Wypadanie odbytnicy
Rokowania, prognozy i postęp choroby
Prognoza wypadania odbytnicy jest korzystna przy właściwym leczeniu. U dzieci w wieku 9 miesięcy do 3 lat w 90% przypadków wystarcza leczenie zachowawcze, a u najmłodszych często dochodzi do samoistnego ustąpienia. U dorosłych, zwłaszcza w podeszłym wieku, leczenie chirurgiczne jest skuteczne, choć ryzyko nawrotu sięga około 15%. Pooperacyjna śmiertelność jest niska, a kontynencja początkowo może się pogorszyć, ale u większości pacjentów poprawia się z czasem. W przypadku nawrotów wskazane jest zastosowanie innej techniki operacyjnej. Nieleczone wypadanie może prowadzić do poważnych powikłań, takich jak uwięźnięcie, krwawienie, owrzodzenie błony śluzowej oraz nietrzymanie stolca. Czynniki ryzyka niepowodzenia funkcjonalnego po rektopeksji z siatką (VMR) obejmują stopień wypadania, obecność dolichocolon oraz wcześniejsze zaparcia, a rehabilitacja pooperacyjna znacząco poprawia rokowanie.
Wypadanie odbytnicy (Rectal prolapse) – Prognoza
Prognoza w przypadku wypadania odbytnicy jest generalnie dobra przy zastosowaniu odpowiedniego leczenia. U dzieci w wieku od 9 miesięcy do 3 lat w 90% przypadków wystarczające jest leczenie zachowawcze, a u najmłodszych pacjentów często dochodzi do samoistnego ustąpienia problemu1. Natomiast u dorosłych pacjentów, szczególnie tych w podeszłym wieku, odpowiednie postępowanie chirurgiczne zwykle pozwala na skuteczne leczenie tego schorzenia, mimo że istnieje ryzyko nawrotu.
Rokowanie pooperacyjne
Śmiertelność pooperacyjna w przypadku zabiegów z powodu wypadania odbytnicy jest niska, jednak odsetek nawrotów może sięgać nawet 15%, niezależnie od zastosowanej procedury operacyjnej2. Kontynencja (trzymanie stolca) zazwyczaj początkowo pogarsza się po leczeniu chirurgicznym, ale u większości pacjentów ulega poprawie z czasem, choć stopień tej poprawy jest trudny do przewidzenia3.
Badania wskazują, że w przypadku nawracającego wypadania odbytnicy, leczenie chirurgiczne może przynieść lepsze rezultaty, jeśli zastosuje się inną operację niż ta użyta do pierwotnej naprawy4. Jest to istotna wskazówka dla chirurgów planujących leczenie pacjentów z nawrotem choroby.
Powikłania nieleczonego wypadania odbytnicy
Nieleczone wypadanie odbytnicy może prowadzić do poważnych komplikacji, takich jak5:
- Uwięźnięcie i zadzierzgnięcie (rzadko)
- Nasilające się krwawienie z odbytnicy (zwykle niewielkie)
- Owrzodzenie błony śluzowej
- Nietrzymanie stolca
Czynniki ryzyka niepowodzenia funkcjonalnego
W kontekście operacji rektopexy z siatką brzuszną (VMR), która jest szeroko akceptowaną metodą leczenia wypadania odbytnicy lub utrudnionej defekacji, zidentyfikowano pewne czynniki ryzyka niepowodzenia funkcjonalnego6. Do czynników tych należą:
- Stopień wypadania odbytnicy – większy stopień wypadania wiąże się z wyższym ryzykiem niepowodzenia
- Obecność dolichocolon (wydłużonego okrężnicy) – predysponuje do pooperacyjnych zaburzeń wypróżnienia
- Wcześniej istniejące zaparcia – zwiększają ryzyko utrzymywania się lub pojawienia się nowych zaparć po operacji
Warto zauważyć, że pooperacyjne leczenie rehabilitacyjne może zmniejszyć ryzyko niepowodzenia funkcjonalnego8. Dlatego kompleksowe podejście do leczenia, obejmujące nie tylko samą operację, ale również odpowiednią rehabilitację, może znacząco poprawić rokowanie.
Wskaźniki nawrotów po różnych typach zabiegów
Zabiegi brzuszne
Zabiegi przeprowadzane z dostępu brzusznego charakteryzują się ogólnie niższym odsetkiem nawrotów, ale wyższym wskaźnikiem powikłań w porównaniu z zabiegami kroczowymi9. Oto szczegółowe dane dotyczące poszczególnych procedur brzusznych:
- Przednia resekcja bez fiksacji krzyżowej – wskaźnik nawrotów wynosi około 7-9%, przy chorobowości 15-29%10
- Rektopeksja z siatką Marlex – wskaźnik nawrotów mieści się w zakresie 2-10%, przy chorobowości 3-29%. Poprawa kontynencji następuje u 50-70% pacjentów, jednak zaparcia mogą nie ulec poprawie, a nawet pogorszyć się po tym zabiegu11
- Rektopeksja z użyciem szwów – wyniki są porównywalne do rektopeksji z siatką12
- Resekcja z rektopeksją – wskaźnik nawrotów wynosi 3-4%, przy czym niektóre badania raportują 0% nawrotów. Chorobowość waha się od 4% do 23%. Zaparcia ulegają poprawie u 60-80% pacjentów, a kontynencja poprawia się u 35-60%13
Zabiegi kroczowe
Zabiegi przeprowadzane z dostępu kroczowego są częściej wykonywane u starszych pacjentów i wiążą się z krótszym pobytem w szpitalu. Charakteryzują się minimalną chorobowością, ale wyższym wskaźnikiem nawrotów niż zabiegi brzuszne14. Szczegółowe dane dotyczące tych procedur to:
- Operacja Delorme’a (resekcja mankietowa błony śluzowej) – wskaźnik nawrotów waha się od 5% do 26%, przy zmiennej chorobowości, która zwykle jest związana z chorobami współistniejącymi pacjenta. Nietrzymanie stolca i zaparcia ulegają poprawie u około 50% pacjentów15. W niektórych badaniach wskaźnik nawrotów po tej procedurze wynosił od 4% do nawet 38%16
- Operacja Altemeiera (odbytniczo-esiczna resekcja kroczowa) – wskaźnik nawrotów waha się od 0% do 50%, ze średnią około 10%. Kontynencja może ulec poprawie, jeśli do procedury dodana zostanie plikacja mięśni dźwigaczy. Jednak badanie Altomare i wsp. wskazuje, że przywrócenie kontynencji po tym zabiegu może być nieprzewidywalne17. W innych badaniach wskaźnik nawrotów po operacji Altemeiera wynosił od 0% do 16%18
Porównanie wyników różnych metod
W 10-letnim doświadczeniu jednego z ośrodków całkowity wskaźnik nawrotowego wypadania wyniósł 16% (16,1% dla napraw kroczowych, 15,4% dla procedur brzusznych)19. Te wyniki są porównywalne z wcześniej raportowanymi w literaturze chirurgicznej, co świadczy o utrzymującej się skuteczności standardowych technik chirurgicznych w leczeniu wypadania odbytnicy.
Należy podkreślić, że wybór metody chirurgicznej powinien być zindywidualizowany i uwzględniać wiek pacjenta, choroby współistniejące, wcześniejsze operacje oraz preferencje chirurga. U pacjentów w podeszłym wieku lub obciążonych chorobami współistniejącymi preferowane są zabiegi kroczowe ze względu na niższe ryzyko powikłań, mimo wyższego odsetka nawrotów20.
Czynniki wpływające na rokowanie
Na rokowanie w wypadaniu odbytnicy wpływa wiele czynników. Do najważniejszych należą:
- Wiek pacjenta – u dzieci rokowanie jest lepsze, gdyż często dochodzi do samoistnej remisji
- Choroby współistniejące – mogą zwiększać ryzyko powikłań pooperacyjnych
- Wybór techniki operacyjnej – dobór odpowiedniej metody w zależności od stanu pacjenta ma kluczowe znaczenie
- Doświadczenie chirurga – wpływa na ryzyko powikłań i skuteczność zabiegu
- Rehabilitacja pooperacyjna – może znacząco poprawić wyniki funkcjonalne21
Najczęstsze powikłania pooperacyjne
Do najczęstszych powikłań pooperacyjnych w leczeniu wypadania odbytnicy należą22:
- Krwawienie – szczególnie w miejscu zespolenia
- Rozejście się rany zespolenia (dehiscencja)
- Owrzodzenie błony śluzowej
- Martwica ściany odbytnicy
- Zaburzenia funkcjonalne – czasowe lub trwałe problemy z kontynencją lub zaparciami
Ryzyko tych powikłań jest wyższe w przypadku operacji brzusznych, choć wiążą się one z niższym odsetkiem nawrotów. Odwrotna sytuacja występuje w przypadku operacji kroczowych, które mają znacznie niższy wskaźnik powikłań, ale wyższy odsetek nawrotów23.
Podsumowanie rokowania
Wypadanie odbytnicy to schorzenie, które przy odpowiednim leczeniu daje dobre rokowanie. Mimo że istnieje ryzyko nawrotu (średnio około 15%), większość pacjentów doświadcza znacznej poprawy jakości życia po leczeniu chirurgicznym2425. Wybór metody leczenia powinien być dokonywany indywidualnie, biorąc pod uwagę wiek pacjenta, choroby współistniejące oraz doświadczenie ośrodka.
U pacjentów w podeszłym wieku oraz obciążonych chorobami współistniejącymi preferowane są zabiegi kroczowe ze względu na niższą chorobowość, pomimo wyższego ryzyka nawrotu. Z kolei u młodszych, zdrowszych pacjentów można rozważyć zabiegi brzuszne, które zapewniają niższy odsetek nawrotów26.
Istotnym elementem wpływającym na rokowanie jest również odpowiednia rehabilitacja pooperacyjna, która może zmniejszyć ryzyko niepowodzenia funkcjonalnego, szczególnie w kontekście utrzymywania się lub pojawienia się nowych zaparć po zabiegu27.
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Materiały źródłowe
- #1 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #2 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #3 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #4 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The recurrence rate for Altemeier perineal rectosigmoidectomy ranges from 0% to 50%, with an average of approximately 10%. Continence may be improved if a levator plication is added to the procedure. A study by Altomare et al indicated that restoration of continence with this procedure can be unpredictable. […] A multicenter study by Bordeianou et al suggested that surgical treatment of recurrent rectal prolapse may yield better results if it employs a different operation from that used for the initial repair.
- #5 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #6https://link.springer.com/article/10.1007/s10151-022-02708-8
Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. […] The aim of the present study was to identify possible predictors of functional failure after VMR. […] The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. […] Postoperative rehabilitation treatment may reduce this risk. […] Functional results, however, may not always be optimal, especially in terms of persistence or new onset of constipation. […] The presence of dolichocolon and long-term constipation are risk factors for the persistence or new onset of postoperative constipation.
- #7https://link.springer.com/article/10.1007/s10151-022-02708-8
Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. […] The aim of the present study was to identify possible predictors of functional failure after VMR. […] The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. […] Postoperative rehabilitation treatment may reduce this risk. […] Functional results, however, may not always be optimal, especially in terms of persistence or new onset of constipation. […] The presence of dolichocolon and long-term constipation are risk factors for the persistence or new onset of postoperative constipation.
- #8https://link.springer.com/article/10.1007/s10151-022-02708-8
Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. […] The aim of the present study was to identify possible predictors of functional failure after VMR. […] The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. […] Postoperative rehabilitation treatment may reduce this risk. […] Functional results, however, may not always be optimal, especially in terms of persistence or new onset of constipation. […] The presence of dolichocolon and long-term constipation are risk factors for the persistence or new onset of postoperative constipation.
- #9 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #10 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The recurrence rate for anterior resection without sacral fixation is about 7-9%, with a morbidity of 15-29%. This recurrence rate is higher than that for other abdominal procedures. […] The recurrence rate for Marlex rectopexy is in the range of 2-10%, with a morbidity of 3-29%. Continence is improved in 50-70% of patients. Constipation, however, is not improved and may worsen after this operation. The results of suture rectopexy are comparable. […] The recurrence rate for resection and rectopexy is 3-4%, with several studies reporting a 0% recurrence rate. Morbidity ranges from 4% to 23%. Because the redundant colon is also resected, constipation improves in 60-80% of patients, and continence improves in 35-60%. […] The recurrence rate for Delorme mucosal sleeve resection ranges from 5% to 26%, with a variable morbidity that is usually related to the patients underlying comorbidities. Fecal incontinence and constipation improve in about 50% of patients.
- #11 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The recurrence rate for anterior resection without sacral fixation is about 7-9%, with a morbidity of 15-29%. This recurrence rate is higher than that for other abdominal procedures. […] The recurrence rate for Marlex rectopexy is in the range of 2-10%, with a morbidity of 3-29%. Continence is improved in 50-70% of patients. Constipation, however, is not improved and may worsen after this operation. The results of suture rectopexy are comparable. […] The recurrence rate for resection and rectopexy is 3-4%, with several studies reporting a 0% recurrence rate. Morbidity ranges from 4% to 23%. Because the redundant colon is also resected, constipation improves in 60-80% of patients, and continence improves in 35-60%. […] The recurrence rate for Delorme mucosal sleeve resection ranges from 5% to 26%, with a variable morbidity that is usually related to the patients underlying comorbidities. Fecal incontinence and constipation improve in about 50% of patients.
- #12 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The recurrence rate for anterior resection without sacral fixation is about 7-9%, with a morbidity of 15-29%. This recurrence rate is higher than that for other abdominal procedures. […] The recurrence rate for Marlex rectopexy is in the range of 2-10%, with a morbidity of 3-29%. Continence is improved in 50-70% of patients. Constipation, however, is not improved and may worsen after this operation. The results of suture rectopexy are comparable. […] The recurrence rate for resection and rectopexy is 3-4%, with several studies reporting a 0% recurrence rate. Morbidity ranges from 4% to 23%. Because the redundant colon is also resected, constipation improves in 60-80% of patients, and continence improves in 35-60%. […] The recurrence rate for Delorme mucosal sleeve resection ranges from 5% to 26%, with a variable morbidity that is usually related to the patients underlying comorbidities. Fecal incontinence and constipation improve in about 50% of patients.
- #13 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The recurrence rate for anterior resection without sacral fixation is about 7-9%, with a morbidity of 15-29%. This recurrence rate is higher than that for other abdominal procedures. […] The recurrence rate for Marlex rectopexy is in the range of 2-10%, with a morbidity of 3-29%. Continence is improved in 50-70% of patients. Constipation, however, is not improved and may worsen after this operation. The results of suture rectopexy are comparable. […] The recurrence rate for resection and rectopexy is 3-4%, with several studies reporting a 0% recurrence rate. Morbidity ranges from 4% to 23%. Because the redundant colon is also resected, constipation improves in 60-80% of patients, and continence improves in 35-60%. […] The recurrence rate for Delorme mucosal sleeve resection ranges from 5% to 26%, with a variable morbidity that is usually related to the patients underlying comorbidities. Fecal incontinence and constipation improve in about 50% of patients.
- #14 Rectal Prolapse: A 10-Year Experiencehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3096348/
Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. […] The overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). […] Recurrence rates have ranged from 7% to 22%, and recurrences have frequently been treated with a repeat Delorme procedure. […] The major disadvantage of these techniques is a higher rate of recurrent prolapse (0%16% for Altemeier, 4%38% for Delorme). […] Our group has demonstrated proficiency in the surgical management of rectal prolapse over the past 10 years, with recurrence rates for abdominal and perineal-based procedures comparable to those previously reported in the surgical literature.
- #15 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The recurrence rate for anterior resection without sacral fixation is about 7-9%, with a morbidity of 15-29%. This recurrence rate is higher than that for other abdominal procedures. […] The recurrence rate for Marlex rectopexy is in the range of 2-10%, with a morbidity of 3-29%. Continence is improved in 50-70% of patients. Constipation, however, is not improved and may worsen after this operation. The results of suture rectopexy are comparable. […] The recurrence rate for resection and rectopexy is 3-4%, with several studies reporting a 0% recurrence rate. Morbidity ranges from 4% to 23%. Because the redundant colon is also resected, constipation improves in 60-80% of patients, and continence improves in 35-60%. […] The recurrence rate for Delorme mucosal sleeve resection ranges from 5% to 26%, with a variable morbidity that is usually related to the patients underlying comorbidities. Fecal incontinence and constipation improve in about 50% of patients.
- #16 Rectal Prolapse: A 10-Year Experiencehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3096348/
Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. […] The overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). […] Recurrence rates have ranged from 7% to 22%, and recurrences have frequently been treated with a repeat Delorme procedure. […] The major disadvantage of these techniques is a higher rate of recurrent prolapse (0%16% for Altemeier, 4%38% for Delorme). […] Our group has demonstrated proficiency in the surgical management of rectal prolapse over the past 10 years, with recurrence rates for abdominal and perineal-based procedures comparable to those previously reported in the surgical literature.
- #17 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The recurrence rate for Altemeier perineal rectosigmoidectomy ranges from 0% to 50%, with an average of approximately 10%. Continence may be improved if a levator plication is added to the procedure. A study by Altomare et al indicated that restoration of continence with this procedure can be unpredictable. […] A multicenter study by Bordeianou et al suggested that surgical treatment of recurrent rectal prolapse may yield better results if it employs a different operation from that used for the initial repair.
- #18 Rectal Prolapse: A 10-Year Experiencehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3096348/
Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. […] The overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). […] Recurrence rates have ranged from 7% to 22%, and recurrences have frequently been treated with a repeat Delorme procedure. […] The major disadvantage of these techniques is a higher rate of recurrent prolapse (0%16% for Altemeier, 4%38% for Delorme). […] Our group has demonstrated proficiency in the surgical management of rectal prolapse over the past 10 years, with recurrence rates for abdominal and perineal-based procedures comparable to those previously reported in the surgical literature.
- #19 Rectal Prolapse: A 10-Year Experiencehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3096348/
Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. […] The overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). […] Recurrence rates have ranged from 7% to 22%, and recurrences have frequently been treated with a repeat Delorme procedure. […] The major disadvantage of these techniques is a higher rate of recurrent prolapse (0%16% for Altemeier, 4%38% for Delorme). […] Our group has demonstrated proficiency in the surgical management of rectal prolapse over the past 10 years, with recurrence rates for abdominal and perineal-based procedures comparable to those previously reported in the surgical literature.
- #20 Rectal Prolapse: A 10-Year Experiencehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3096348/
Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. […] The overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). […] Recurrence rates have ranged from 7% to 22%, and recurrences have frequently been treated with a repeat Delorme procedure. […] The major disadvantage of these techniques is a higher rate of recurrent prolapse (0%16% for Altemeier, 4%38% for Delorme). […] Our group has demonstrated proficiency in the surgical management of rectal prolapse over the past 10 years, with recurrence rates for abdominal and perineal-based procedures comparable to those previously reported in the surgical literature.
- #21https://link.springer.com/article/10.1007/s10151-022-02708-8
Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. […] The aim of the present study was to identify possible predictors of functional failure after VMR. […] The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. […] Postoperative rehabilitation treatment may reduce this risk. […] Functional results, however, may not always be optimal, especially in terms of persistence or new onset of constipation. […] The presence of dolichocolon and long-term constipation are risk factors for the persistence or new onset of postoperative constipation.
- #22 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #23 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #24 Rectal Prolapse: Practice Essentials, Anatomy, Pathophysiologyhttps://emedicine.medscape.com/article/2026460-overview
The prognosis generally is good with appropriate treatment. Spontaneous resolution usually occurs in children. Of patients with rectal prolapse who are aged 9 months to 3 years, 90% will need only conservative treatment. Continence usually is initially worse after surgical treatment, but in most patients it improves over time; however, the degree of improvement is unpredictable. […] Untreated rectal prolapse can lead to incarceration and strangulation (rare). More commonly, increasing difficulties with rectal bleeding (usually minor), ulceration, and incontinence occur. […] Postoperative mortality is low, but the recurrence rate can be as high as 15%, regardless of the operative procedure performed. The most common postoperative complications involve bleeding and dehiscence at the anastomosis. Other complications include mucosal ulceration and necrosis of the rectal wall. Operative complications are higher for abdominal operations, with a lower recurrence rate; the opposite is true for perineal operations, which have a much lower complication rate but a higher recurrence rate.
- #25 Rectal Prolapse: A 10-Year Experiencehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3096348/
Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. […] The overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). […] Recurrence rates have ranged from 7% to 22%, and recurrences have frequently been treated with a repeat Delorme procedure. […] The major disadvantage of these techniques is a higher rate of recurrent prolapse (0%16% for Altemeier, 4%38% for Delorme). […] Our group has demonstrated proficiency in the surgical management of rectal prolapse over the past 10 years, with recurrence rates for abdominal and perineal-based procedures comparable to those previously reported in the surgical literature.
- #26 Rectal Prolapse: A 10-Year Experiencehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3096348/
Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option. […] The overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures). […] Recurrence rates have ranged from 7% to 22%, and recurrences have frequently been treated with a repeat Delorme procedure. […] The major disadvantage of these techniques is a higher rate of recurrent prolapse (0%16% for Altemeier, 4%38% for Delorme). […] Our group has demonstrated proficiency in the surgical management of rectal prolapse over the past 10 years, with recurrence rates for abdominal and perineal-based procedures comparable to those previously reported in the surgical literature.
- #27https://link.springer.com/article/10.1007/s10151-022-02708-8
Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. […] The aim of the present study was to identify possible predictors of functional failure after VMR. […] The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. […] Postoperative rehabilitation treatment may reduce this risk. […] Functional results, however, may not always be optimal, especially in terms of persistence or new onset of constipation. […] The presence of dolichocolon and long-term constipation are risk factors for the persistence or new onset of postoperative constipation.