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Robotic Combined Anterior & Posterior Repair of a Rectal Prolapse, Rectocele, and Sigmoidocele with a Mesh

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Borsuk D., Studniarek A., Gantt G., Kochar K., Marecik S.
Polish Journal of Surgery
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2019
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vol. 91(5)
34-37
EN
RP is often seen in patients over the age of fifty, particularly women. These patients frequently suffer from other concomitant pathologies like rectocele, sigmoidocele, cystocele, or even enterocele. Rectopexy with a mesh has been an established treatment for rectal prolapse. The utilization of the robotic system allows for a successful repair within a confined pelvic space, especially for precise suture placement when working with the mesh. A 77-year-old female presented with ODS symptoms found to be caused by a progressive rectal prolapse. Her pre-operative ODS score was 9/20. Pelvic floor evaluation revealed concomitant rectocele and sigmoidocele. The patient was offered a robotic-assisted rectopexy with mesh placement to address the three concomitant pathologies. During the procedure, a posterior mesorectal mobilization with autonomic nerve preservation was performed to address the posterior leading edge of the prolapse. Subsequently, the vagina was separated from the anterior portion of the rectum and dissected down to the levator ani muscle and the perineal body. This allowed for the affixation of a polypropylene mesh to the anterior portion of the rectum. Anterior suspension of the mobilized rectum with the mesh addressed all three pathologies. No recurrence or complications occurred at two-year follow-up. The patient’s ODS score decreased to 1/20.
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The Effect of Surgical Treatment on Anal Sphincter Function in Patients with Rectal Prolapse

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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.
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Mikulicz’S Procedure with Levator Muscle and External Anal Sphincter Plasty in the Treatment of Rectal Prolapse

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Waniczek D., Copija A., Janiszewska J., Maruszczak P., Raźnikiewicz A., Arendt J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 12
626-631
EN
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.
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Rectal Prolapse in Young Women

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Wnęk B., Waraczewski K., Chalcarz M., Kędzia A., Łożyńska-Nelke A., Hołodyńska P.
Polish Journal of Surgery
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2013
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vol. 85
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issue 8
438-445
EN
Rectal prolapse belongs to the group of rare diseases of the rectum and anus. It is mostly observed in elderly multiparous women in the seventh and eighth decade. The precise cause of this pathology is not thoroughly understood that is why there are no optimal standards of treatment. The aim of the study was to present pathophysiology, diagnostics and optimal surgical procedures employed in young patients with rectal prolapse. Material and methods. Out of a 56-patient group treated in Department of General and Colorectal Surgery in the years 2006-2011 a smaller one consisting of 11 young women between the ages 20-40 was selected. According to the literature this is a very rare time of the mentioned pathology occurrence. In the studied females grade of rectal prolapse as well as faecal incontinence based on Jorge-Wexner’s (Cleveland) scale were assessed before and after the operative treatment. All of them underwent transabdominal Wells and Frikman-Goldberg prolapse procedures. Results. Transabdominal approaches repair pathologies of the pelvic floor and have promising longstanding results improving quality of life. No rectal prolapse recurrences were observed. The mean score of the Wexner’s grading system was 7.81 diminishing to 1.9 points postoperatively. Conclusions. Rectal prolapse if untreated, is a pathology that substantially changes patients’ quality of life for the worse. Individual, standardized surgical approach to each patient is necessary. Transabdominal methods carry a low risk of complications and improve quality of life of young patients enabling a relatively quick return to normal life
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Abdominal Rectopexy with Absorbable and Non-Absorbable Materials in the Treatment for Rectal Prolapse

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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.
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