RESUMEN
PURPOSE: In the attempt to understand the reasons for and to find a solution to the high recurrence rate after perineal surgery for complete rectal prolapse, we retrospectively analysed the long-term results of Altemeier's procedure alone, or associated with Trans-Obturator Colonic Suspension (TOCS) in a large series of patients with a median interval of 84 months (range 6-258). METHODS: Medical records of 110 patients undergoing Altemeier with levatorplasty (group 1) and 20 patients submitted to the same procedure associated with TOCS (group 2) for newly diagnosed complete rectal prolapse were reviewed. All patients had been recruited after preoperative clinical examination, SF-36 quality of life, continence score and colonoscopy. RESULTS: Mortality was nil. The overall complication and the recurrence rates were 12.3%, and 15.0% (P= 0.769) and 24.6% and 5.0% (P=0.067) in group 1 and 2, respectively. Twelve patients of group 1 with a recurrence were submitted to a redo-Altemeier, 8 to a redo-Altemeier associated with TOCS, and 6 associated with an anterior coloplasty with a mesh. The only patient of group 2 with a recurrence was submitted to a Hartmann's operation. Preoperative vs postoperative mean (SD) continence score was 15.8 (3.1) and 15.6 (3.3) versus 4.1 (1.8) and 3.9 (1.9) in group 1 and 2, respectively (P < 0.001). All parameters of SF-36 improved after surgery (P<0.01) and no differences between the 2 groups were found CONCLUSIONS: Long-term results confirmed the safety and effectiveness of Altemeier's procedure for the treatment of complete rectal prolapse, with the limit of a non-negligible incidence of anastomotic complications and recurrences. The combination of Altemeier with TOCS showed a positive trend to a reduction of the recurrence rate, not worsening morbidity and outcomes.
Asunto(s)
Prolapso Rectal , Humanos , Calidad de Vida , Prolapso Rectal/cirugía , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this prospective study was to assess the safety and effectiveness of a new single laparoscopic operation devised to relieve obstructed defecation, gynecologic and urinary symptoms in a large series of female patients with multiorgan pelvic prolapse. METHODS: We submitted 384 female patients to laparoscopic pelvic organ prolapse suspension operation, a new technique based on suspension of the middle pelvic compartment, by using a polypropylene mesh and followed up 368 of them, with defecography performed 12 months after surgery and a standardized protocol. RESULTS: The 368 patients were followed-up for 36.3 (±4.4) months, Recurrence rate was 4.9% for obstructed defecation syndrome and 3.3% for stress urinary incontinence. Complication rate was 2.9%. The mean period of daily activity resumption was 16.3 days (±4.8 days). Anorectal and urogynecologic symptoms and scores significantly improved after the operation (P < 0.001), with no worsening of anal continence. Incidence of postoperative fecal urgency was 0%. Postoperative defecography showed a significant (P < 0.001) improvement of all parameters in 315 patients (82%). Short Form 36 Health Survey score significantly improved after the operation (P < 0.01). An excellent/good overall Satisfaction Index was reported by 78.0% of patients. CONCLUSIONS: In our experience the Laparoscopic-Pelvic Organ Prolapse Suspension seems to be safe and effective as a 1-stage treatment of associated pelvic floor diseases. Randomized studies with an appropriate control group and longer follow-up are now needed to assess the effectiveness of this promising technique.
Asunto(s)
Laparoscopía , Trastornos del Suelo Pélvico/cirugía , Prolapso de Órgano Pélvico/cirugía , Adulto , Anciano , Estreñimiento/etiología , Estreñimiento/cirugía , Femenino , Enfermedades de los Genitales Femeninos/etiología , Enfermedades de los Genitales Femeninos/cirugía , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Laparoscopía/efectos adversos , Persona de Mediana Edad , Prolapso de Órgano Pélvico/complicaciones , Estudios Prospectivos , Resultado del Tratamiento , Enfermedades Urológicas/etiología , Enfermedades Urológicas/cirugíaRESUMEN
A randomized study was carried out to compare the mid-term outcome of transanal rectal resection with the CCS-30 TRANSTAR and two TST36 staplers in patients with obstructed defecation syndrome. After selection, patients were randomly assigned to 2 groups:104 underwent a TRANSTAR operation and 104 a transanal rectal resection with two TST36 staplers. Patients were followed up with clinical examination, and defecography. Cumulative complication rate was significantly higher in TRANSTAR operation (Pâ¯=â¯0.019). All symptoms and defecographic parameters significantly improved (Pâ¯<â¯0.001), without differences. Costs were significantly lower with double TST (Pâ¯=â¯0.035). Recurrence rates were 6.2% in TRANSTAR group and 11.4% with double TST (Pâ¯=â¯0.206). Two circular TST 36 staplers consent to obtain the same clinical and functional results than the CCS-30, with significantly lower complication rate and costs.
Asunto(s)
Estreñimiento/cirugía , Defecación/fisiología , Cirugía Endoscópica por Orificios Naturales/métodos , Engrapadoras Quirúrgicas , Grapado Quirúrgico/instrumentación , Adulto , Anciano , Colonoscopía , Estreñimiento/diagnóstico , Estreñimiento/fisiopatología , Defecografía , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Manometría , Persona de Mediana Edad , Recto , Estudios Retrospectivos , Síndrome , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: The stapled transanal rectal resection (STARR) procedure is safe and effective. OBJECTIVE OF THE STUDY: To compare STARR performed with PPH-01 (STARR) and CCS 30 (Transtar). MATERIALS AND METHODS: Sixty-four patients underwent STARR for obstructed defecation syndrome (32 STARR and 32 Transtar) and were observed from January 2007 to June 2009. Patients were studied by visit with questionnaires, colonoscopy or barium enema, defecography, and anorectal manometry. Postoperatively they were assessed through visit and questionnaires. RESULTS: All patients improved symptoms without statistical differences. The obstructed defecation syndrome score changed from 13 to 1.8 at 6 months and to 1 at 1 year in the STARR group (P < .05), and the score changed from 15 to 2 at 6 months and to 1 at 1 year in the Transtar group (P < .05). There were no intraoperative complications in the STARR group, but there were 2 dehiscences of suture in the Transtar group. There were no differences with regard to complications. CONCLUSION: Transtar is a more complex technique with more severe complications. A major resection is not always more effective.
Asunto(s)
Estreñimiento/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Obstrucción Intestinal/cirugía , Complicaciones Posoperatorias/epidemiología , Prolapso Rectal/cirugía , Rectocele/cirugía , Adulto , Anciano , Estreñimiento/etiología , Defecografía , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
The authors report a rare case of composite tumour of the stomach in a 53-year-old woman documenting the neuroendocrine and glandular features of the tumour by means of immunohistochemical investigations. The authors examine the diagnostic and therapeutic possibilities currently available for the management of this group of rare tumours of uncertain histogenesis. They conclude in favour of elective surgical treatment depending on the site and stage of the tumour in keeping with the data reported in the literature. They also discuss the prognosis of such tumours.