Histological and mechanical differences in the skin of patients with rectal prolapse

Joshi, H. M.; Woods, Alex; Smyth, E.; Gosselink, M.; Cunningham, Chris; Lindsey, Ian; Urban, J; Jones, Oliver; Vollrath, Friz

doi:10.1007/s00384-015-2222-x

Cited by 13 publications

(7 citation statements)

References 18 publications

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“…4,24 This notion is strengthened by the observations of higher rates of RP and POP among women with hereditary CTDs, such as Marfan and Ehlers-Danlos syndrome, 23,27 and alterations in elastin composition and metabolism. 28,29 Although CTD/myopathy was not significantly associated with RPR in our study, likely because of the small numbers, it is possible that some women had undiagnosed or subclinical connective tissue abnormalities that predisposed them to RP, POP, and RPR. Consistent with previously published findings, 22 we did not identify aging as an independent risk factor for RPR.…”

Section: Discussioncontrasting

confidence: 54%

Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse

Catanzarite

Klaristenfeld

Tomassi

et al. 2018

Diseases of the Colon &Amp; Rectum

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BACKGROUND Pelvic organ prolapse is prevalent among women with rectal prolapse. OBJECTIVE This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair. DESIGN A retrospective cohort. SETTING This study was performed at a single managed-care institution. PATIENTS Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURES Full-thickness rectal prolapse recurrence was compared between 4 groups: abdominal repair without pelvic organ prolapse (AR−POP); abdominal repair with pelvic organ prolapse (AR+POP); perineal repair without pelvic organ prolapse PR−POP; and perineal repair with pelvic organ prolapse (PR+POP). Recurrence-free period and hazard of recurrence were compared using Kaplan-Meier and Cox proportional hazards methods. To identify potential confounding risk factors for rectal prolapse recurrence, the characteristics of subjects with/without recurrence were compared with univariable and multivariable analyses. RESULTS Overall, pelvic organ prolapse was present in 33% of 112 women and was more prevalent among subjects with rectal prolapse recurrence (52.4% vs 28.6%, p = 0.04). Median follow-up was 42.5 months; rectal prolapse recurrence occurred in 18.8% at a median of 9 months. The rate of recurrence and the recurrence-free period differed significantly between groups: AR−POP 3.8%, 95.7 months; AR+POP 13.0%, 86.9 months; PR−POP 34.8%, 42.1 months; PR+POP 57.1%, 23.7 months (p < 0.001). Compared with AR−POP the HR (95% CI) of rectal prolapse recurrence was 3.1 (0.5–18.5) for AR+POP; 14.7 (3.0–72.9) for PR−POP and 31.1 (6.2–154.5) for PR+POP. Compared with AR+POP, PR+POP had a shorter recurrence-free period (p < 0.001) and a higher hazard of recurrence (HR, 10.2; 95% CI, 2.1–49.3). LIMITATIONS The retrospective design was a limitation of this study. CONCLUSIONS Pelvic organ prolapse was associated with a higher rectal prolapse recurrence rate and earlier recurrence in women undergoing perineal, but not abdominal, repairs. Multidisciplinary evaluation can facilitate individualized management of women with rectal prolapse. Abdominal repair should be considered in women with concomitant rectal and pelvic organ prolapse. See Video Abstract, at http://links.lww.com/DCR/A513.

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Section: Discussioncontrasting

confidence: 54%

Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse

Catanzarite

Klaristenfeld

Tomassi

et al. 2018

Diseases of the Colon &Amp; Rectum

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“…In 2015, Joshi et al [8] demonstrated a significant increase in the dermal elastic fibers in patients with RP compared to normal control patients.…”

Section: Dear Sirmentioning

confidence: 98%

Hiatal hernia, mitral valve prolapse and defecatory disorders: An underlying rectal prolapse?

et al. 2016

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The treatment of rectal prolapse (RP) remains a surgical challenge with a recurrence rate as high as 30 %, being usually between 10 and 20 %. These results lead to a continuous search for the ideal surgical treatment. The majority of failures might be secondary to patients' selection among what is probably an excessively large number of surgical options. The aim is a tailored surgical approach that, addressing all the anatomical changes associated with rectal prolapse, may reduce recurrence rates. Clinical experience shows that sometimes even when surgical results are good with satisfactory anatomical restoration, functional results are not. Ultra-structural changes might exist due to chronic straining as well as pre-existing disorders leading to general pelvic floor weakness. If these factors are recognized before surgery, they might affect the patient's choice of procedure thus reducing recurrence.Recently, we evaluated longer-term results of 183 patients who underwent laparoscopic ventral mesh rectopexy (LVR) for both internal and external rectal prolapse. Median follow-up was 24 months, and 21 patients experienced recurrence (11 %). Reviewing our data, we observed a higher incidence of hiatal hernia (HH) in patients with recurrence.Briefly, data on previous upper-gastrointestinal endoscopy were available for 86 patients out of 183. Of those, 32 had a documented HH (35 % considering only those with documentation) before surgery. HH was more common in patients with RP recurrence: 14 out of 21 (66.7 %). Analyzing comorbidities in this cohort of patients with recurrence, we observed that 8 patients (38 %) had also mitral valve prolapse (MVP). Overall the MVP was reported in 19 out of 183 patients (10 %). However, this percentage is obviously underestimated being obtained from retrospective information about patients who had undergone cardiac evaluation in the past.We decided to assess whether this apparently strong association between HH and MVP among patients with recurrent RP after LVR might exist in a cohort of patients with a proven HH.From a prospectively kept database, we identified female patients with an endoscopically proven HH. To reduce bias in patient selection, only patients with a body mass index \30 kg/cm 2 were considered. Patients with previous cardiothoracic, abdominal (other than appendectomy or cholecystectomy), or pelvic floor surgery were excluded. Patients with chronic pulmonary disease as well as neoplastic or inflammatory bowel disease were also excluded. Patients suitable for the study were studied for defecatory disorders (DDs) including constipation and incontinence.DDs were evaluated using the Wexner Constipation Score (WCS) and the Fecal Incontinence Severity Index (FISI). A WCS C5 and a FISI C10 were considered clinically relevant. Patients with abnormal scores underwent proctological examination and a proctogram. The prolapse was graded after the proctogram using the Oxford Prolapse Grading System (internal rectal prolapse: I-IV; external rectal prolapse: V) and considering severe ...

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“…Animal studies appear to support our hypothesis that, in part, fibulin deficiency or deficiency in elastin homeostasis may play a role in the development of prolapse [6,8,24]. Mice lacking lysyl oxidaselike 1 (LOXL-1), a key protein in the assembly of elastic fibres, do not deposit normal elastin fibres in the uterine tract postpartum and subsequently develop prolapse [5]. Drewes et al [8] and Budatha et al [22] showed that mice deficient in fibulin-5 also developed prolapse.…”

Section: Discussionmentioning

confidence: 71%

Expression of fibulin‐5 in the skin of patients with rectal prolapse

et al. 2015

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Histological and mechanical differences in the skin of patients with rectal prolapse

Abstract: Patients with prolapse have a higher concentration of elastin fibres in the skin, and these differences are quantitatively demonstrated through mechanical testing. This suggests that the aetiology may be a result of a dysfunction of elastin fibre assembly.

Cited by 13 publications

References 18 publications

Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse

Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse

Hiatal hernia, mitral valve prolapse and defecatory disorders: An underlying rectal prolapse?

Expression of fibulin‐5 in the skin of patients with rectal prolapse

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