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Surgical Treatment of Rectocele as the Most Common Cause of Rectal Voiding Disturbances. Own Experience with the Use of Prosthetic Material

100%
Kościński T., Stadnik H.
Polish Journal of Surgery
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2010
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vol. 82
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issue 10
556-563
EN
The aim of the study was to present different methods of reconstruction in case of rectovaginal septum defects, considering female patients with impaired colorectal voiding.Material and methods. During the period between 2001 and 2010, 39 female patients, aged between 42 and 75 years (mean age-58 years) were subject to surgical intervention. Patients complained of voiding disturbances, sensation of a "mass" in the pelvis (64.1%), dyspareunia (30.8%), anal sphincter insufficiency (17.9%) and urinary incontinence (10.3%).Defecography and MRI examinations confirmed rectocele (100%), enterocele (46.6%), pelvic floor prolapse (35.9%), vaginal prolapse (30.8%), and rectal prolapse (25.6%).Considering the surgical treatment of rectocele the following prosthetic material was used: polypropylene mesh and collagen implants (Pelvicol ®). In case of 19 patients with low rectocele the transvaginal approach was used. In case of high rectocele and coexisting pelvic organ prolapse the mesh was implanted by means of laparotomy (12 pts) or the abdomino-vaginal approach (8 pts).Results. Permanent reconstruction of the rectovaginal septum and withdrawal of voiding disturbances was observed in all patients operated by means of the transvaginal approach. Dyschesia symptoms were present in 16.6% of patients after mesh implantation by means of laparotomy, and in 12.5% of patients after the abdomino-vaginal approach. 10.3% of patients complained of pelvic pain and rectal tenesmus. All the above-mentioned symptoms were observed after polypropylene mesh implantation. The percentage of reoperations, due to complications amounted to 17.9%. Insignificant erosion of the prosthetic material was diagnosed in 7.7% of patients. 94.6% of patients were satisfied with the proposed treatment.Conclusions. The use of prosthetic material in the treatment of pelvic floor anatomical defects is an effective and safe method, considering patients with colorectal voiding disturbances.
2
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The Effect of Surgical Treatment on Anal Sphincter Function in Patients with Rectal Prolapse

100%
Kościński T., Stadnik H.
Polish Journal of Surgery
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2008
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vol. 80
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issue 2
75-80
EN
The aim of the study was analysis of an anal sphincter function in patients before and after surgery for rectal prolapse.Material and methods. Between 1987 and 2005, 49 patients underwent operations for rectal prolapse. The anal sphincter function was analyzed in 17 of these patients. Abdominal approach surgery was performed in 13 patients; this involved rectopexy in 11 and sigmorectal resection in two others. A transanal approach was chosen in four patients, with the Mikulicz technique in two cases, the Delorme procedure in one, and the Altmeier procedure in the remaining case.Results. In all patients who were operated using the transanal approach, we observed some regression in anal sphincter insufficiency. Among the patients operated using the abdominal approach, first degree incontinence persisted in three cases, second degree in five cases, and third degree persisted in four cases. As a result of the surgical treatment of rectal prolapse by rectopexy and transanal approach, we observed a statistically significant increase in the resting anal sphincter pressure; this increase on average reached 58.8 mm Hg. A statistically significant increase in the average maximum squeeze anal sphincter pressure (95.9 mm Hg) was attained after the surgical procedures were performed on patients with rectal prolapse.Conclusion. The results suggest that the improvement of anal function in the control of stool and flatus after surgical treatment for rectal prolapse appears to be the result of an increase in the rest and maximal squeeze pressures of the anal sphincters.
3
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Abdominal Rectopexy with Absorbable and Non-Absorbable Materials in the Treatment for Rectal Prolapse

81%
Kościński T., Meissner W., Stadnik H.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
668-671
EN
The aim of the study was to present and compare own results of abdominal rectopexy performed with absorbable and nonabsorbable materials used in surgical repair of rectal prolapse.Material and methods. In the years 1991-2009, 50 patients were operated on for rectal prolapse. The first 8 patients (group I) were operated using absorbale polyglycolic acid mesh. The next 42 patients were operated using non-absorbable polypropylene mesh (group II). 12 patients with chronic, incurable constipation had sigmoidectomy and rectopexy performed at the same operation. Rectopexy was performed with the mesh and fixed to the pelvic fascia and periosteum and mesorectum, leaving the anterior one third of the rectum free. 6 months after surgery functional outcomes were evaluated. Statistic analysis with the level of statistical significance p<0,005 was applied to obtained functional results.Results. On the follow up visits, there were no symptoms of the recurrence of rectal prolapse in 5 patients (62.5%) from group I and in 25 patients (92.6%) from group II. Patients relapsing were reoperated 24 to 98 months after primary surgery. In all patients from group I (absorbable mesh), prosthetic material was not found at reoperation. In redo surgery only non-absorbable mesh was used.Conclusions. The effectiveness of rectal fixation depends on the on the durability of the prosthetic material. In the studied group polypropylene mesh was superior in rectopexy to absorbable mesh.
4
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Assesment of Diagnostic and Prognostic Value of Transduodenal Fine Nedle Biopsy in Patients with Tumors of the Pancreatic Head in the Material of Deparment of General, Gastroenterological and Endocrinological Surgery, Medical University in Poznań

61%
Stadnik H., Brzuzgo K., Szmeja J., Janicka-Jedyńska M., Majewski P., Drews M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 11
591-595
EN
Pancreatic cancer is the thirteen leading most common malignancy, accounting for up to 2% of all malignancies. In majority of cases pancreatic cancer is diagnosed when local progression of the malignancy makes radical surgical treatment impossible. The extent of surgical treatment of tumors of the pancreatic head is planned on the basis of preoperative imaging studies and endoscopic studies and the final decision depends on intraoperative assessment of the lesion progression and results of cytological or histopathological examination of intraoperatively collected specimens. Fine needle aspiration biopsy (FNAB) is performed before possible resection of the tumor of the pancreatic head.The aim of the study was to compare results of FNAB with final histopathological assessment of collected specimen and survival of patients with negative cytological examination and patients in whom transduodenal fine needle aspiration biopsy confirmed the presence of cancer cells.Material and methods. This retrospective study involved 63 patients hospitalized due to tumor of the pancreatic head in Department of General, Gastroenterological and Endocrinological Surgery between 2000 and 2007. All patients underwent fine needle aspiration biopsy during the laparotomy. In some patients, an intraoperative decision was taken to proceed to core biopsy from suspected malignancy sites despite negative result of cytological examination. This analysis included only patients with evaluable material collected for cytological examination. Long-term results of treatment were obtained basing on clinical examination of patients who attended a follow-up visit and telephone survey conducted among patients and their families in the event of patients who did not attend a followup visit.Results. The longest overall survival of patients with positive cytological examination who underwent a palliative procedure was 10 months, while in patients who underwent radical treatment amounted to 2 years. Sensitivity of fine needle aspiration biopsy (FNAB) in our study was 85.7%Conclusions. FNAB is an indispensible part of diagnostic workup in the pancreatic cancer and cannot be omitted even in inoperable cancers confirmed by imaging studies. FNAB not only guides surgical treatment but also dictates adequate adjuvant and neoadjuvant systemic therapy - radio- and chemotherapy.
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