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KMID : 1141920220380060415
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Annals of Coloproctology
2022 Volume.38 No. 6 p.415 ~ p.422
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Transanal rectopexy for external rectal prolapse
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Chivate Shantikumar Dhondiram
Chougule Meghana Vinay
Thakrar Palak Harshuk
Chivate Rahul Shantikumar
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Abstract
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Purpose : The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance.
Methods : Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope. The procedure was supplemented by ultrasound-guided injection into the retrorectal space of a 2 mL solution of sodium tetradecyl sulfate/polidocanol mixed with air. Patients were functionally assessed before and 6 months after surgery with the Agachan constipation score and the Pescatori incontinence score.
Results : There were 36 adult patients (26 males; the range of age, 23?92 years). The mean operative time was 27 minutes (range, 23?50 minutes) with no recorded perioperative morbidity. The median follow-up was 66 months (range, 48?84 months) with 1 (2.8%) recurrence presenting 18 months after surgery. There were 19 patients (52.8%) who presented with incontinence before surgery with 17 out of 19 (89.5%) reporting improvement in their Pescatori score (P<0.001). No patient had worsening incontinence and there were no de novo incontinence cases. Constipation scores improved in 23 out of 36 patients (63.9%) with a mean score reduction difference of 7.91 (P=0.001).
Conclusion : Transanal sutured sacral rectopexy with supplemental presacral sclerosant injection is safe and effective in the management of FTRP with sustained improvement in bowel function.
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KEYWORD
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Full-thickness rectal prolapse, Sutured transanal sacral rectopexy, Presacral hemorrhage
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