Methylene blue submucosal infiltration may facilitate transanal submucosal dissection

Cuda, Tahleesa; Riddell, Andrew D.; Westwood, David A.; Hamilton, Amber; Stevenson, Andrew

doi:10.1111/codi.13872

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…S4). Injection of a dilute solution of methylene blue and adrenaline (800 mL of saline mixed with 0.25 mL methylene blue and 0.5 mL of 1:1000 adrenaline) in the submucosal plane allows clear delineation between the submucosa which will be stained blue and the muscularis propria which will appear ivory white 10 . The submucosal infiltration also elevates the mucosa to aid in dissection and provides haemostasis (Fig.…”

Section: Figmentioning

confidence: 99%

How to do a Delorme's sleeve mucosectomy and muscular plication for full‐thickness rectal prolapse

Lonne

Sakata

Pappas

et al. 2023

ANZ Journal of Surgery

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How to do a Delorme's sleeve mucosectomy and muscular plication for full-thickness rectal prolapse Full thickness, or complete rectal prolapse, is a circumferential protrusion of all layers of the rectum through the anus. This disabling condition is common in the elderly and is associated with chronic complications such as difficulty maintaining perianal hygiene, faecal incontinence and mucus discharge, as well as acute complications related to the prolapse itself including pain, ulceration, bleeding, incarceration and gangrene. 1 Surgery is the only definitive treatment option for rectal prolapse and but there is no single, accepted standard procedure. [1][2][3] Minimally invasive trans-abdominal surgery, such as ventral rectopexy using synthetic or biologic grafts and resection rectopexy, have become widespread in this modern era, 4-6 and perineal approaches, such as the Altmeier's and Delorme's procedures, are generally offered to frail patients who are unable to tolerate pneumoperitoneum.The Altmeier's procedure is a perineal rectosigmoidectomy. 7 The Delorme's procedure on the other hand, is a perineal sleeve mucosectomy with muscular plication, and this cannot be offered to patients with prolapse necrosis requiring resection. Both perineal operations are associated with low morbidity and acceptable recurrence rates. 3 Prone jack-knife position provides both primary and assistant surgeons optimal comfort and space to work, as well as exposure and circumferential access to the prolapse. We do not place the patient in lithotomy as is commonly described where possible because, while it is standard for the primary surgeon to be seated square in between the patient's raised legs, it is usual for the surgical assistant to have to stand up and bend-over throughout the operation to see and assist. 8 We find it much easier to approach the prolapse in prone jack-knife and are able to suction any blood efficiently in this position. 9 Here, we offer a step-by-step description of the Delorme's procedure in our favoured prone jack-knife position for elective patients with full-thickness rectal prolapse. The principles of this technique are to reduce the prolapse, relieve incontinence and prevent obstructive defecation.

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Section: Figmentioning

confidence: 99%

How to do a Delorme's sleeve mucosectomy and muscular plication for full‐thickness rectal prolapse

Lonne

Sakata

Pappas

et al. 2023

ANZ Journal of Surgery

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“…Submucosal injection with a solution of 0.25 mL of methylene blue and 1 mL of 1:1000 epinephrine diluted in 800 mL normal saline is used to clearly delineate the submucosa, which will be stained blue, and the muscularis propria, which will remain white. 1 A circumferential mucosectomy is performed using sharp dissection, and 2-0 absorbable monofilament sutures are used for full-thickness muscular plication. Postoperatively, patients stay 1 to 2 nights in the hospital and are discharged home on a course of metronidazole, fiber supplements, and a polyethylene glycol laxative.…”

mentioning

confidence: 99%

Sutured Transanal Mucosectomy and Plication Procedure

Cao,

Lonne,

Moloney

et al. 2024

Diseases of the Colon &Amp; Rectum

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Oral Patch/Film for Drug Delivery—Current Status and Future Prospects

Yan,

et al. 2024

Biopolymers

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In recent years, there has been extensive research into drug delivery systems aimed at enhancing drug utilization while minimizing drug toxicities. Among these systems, oral patches/films have garnered significant attention due to their convenience, noninvasive administration, ability to bypass hepatic first‐pass metabolism, thereby enhancing drug bioavailability, and their potential to ensure good compliance, particularly among special patient populations. In this review, from the perspective of the anatomical characteristics of the oral cavity and the advantages and difficulties of oral drug delivery, we illustrate the design ideas, manufacturing techniques, research methodologies, and the essential attributes of an ideal oral patch/film. Furthermore, the applications of oral patches/films in both localized and systemic drug delivery were discussed. Finally, we offer insights into the future prospects of the oral patch/film, aiming to provide valuable reference for the advancement of oral localized drug delivery systems.

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Methylene blue submucosal infiltration may facilitate transanal submucosal dissection

Cited by 4 publications

References 6 publications

How to do a Delorme's sleeve mucosectomy and muscular plication for full‐thickness rectal prolapse

How to do a Delorme's sleeve mucosectomy and muscular plication for full‐thickness rectal prolapse

Sutured Transanal Mucosectomy and Plication Procedure

Oral Patch/Film for Drug Delivery—Current Status and Future Prospects

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