Multimedia article. External pelvic rectal suspension (the express procedure) for internal rectal prolapse, with or without concomitant rectocele repair: a video demonstration.

Full Abstract

PURPOSE:
Internal rectal prolapse has been proposed as a cause of symptomatic rectal evacuatory dysfunction. Abdominal rectopexy, the standard surgical approach, has significant attendant risk and does not address any concomitant rectocele. This video was designed to demonstrate a novel surgical method that uses porcine collagen implants (Permacol), designed to correct internal rectal prolapse, with or without rectocele.

METHODS:
Inclusion criteria:
severe rectal evacuatory dysfunction refractory to maximal conservative therapy and full-thickness internal rectal prolapse impeding rectal emptying on defecography with or without associated functional rectocoele; normal colonic transit. Patients undergo comprehensive preoperative and postoperative symptomatic assessment and anorectal physiologic testing, including defecography. A crescenteric perineal skin incision allows development of the rectovaginal/rectoprostatic plane to Denonvilliers fascia, with rectal mobilization. A curved tunneller inserted via the perineal wound is guided retropubically to emerge through suprapubic wounds created on each side. Permacol T-strips are sutured to the anterolateral rectal wall bilaterally, upward traction exerted, and the stem of each T-strip is sutured to the suprapubic periosteum, suspending the rectum. Concomitant rectocele is repaired using a Permacol patch in the rectovaginal plane.

RESULTS:
Short-term results for the "Express" are encouraging with improvement in evacuatory and prolapse symptoms and concomitant anatomic improvement at defecography.

CONCLUSIONS:
This procedure promises to be an effective technique for managing patients with refractory evacuatory dysfunction secondary to internal rectal prolapse, with or without rectocele.

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Author information

Author/s: Dench, Julia E (JE); Scott, S Mark (SM); Lunniss, Peter J (PJ); Dvorkin, Lee S (LS); Williams, Norman S (NS);

Affiliation: Centre for Academic Surgery, GI Physiology Unit, The Royal London Hospital, Whitechapel, London, United Kingdom.

Journal and publication information

Publication Type: Interactive Tutorial

Journal: Diseases of the colon and rectum (Dis Colon Rectum), published in United States. (Language: eng)

Reference: 2006-Dec; vol 49 (issue 12) : pp 1922-6

Dates: Created 2006/11/30; Completed 2007/01/09; Revised 2007/12/06;

PMID: 17053866, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Collagen - therapeutic use
Digestive System Surgical Procedures - methods
Female
Humans

Questionnaires
Rectal Prolapse - surgery
Rectocele - surgery
Suture Techniques

Associated Chemicals: Permacol (0) ; Collagen (9007-34-5)

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