a gentleman with isr has prolapse of colon after isr, while a feels a whitehead procedure in 2 phases may be good, has anyone any experience on this
Hi Dr Saklani, no experience at all with this problem but I would rather go with the Altemeier procedure to correct the defect. Good luck with your patient.
STAR is very good when you have rectum, in this case there are no rectum at all, it was removed, with colon, the STAR procedure may take you to a stenosis of the lumen.
Age of the patient?
Reason for ISR? When was it performed? What is the histology? How long after did the prolapse develop?
Other comorbidity?
Body habitus?
Degree of prolapse?
Symptoms from prolapse?
Bladder function?
Residual sphincter function?
Ano-rectal physiological abnormalities are a specialist area. Unfortunately, it is impossible to advice anyone on the appropriate procedure for any intervention chosen is on a highly individualized basis!
This is one area where surgery is not performed to "fix" anatomical abnormalities; a number of patients are managed conservatively, depending on their symptoms.
The (unfortunate-for-some) truth of the matter is that if ISR etc. are offered, then at least a referral system should be available to manage the subsequent iatrogenic complications. My introduction to anorectal physiology many years ago started with the teaching that an abdominal wall stoma is better than an anal one. This still holds true. Sorry - but I do not believe these are the sort of conditions where over-the-net advice can or should be given.
Thanks. We are a tertiary centre and perform quite a few
Question is a bit old . The problem solution well described by dr john marks from philadelphia
Colorectal Dis. 2018 Jan 24. doi: 10.1111/codi.14030. [Epub ahead of print]
Full-thickness neorectal prolapse after transanal transabdominal proctosigmoidectomy for low rectal cancer: a cohort study.
Guraieb-Trueba M1, Helber AR2, Marks JH2.
Author information
Abstract
AIM:
Transanal transabdminal-proctosigmoidectomy with a coloanal anastomosis (TATA) is an alternative to to abdomino-perineal resection of the rectum (APR) for low rectal cancer. Neorectal prolapse is an unusual complication following TATA.. This study aimed to determine the incidence of neorectal prolapse after TATA for low rectal cancer.
METHODS:
this cohort study was conducted in a tertiary referral colorectal center. From a prospectively maintained database which includes 1,093 patients treated for rectal cancer between 1984-2016) we identified those who underwent sphincter-preserving surgery.. Data regarding the incidence, management, and outcomes of neorectal prolapse were analyzed.
RESULTS:
A total of 409 patients were identified of whom 185 underwent open surgery and 224 minimally invasive procedures. All received neoadjuvant chemoradiation. Neorectal prolapse occurred in 4.6% (n=19) with an incidence of 2.2% in the open and 6.7% in the MIS group (p=0.023), with no difference between MIS techniques. There was 1 neorectal prolapse recurrence (5.9%). The incidence was higher in women (9.5%) than men (2.5%) (p=0.011). There were no differences in local recurrence rates between the neorectal prolapse group (5.3%) and our population without prolapse (3.4%) (p=0.79).
CONCLUSION:
Neorectal prolapse is a rare occurrence following minimally invasive sphincter saving surgical procedures performed for rectal cancer It appears to be more frequent in patients who undergo MIS procedures and in women. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
You've misunderstood - we all perform ISR/ ULARs etc. And all of us who do are aware of the possibility of prolapse. The issue is having the facilities available to diagnose and know-how to manage the complication which technically, we have created.
Are you saying you have an ano-rectal physiology lab? If so, then those figures should help you make a decision as to whether surgery is indicated or not. The abstract above doesn't answer the query
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