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KMID : 0371319690110040269
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Journal of the Korean Surgical Society
1969 Volume.11 No. 4 p.269 ~ p.274
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Ripstein Operation (3 Cases)
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李榮男/Lee, Young Nam
崔東河/朴永寬/崔鳳洛/李鐵/Choi, Dong Ha/Park, Young Kwan/Choi, Bong Nak/Lee, Chul
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Abstract
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The authors report experience with 3 cases of massive rectal prolapse which were treated by Ripstein operation.
Recently Charles B. Ripstein introduced a new surgical procedure for the treatment of massive rectal prolapse. Most procedures advocated for the treatment of massive rectal prolapse have been based on the concept of Moschcowitz that prolapse is a sliding hernia resulting from a defect in the pelvic floor anterior to the rectum, and that the deep rectovesical pouch represents a hernial sac. He contends that this theory does not hold up on close scrutinity. He states that patients with massive rectal prolapse do have one factor in common. The rectum is always mobile and can be moved forward from the hollow of the sacrum so that the lower segment of bowel runs a straight vertical course. In many instances this is due to a congenital mesorectum. In others, no definite mesentery is present but loose areolar tissue separates the rectum from the sacrum.
In the normal individual, straining pushes the rectum and rectosigmoid backward into the hollow of the sacrum. In the patient with prolapse, the rectum moves forward forming a straight tube. Increasing intraabdominal pressure acts in the vertical axis of the bowel and causes intussusception of the rectosigmoid into the ampulla.
The aim of Ripstein procedure is posterior fixation of the rectum so that it cannot move forward from the hollow of the sacrum where increased intraabdominal pressure tends to force it backward rather than downward in its vertical axis. This procedure is recommneded for the young to middleaged adult patients who are in the most physically active period of life.
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