Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function

Background:The problem of complete rectal prolapse is formidable, with no clear predominant treatment of choice. Surgical management is aimed at restoring physiology by correcting the prolapse and improving continence and constipation with acceptable mortality and recurrence rates. Abdominal procedures are ideal for young fit patients, whereas perineal procedures are reserved for older frail patients with significant comorbidity. Laparoscopic procedures with their advantages of early recovery, less pain, and possibly lower morbidity are recently added options. Regardless of the therapy chosen, matching the surgical selection to the patient is essential.Objective: To review the present status of the surgical treatment of rectal prolapse.Data Sources: Literature review using MEDLINE. All articles reporting on rectopexy were included.Study Selection: Articles reporting on prospective and retrospective comparisons were included. Case reports were excluded, as were studies comparing data with historical controls. Data Extraction:The results were tabulated to show outcomes of different studies and were compared. Studies that did not report some of the outcomes were noted as "not stated."Data Synthesis: Abdominal operations offer not only lower recurrence but also greater chance for functional improvements. Suture and mesh rectopexy produce equivalent results. However, the polyvinyl alcohol (Ivalon) sponge rectopexy is associated with an increased risk of infectious complications and has largely been abandoned. The advantage of adding a resection to the rectopexy seems to be related to less constipation. Laparoscopic rectopexy has similar results to open rectopexy but has all of the advantages related to laparoscopy. Perineal procedures are better suited to frail elderly patients with extensive comorbidity.Conclusions: Abdominal procedures are generally better for young fit patients; the results of all abdominal procedures are comparable. Suture and mesh rectopexy are still popular with many surgeons-the choice depends on the surgeon's experience and preference. Similarly, the procedure may be done through a laparoscope or by laparotomy. Perineal procedures are preferable for patients who are not fit for abdominal procedures, such as elderly frail patients with significant comorbidities. The decision between perineal rectosigmoidectomy and Delorme procedures will depend on the surgeon's preference, although the perineal rectosigmoidectomy has better outcomes.

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“…38,50 A number of studies have looked at the effect of the division or preservation of ligaments and are shown in Table 5 and Table 6.…”

Section: Role Of Division Of Ligamentsmentioning

confidence: 99%

Surgical Management of Rectal Prolapse

Madiba

Baig²,

Wexner³

2005

Arch Surg

304

228

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“…Bei unvollständiger Durchtrennung scheint die Rezidivrate erhöht, allerdings das funktionelle Ergebnis günstiger, da die postoperative Inkontinenz und Obstipation weniger ausgeprägt sind [16,18,23]. Die Reduktion postoperativer Entleerungsstörung durch eine Vermeidung der rektalen Mobilisation wird bei der ventralen Rektopexie diskutiert [6].…”

Section: Ausmaß Der Lateralen Rektummobilisationunclassified

Rektumprolaps

Matzel

Heuer²,

Zhang³

2008

Chirurg

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Surgical treatment of rectal prolapse aims to correct morphology and restore function. Many techniques are available, but none can be considered a gold standard. Abdominal approaches differ with regard to abdominal access, extent of rectal mobilisation, technique of rectal pexy, and concomitant sigmoid resection. Local (perineal/transanal) procedures plicate or resect the rectum. The choice of operative approach is based on the patient's condition and expected outcome of the procedure, e.g. recurrence rate, morbidity, and function. Abdominal operations are favored in fit patients, while local procedures are considered for the elderly and frail. This review compares differences in the most common techniques, focussing on recurrence, morbidity, and functional outcome.

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“…Mobilisation zu postoperativen Entleerungsstörung führt [18,23], die Dissektion auf den ventralen Aspekt des Rektums im Spatium rectovaginale limitiert und ein anterior am Rektum fixiertes Netz am Promontorium angeheftet [6].…”

Section: Praxis Coloproctologyunclassified