Ch.60 - Rectal Prolapse

Question 1

What is the Thiersch procedure?

What is the recurrence rate?

What’s the risk with this procedure?

Who is it recommended to?

Answer 1

Reduction of prolapsed, placement of subcutaneous suture or mesh to encircle the anus to prevent further descent by providing a mechanical barrier

33-44% recurrence rate

Risk: can lead to severe outlet constipation

Recommended only for pts at high risk for anesthetic complication

Question 2

What is Delorme?

Advocated for which population?

Complication rate high or low?

Recurrence rate?

Answer 2

Mucosal sleeve resection.

Advocated for pts with a short segment of full-thickness rectal prolapse, considered “high risk” for abdominal procedures such as those with “hostile abdomen”

Complication is low

Recurrence: 16-30%

Question 3

Altemeier.

Fecal incontinence gets better or worse?

Recurrence rate? Complication rate?

What are some complications?

Levatorplasty may help with what?

Answer 3

May worsen fecal incontinence due to loss of rectal reservoir

As high as 20% recurrence rate, <10% complication rate.

Complications: suture line bleeding, pelvic abscess, leak

Levatorplasty may improve fecal incontinence

Question 4

Abdominal rectopexy.

Recurrence rate?

Extensive rectal mobilization -> higher or lower recurrence rate? What is a potential complication with doing this?

What’s the incidence of new onset constipation after rectopexy?

Answer 4

0-9%

Lower recurrence rate with extensive mobilization. But can result in worsening constipation.

15%

Question 5

Abdominal resection rectopexy

Absorbable or nonabsorbable sutures?

Where are the sutures placed? Securing the rectum to the sacrum at which vertebral level?

Resection rectopexy may improve what problem?

Answer 5

Non-absorbable

In the anterior sacral ligament. Anchors the rectum at about S1.

Resection improves constipation.

Question 6

What is Ripstein procedure

Well’s procedure

D’Hoore

Answer 6

Ripstein: partial anterior rectal encirclement

Well’s: partial posterior.
After full mobilization of the rectum a recangular piece of sterilized ivalon sponge was fixed to the presacral fascia. The rectum then drawn upward out of the pelvis and the lateral edges of the sponge wrapped around the rectum to encompass the rectum 3/4 of the way and sewn in place

D’Hoore: partial anterior prior to attachment of the mesh to the sacrum. Mobilize the anterior wall of the rectum