Resection Rectopexy is Still an Acceptable Operation for Rectal Prolapse

2018 ◽  
Vol 84 (9) ◽  
pp. 1470-1475
Author(s):  
Maria EmÍLia Carvalho E Carvalho ◽  
Tracy Hull ◽  
Massarat Zutshi ◽  
Brooke H. Gurland
Keyword(s):  
Rectal Prolapse ◽  
Resection Rectopexy ◽  
Recurrence Rates ◽  
Institutional Review ◽  
Prolapse Recurrence ◽  
Ventral Mesh Rectopexy ◽  
American Society ◽  
Mesh Rectopexy ◽  
American Society Of Anesthesiologists

The aim of this study was to compare resection rectopexy (RR) with ventral mesh rectopexy (VMR). This institutional review board–approved retrospective study compared patients with rectal prolapse, who underwent RR or VMR from 2009 to 2016. The primary end point was the comparison of complications and prolapse recurrence rates. Seventy-nine RR and 108 VMR patients qualified. Using propensity score matching, the two groups were not significantly different (P = 0.818). There were no differences regarding gender (female 103 vs 72; P = 0.4) and age (59.3 vs 53.9; P = 0.054). Patients in the VMR group had a greater body mass index (25.5 vs 22.9; P = 0.001) and poorer physical status (American Society of Anesthesiologists 3 57.4% vs 41.8%; P = 0.04). The VMR group had more: robotic approaches (69.4% vs 8.9%; P < 0.001), concomitant urogynecological procedures (63 vs 19; P < 0.001), and longer operative time (269 vs 206 minutes; P < 0.001) but a reduced length of stay (2 vs 5 days; P < 0.001). The median follow-up (16 vs 26 months; P = 0.125) and the median time of recurrence (14 vs 38 months; P = 0.163) were similar. No differences were observed for complications or recurrence (10.2% vs 10.1%; P = 0.43). We failed to identify superiority based on surgical technique.

scholarly journals The Paisley Pattern Breast Reduction

2019 ◽  
Vol 27 (2) ◽  
pp. 189-194
Author(s):  
Devra B. Becker
Keyword(s):  
Chart Review ◽  
Operative Time ◽  
Breast Reduction ◽  
Proof Of Concept ◽  
Flap Necrosis ◽  
Institutional Review ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Wise Pattern

Background: Skin resection patterns inform the shape and scars after breast reduction. The 2 most commonly performed skin resection patterns, the Wise pattern and vertical pattern, each have limitations. The most common challenge is addressing excess lateral skin while avoiding medial scars. The Paisley Pattern breast reduction addresses this by incorporating lateral dogear excision in the skin resection design. Methods: Thirty consecutive patients received a Paisley Pattern breast reduction. After institutional review board approval, a chart review was performed to evaluate resection weight, operative time, American Society of Anesthesiologists class, flap necrosis, and seroma. Results: Operative times were comparable to published times for the Wise and vertical pattern techniques. No patients had lateral flap necrosis, and no patients required a return to the operating room during the follow-up period. One patient developed a unilateral seroma that was drained by interventional radiology. Conclusions: This report of a novel skin resection design demonstrates a proof of concept that the skin resection pattern can be performed safely in a wide variety of patients. Although there is a learning curve to the technique to prevent over-resection laterally, it provides efficient and aesthetically acceptable alternative to the Wise and vertical skin resection patterns for both large and small reductions.

scholarly journals Laparoscopic Rectopexy – A New Management for Rectal Prolapse at the Georgetown Public Hospital Corporation

2019 ◽  
pp. 19-20
Author(s):  
Joshua Bhudial ◽  
Hemraj Ramcharran ◽  
Navin Rambarran ◽  
Zoilo Leon
Keyword(s):  
Rectal Prolapse ◽  
Design Method ◽  
Laparoscopic Rectopexy ◽  
Pelvic Diaphragm ◽  
Laparoscopic Ventral Mesh Rectopexy ◽  
The Caribbean ◽  
Ventral Mesh Rectopexy ◽  
Mesh Rectopexy

Introduction: Rectal prolapse is a debilitating and unpleasant condition adversely affecting the quality of life. It is a distal displacement of the rectum through the pelvic diaphragm that produces pressure symptoms on other pelvic organs causing fecal incontinence, obstructive defecation, or even strangulation. Different perineal and abdominal approaches have been described for surgical correction of rectal prolapse. Laparoscopic Rectopexy has been proven to be an effective treatment for rectal prolapse. Objective: LPR has recently been practiced as a method of treatment for rectal prolapse at GPHC. This study aims to assess the clinical and functional outcomes of the patients who underwent Laparoscopic Rectopexy in the effort to highlight this practice in Guyana and the Caribbean. Design /Method: The study design includes a retrospective review and prospective follow-up of a series of 4 patients who underwent LPR at GPHC for rectal prolapse. Pre-operative, intra-operative and post-operative factors surrounding the procedure were recorded and analyzed. Results: All patients were males of 29-52 years of age. One (1) Patient was a smoker and One (1) used alcohol. Two (2) patients had a previous perineal approach for rectal prolapse that recurred. No comorbidities were recorded. All patients had complete rectal procidentia. Laparoscopic Ventral Mesh Rectopexy was done for each patient. None of the cases were converted. All patients were fully ambulant by postoperative day one and all were discharged by postoperative day three. No short-term recurrence was recorded for three patients; the fourth patient did not complete the six months postoperative period. Conclusion: Laparoscopic Rectopexy was successfully pioneered at GPHC as a method of management for rectal prolapse with good outcomes.

scholarly journals Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis

BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
H S Lobb ◽  
C C Kearsey ◽  
S Ahmed ◽  
R Rajaganeshan
Keyword(s):  
Systematic Review ◽  
Rectal Prolapse ◽  
Recurrence Rate ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Complete Rectal Prolapse ◽  
Recurrence Rates ◽  
Suture Rectopexy ◽  
Ventral Mesh Rectopexy ◽  
Mesh Rectopexy

Abstract Background This systematic review and meta-analysis aimed to compare recurrence rates of rectal prolapse following ventral mesh rectopexy (VMR) and suture rectopexy (SR). Methods MEDLINE, Embase, and the Cochrane Library were searched for studies reporting on the recurrence rates of complete rectal prolapse (CRP) or intussusception (IS) after SR and VMR. Results were pooled and procedures compared; a subgroup analysis was performed comparing patients with CRP and IS who underwent VMR using biological versus synthetic meshes. A meta-analysis of studies comparing SR and VMR was undertaken. The Methodological Items for Non-Randomized Studies score, the Newcastle–Ottawa Scale, and the Cochrane Collaboration tool were used to assess the quality of studies. Results Twenty-two studies with 976 patients were included in the SR group and 31 studies with 1605 patients in the VMR group; among these studies, five were eligible for meta-analysis. Overall, in patients with CRP, the recurrence rate was 8.6 per cent after SR and 3.7 per cent after VMR (P &lt; 0.001). However, in patients with IS treated using VMR, the recurrence rate was 9.7 per cent. Recurrence rates after VMR did not differ with use of biological or synthetic mesh in patients treated for CRP (4.1 versus 3.6 per cent; P = 0.789) and or IS (11.4 versus 11.0 per cent; P = 0.902). Results from the meta-analysis showed high heterogeneity, and the difference in recurrence rates between SR and VMR groups was not statistically significant (P = 0.76). Conclusion Although the systematic review showed a higher recurrence rate after SR than VMR for treatment of CRP, this result was not confirmed by meta-analysis. Therefore, robust RCTs comparing SR and biological VMR are required.

Laparoscopic ventral mesh rectopexy in male patients with internal or external rectal prolapse

2014 ◽  
Vol 16 (12) ◽  
pp. 995-1000 ◽  
Author(s):  
A. E. Owais ◽  
H. Sumrien ◽  
K. Mabey ◽  
K. McCarthy ◽  
G. L. Greenslade ◽  
...  
Keyword(s):  
Rectal Prolapse ◽  
Laparoscopic Ventral Mesh Rectopexy ◽  
Male Patients ◽  
External Rectal Prolapse ◽  
Ventral Mesh Rectopexy ◽  
Mesh Rectopexy

Outcome of laparoscopic ventral mesh rectopexy for external rectal prolapse

2014 ◽  
Vol 16 (11) ◽  
pp. 914-919 ◽  
Author(s):  
J. Randall ◽  
E. Smyth ◽  
K. McCarthy ◽  
A. R. Dixon
Keyword(s):  
Rectal Prolapse ◽  
Laparoscopic Ventral Mesh Rectopexy ◽  
External Rectal Prolapse ◽  
Ventral Mesh Rectopexy ◽  
Mesh Rectopexy

Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project

Neurosurgery ◽  
2021 ◽  
Author(s):  
James Harrop ◽  
Alexandra Emes ◽  
Ameet Chitale ◽  
Chengyuan Wu ◽  
Fadi Al Saiegh ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Odds Ratio ◽  
Lumbar Fusion ◽  
Evidence Based ◽  
Multiple Logistic Regression ◽  
Surgical Indications ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Based Medicine

Abstract BACKGROUND United States (U.S.) healthcare is a volume-based inefficient delivery system. Value requires the consideration of quality, which is lacking in most healthcare disciplines. OBJECTIVE To assess whether patients who met specific evidence-based medicine (EBM)-based criteria preoperatively for lumbar fusion would achieve higher rates of achieving the minimal clinical important difference (MCID) than those who did not meet the EBM indications. METHODS All elective lumbar fusion cases, March 2018 to August 2019, were prospectively evaluated and categorized based on EBM guidelines for surgical indications. The MCID was defined as a reduction of ≥5 points in Oswestry Disability Index (ODI). Multiple logistic regression identified multivariable-adjusted odds ratio of EBM concordance. RESULTS A total of 325 lumbar fusion patients were entered with 6-mo follow-up data available for 309 patients (95%). The median preoperative ODI score was 24.4 with median 6-mo improvement of 7.0 points (P &lt; .0001). Based on ODI scores, 79.6% (246/309) improved, 3.8% (12/309) had no change, and 16% (51/309) worsened. A total of 191 patients had ODI improvement reaching the MCID. 93.2% (288/309) cases were EBM concordant, while 6.7% (21/309) were not. In multivariate analysis, EBM concordance (P = .0338), lower preoperative ODI (P &lt; .001), lower ASA (American Society of Anesthesiologists) (P = .0056), and primary surgeries (P = .0004) were significantly associated with improved functional outcome. EBM concordance conferred a 3.04 (95% CI 1.10-8.40) times greater odds of achieving MCID in ODI at 6 mo (P = .0322), adjusting for other factors. CONCLUSION This analysis provides validation of EBM guideline criteria to establish optimal patient outcomes. The EBM concordant patients had a greater than 3 times improved outcome compared to those not meeting EBM fusion criteria.

scholarly journals Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Erica F Bisson ◽  
Kai-Ming G Fu ◽  
Paul Park ◽  
Leslie Robinson ◽  
...  
Keyword(s):  
Sexual Function ◽  
Sexual Life ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Negative Effect ◽  
American Society ◽  
Lumbar Spondylolisthesis ◽  
American Society Of Anesthesiologists ◽  
The Impact

Abstract INTRODUCTION There is a paucity of investigation on the impact of spondylolisthesis surgery on back-pain related sexual inactivity. To this end, we utilized the prospective Quality Outcomes Database (QOD) registry to investigate factors predictive of improved sex life following surgery. METHODS This was an analysis of a prospective registry of 608 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Of these, 218 patients were included who were sexually active and had both baseline and 24-mo sexual function follow-up. Baseline variables were collected. Outcomes were collected at 24 mo. Sexual function was assessed by the associated question in the Oswestry Disability Index, “With regards to pain, how would you say your sex life is?” Outcomes were dichotomized into patients who had improved sexual function and those who had same or worse sexual function. RESULTS Mean age was 58.0 ± 11.0 yr and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had an impaired sex life. At final follow-up, 130 patients (73.0% of the 178 impaired) had an improved sex life. In univariate comparisons, those with improved sexual life had lower body mass index (BMI) (29.6 ± 5.5 vs 34.4 ± 6.0; P < .001) and a lower proportion of American Society of Anesthesiologists' grades 3 or 4 (33.1%% vs 54.2%; P = .01). Following surgery, those with improved sex lives noted higher satisfaction following surgery (84.5% vs 64.6% would undergo surgery again, P = .002). In adjusted analyses, lower BMI was associated with an improved sex life at 24 mo (OR = 1.14; 95% CI [1.05-1.20]; P < .001). CONCLUSION Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report an improvement in sex life postoperatively. Improvement in sex life was associated with significantly greater satisfaction with surgery. Lower BMI was predictive of improved sex life postoperatively.

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