73.[Crossref][PubMed]
- 7. Riedel BD: Gastrointestinal manifestations of cystic fibrosis. Pediatric Annals 1997; 26: 235-41.[PubMed]
- 8. Meyers JO, Wong WD, Rothenberger D et al.: Rectal prolapse in males implications for management. Dis Colon Rectum 1990; 33: 28.
- 9. Ziembikiewicz A, Krasnodębski IW : Surgical treatment of full-thickness rectal prolapse. Proktologia 2005; 6 (4): 282-98.
- 10. Kimmins MH, Evetts BK, Isler J et al.: The Altemeier repair: outpatient treatment of rectal prolapse. Dis Colon Rectum 2001; 44(4): 565-70.[Crossref]
- 11. Pescatori M, Zbar AP: Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period. Colorectal Dis 2009, 11(4): 410-19.[WoS][Crossref]
- 12. Załęski S, Olszewski J, Lipiński S: Całkowite nieodprowadzalne wypadnięcie odbytnicy wyleczone sposobem Mikulicza. Pol Przegl Chir 1981; 53(6): 535-38.
- 13. Kościński T, Stadnik H: Leczenie chirurgiczne nawrotów wypadania odbytnicy - doświadczenia własne. Pol Przegl Chir 2006; 78(7): 757-65.
- 14. Mikulicz J: Zur operativen Behandlung des Prolapsus recti et coli invaginati. Arch Klin Chir 1889; 38: 74-97.
- 15. Miles WE: Recto-sigmoidectomy as a method of treatment for procidentia recti. JR Soc Med 1933; 26: 1445-52.
- 16. Miller R, Bartolo DC, Locke-Edmunds JS et al.: Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg 1988; 75: 101.
- 17. Zuo ZG, Song HY, Xu C et al.: Application of Altemeier procedure in the emergent management of acute incarcerated rectal prolapse. ZhonghuaWei Chang Wai Ke Za Zhi 2010; 13(6): 427-29.
- 18. Habr-Gama A, Jacob CE, Jorge JM, Seid VE et al.: Rectal procidentia treatment by perineal rectosigmoidectomy combined with levator ani repair. Hepatogastroenterology 2006; 53: 213-17.
- 19. Zbar AP, Takashima S, Hasegawa T et al.: Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Tech Coloproctol 2002; 6(2): 109-16.[Crossref]
- 20. Chun SW, Pikarsky AJ, You SY et al.: Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol 2004; 8(1): 3-8.[Crossref]
- 21. Glasgow SC, Birnbaum EH, Kodner IJ et al.: Recurrence and quality of life following perineal proctectomy for rectal prolapse. J Gastrointest Surg 2008; 12(8): 1446-51.[PubMed][Crossref]
- 22. Cirocco WC: The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum 2010; 53(12): 1618-23.[WoS][Crossref][PubMed]
- 23. Riansuwan W, Hull TL, Bast J et al.: Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World JSurg 2010; 34(5): 1116-22.[Crossref]
- 24. Deen KI, Grant E, Billingham C et al.: Abdominal resection rectopexy with pelvic floor repair versus rectosigmoidectomy and pelvic floor repair for fullthickness rectal prolapse. Br J Surg 1994; 81: 302-04.
- 25. R is F, Colin JF, Chilcott M et al.: Altemeier’s procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Colorectal Dis 2011; 12.[WoS]
- 26. Boccasanta P, Venturi M, Spennacchio et al.: Trans-Obturator Colonic Suspension (TOCS) during Altemeier’s Operation for Full-Thickness Rectal Prolapse: Preliminary Results with a New Technique. Colorectal Dis 2011; 1.[WoS]
- 27. Williams JG, Rothenberger DA, Madoff RD et al.: Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum 1992; 35(9): 830-34.[PubMed][Crossref]
- 28. Mongardini M, Iachetta RP, Cola A et al.: Altemeier operation associated with dynamic graciloplasty: a case report. J Med Case Reports 2009; 3: 9317.
- 29. Atallah S, Albert M, Debeche-Adams TH et al.: The Altemeier procedure using biologic mesh. TechColoproctol 2011.
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