Life after <scp>PROSPER</scp>. What do people do for external rectal prolapse?

Gunner, Charlotte; Senapati, Asha; Northover, John; Brown, S. R.

doi:10.1111/codi.13255

Cited by 26 publications

(22 citation statements)

References 10 publications

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“…Robotic surgery eases suturing and enables reinforcement of the stapled anastomosis, facilitating intracorporeal anastomoses [2]. The latter have been associated with reduced incidence of hernia and faster recovery [3]. Drawbacks of the robotic approach are the associated costs and longer operative time [4].…”

Section: Conflicts Of Interestmentioning

confidence: 99%

A stepwise approach to Delorme’s procedure for rectal prolapse – a video vignette

Sridhar

Mittal

2020

Colorectal Disease

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Multiple abdominal and perineal approaches have been described for the treatment of full-thickness rectal prolapse. There has been no consensus on the optimal approach, with randomized controlled trials and metaanalysis failing to show superiority of any particular approach [1,2]. Recently, use of the laparoscopic abdominal approach has increased, although this technique may not be suitable for all patients [3]. The Delorme's procedure is useful for treating rectal prolapse in elderly patients with significant comorbidities, patients at high risk for general anaesthesia and patients with recurrence after an abdominal procedure [4,5]. We describe the steps of the procedure in a 65-yearold man with a recurrent rectal prolapse (Video S1). The procedure can be performed under general or spinal anaesthesia, with the patient in the lithotomy position. Use of a headlight is advisable. The prolapse is reproduced to assess the length of mucosectomy required (double the length of the prolapse). After application of a Lone Star retractor (Cooper Surgical, Trumbull, CT, USA), the dentate line is visualized and the mucosa marked circumferentially 2 cm proximally. The submucosa is infiltrated with a saline/ adrenaline solution (1:100 000) and incised circumferentially. A mucosal sleeve is developed, with care being taken not to buttonhole the mucosa or the muscle. This is followed by plication of the muscle with 2-0 or 3-0 Polydioxanone and mucosal approximation with 3-0 polygalactin. Our patient made an uneventful recovery and was recurrence-free 10 months after the procedure. The Delorme's procedure can be a valuable tool for treating a select group of patients with rectal prolapse. A stepwise approach helps to standardize the procedure and reduces intra-operative complications and postoperative morbidity.

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Section: Conflicts Of Interestmentioning

confidence: 99%

A stepwise approach to Delorme’s procedure for rectal prolapse – a video vignette

Sridhar

Mittal

2020

Colorectal Disease

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“…A recent randomized control trial (PROSPER) did not show any significant difference in recurrence rates between abdominal and perineal approaches . Limiting factors in this and most studies have been the differences in follow‐up duration, cohort size and institutional preferences in surgical approach . A recent Dutch guideline concluded that higher quality studies are required .…”

Section: Introductionmentioning

confidence: 99%

“…Perineal approaches include Delorme's repair (DR), perineal rectosigmoidectomy (PR, also known as Altemeier's repair) and Thiersch encirclement procedures. Traditionally, the perineal approach is reserved for the frail and elderly as it can be performed under spinal anaesthesia and its morbidity is reportedly lower . On the other hand, an abdominal approach is considered to have a lower recurrence rate, but it is generally associated with higher morbidity rates.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of surgical management of rectal prolapse

Levitt

Makin

et al. 2019

ANZ Journal of Surgery

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Background: Various surgical options for rectal prolapse are available but none have been shown to be clearly superior. The aims of this study were to investigate the long-term recurrence rate of a variety of surgical approaches, their associated morbidities and the types of reoperation used to treat recurrence. Methods: A retrospective analysis was performed of all cases of rectal prolapse surgery within one colorectal surgical unit between January 2000 and June 2017. Abdominal approaches consisted of rectopexy (RP) and resection rectopexy (RRP); perineal approaches included perineal rectosigmoidectomy (PR) and Delorme's repair (DR). Complications were graded according to the Clavien-Dindo classification. The median follow-up was 4.5 years (interquartile range 1.5-10.1, maximum 16.5). Statistical analysis was performed using Kaplan-Meier to determine recurrence rates. Results: A total of 157 patients were included in the study. The numbers for each procedure were: DR (n = 55), RRP (n = 44), RP (n = 38) and PR (n = 20). The majority were females (94%). The perineal group were significantly older than the abdominal group (80 versus 67 years, P = 0.0001). At 5 years, the recurrence rates were 52%, 30%, 5% and 3% for DR, PR, RP and RRP, respectively. Morbidity was highest in PR (20%) followed by RRP (18%), RP (16%) and DR (7%) (n.s.). The overall morbidity rates for perineal group and abdominal group were 10.7% and 17.1%, respectively (n.s.). Conclusion: Abdominal approaches have a significantly lower recurrence rate at 5 years but tend to be associated with higher morbidity.

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“…In this article we focus on surgical management of full thickness rectal prolapse. There are a range of surgical techniques available (box 1),23 but there is no consensus on which is the most effective 5. Traditionally, the open abdominal procedure was reserved for younger, fitter patients, and perineal procedures were preferred for older people as they are considered safer 3…”

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confidence: 99%