Rectal Prolapse: An Overview of Clinical Features, Diagnosis, and Patient-Specific Management Strategies

被引:105
作者
Bordeianou, Liliana [1 ]
Hicks, Caitlin W. [2 ]
Kaiser, Andreas M. [3 ]
Alavi, Karim [4 ]
Sudan, Ranjan [5 ]
Wise, Paul E. [6 ]
机构
[1] Massachusetts Gen Hosp, Dept Surg, Boston, MA 02114 USA
[2] Johns Hopkins Univ Hosp, Dept Surg, Baltimore, MD 21287 USA
[3] Univ So Calif, Dept Colorectal Surg, Los Angeles, CA 90033 USA
[4] UMass Mem Med Ctr, Dept Surg, Worcester, MA 01605 USA
[5] Duke Univ, Dept Surg, Med Ctr, Durham, NC 27710 USA
[6] Washington Univ, Dept Surg, Sch Med, St Louis, MO 63110 USA
关键词
Rectal prolapse; Management; Surgery; Rectopexy; D'Hoore Procedure; Altemeier Procedure; Delorme Procedure; PELVIC FLOOR DISORDERS; QUALITY-OF-LIFE; ABDOMINAL RECTOPEXY; PERINEAL PROCTECTOMY; SURGICAL-MANAGEMENT; PRACTICE PARAMETERS; FECAL INCONTINENCE; RANDOMIZED-TRIAL; RECURRENCE; INTUSSUSCEPTION;
D O I
10.1007/s11605-013-2427-7
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangulation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to understand each patient's symptoms, bowel habits, anatomy, and pre-operative expectations. Preoperative workup includes physical exam, colonoscopy, anoscopy, and, in some patients, anal manometry and defecography. With this information, a tailored surgical approach (abdominal versus perineal, minimally invasive versus open) and technique (posterior versus ventral rectopexy +/- sigmoidectomy, for example) can then be chosen. We propose an algorithm based on available outcomes data in the literature, an understanding of anorectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients.
引用
收藏
页码:1059 / 1069
页数:11
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