Dissertations / Theses: 'Prolapsus rectal'

1

Castinel, Alain. "Troubles de la statique du rectum : expérience du service de proctologie de l'hôpital Bagatelle." Bordeaux 2, 1993. http://www.theses.fr/1993BOR23008.

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2

Duchamp, Christophe Bresler Laurent. "Le prolapsus total du rectum quel traitement à l'aube du XXIème siècle /." [S.l] : [s.n], 2003. http://www.scd.uhp-nancy.fr/docnum/SCDMED_T_2003_DUCHAMP_CHRISTOPHE.pdf.

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3

Quillet, Christophe. "Prolapsus du rectum : promontofixation modifiée avec haubanage postérieur." Bordeaux 2, 1990. http://www.theses.fr/1990BOR25176.

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4

BOSSE, JEAN-LOUIS. "Le prolapsus rectal : nouvelle proposition therapeutique." Lille 2, 1993. http://www.theses.fr/1993LIL2M137.

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5

Jubier, Anne-Sophie. "La sigmoidectomie associée à la rectopexie dans le traitement du prolapsus rectal, à propos de 34 cas." Montpellier 1, 1992. http://www.theses.fr/1992MON11013.

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6

CORBI, HERVE. "Le prolapsus rectal : mise au point physiopathologique, diagnostique et therapeutique ; a propos de 16 patients." Toulouse 3, 1992. http://www.theses.fr/1992TOU31167.

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7

Pernice, Jean-Laurent. "Principes et indications du traitement chirurgical du prolapsus rectal de l'adulte suivant la technique de Orr-Loygue." Montpellier 1, 1988. http://www.theses.fr/1988MON11162.

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8

Fabre, Pierre. "Constipation terminale : existe-t-il un traitement chirurgical par voie endorectale ? resultats preliminaires de 40 interventions." Toulouse 3, 1991. http://www.theses.fr/1991TOU31041.

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9

Sielezneff, Igor. "Traitement chirurgical des prolapsus du rectum : a propos de 95 observations." Aix-Marseille 2, 1992. http://www.theses.fr/1992AIX20724.

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10

BUISSON, THIERRY. "Peut-on prevenir la constipation des rectopexies ? etude preliminaire a propos de 15 cas de rectopexies avec conservation des ailerons." Reims, 1993. http://www.theses.fr/1993REIMM066.

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11

LAMARCHE, PIQUEMAL MARTINE. "Traitement par la methode de delorme du prolapsus rectal non exteriosie a l'origine d'une constipation terminale." Toulouse 3, 1992. http://www.theses.fr/1992TOU31130.

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12

BULGARE, JEAN-CHARLES. "Traitement chirurgical de la procidence interne du rectum par la technique de delorme interne." Aix-Marseille 2, 1994. http://www.theses.fr/1994AIX20728.

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13

Siproudhis, Laurent. "Distensions rectales isobariques : un modele d'etude dynamique de la physiologie anorectale chez l'homme (doctorat : biologie et sciences de la sante)." Rennes 1, 1998. http://www.theses.fr/1998REN1B031.

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14

Dentel, Patricia. "Traitement chirurgical du prolapsus rectal par les techniques d'Orr-Loygue et de Delorme : résultats à propos de 57 observations." Université Louis Pasteur (Strasbourg) (1971-2008), 1993. http://www.theses.fr/1993STR1M170.

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15

Agay, Didier. "Les troubles de statique recto-perinéale : intérêt de la rectographie numérisée, la manométrie anorectale, la dynamométrie anale à propos de 32 malades." Montpellier 1, 1988. http://www.theses.fr/1988MON11340.

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16

Marouby, Dominique. "Le Traitement chirurgical du prolapsus rectal total de l'enfant : intérêt d'une variante originale de l'intervention de Lockhart-Mummery." 63-Aubière : Imp. Sciences, 1985. http://catalogue.bnf.fr/ark:/12148/cb36111267n.

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17

Altman, Daniel. "Evaluation and treatment of pelvic organ prolapse : clinical, radiological and histopathological aspects /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-628-6237-5/.

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18

Joshi, Heman. "The aetiology and pathogenesis of rectal prolapse." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:ff820a2b-48a6-4a5c-92c7-e7d2fdc22e95.

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It is still an enigma that some patients develop rectal prolapse whilst others with similar risk factors do not. Biomechanical assessment of the skin may provide further insight into the aetiology of this complex condition. Components of connective tissue other than collagen have been found to be involved in patients with rectal prolapse. Elastin fibres are an abundant and integral part of many extracellular matrices and are especially critical for providing the property of elastic recoil to tissues. The significance of elastin fibres is clearly reflected by the numerous human conditions in which a skin phenotype occurs as a result of elastin fibre abnormalities. The organization of elastic fibres differs between controls and subsets of patients with rectal prolapse, and their importance for maintaining the structural and functional integrity of the pelvic floor has been demonstrated in transgenic mice, with animals which have a null mutation in fibulin-5 (Fbln5) developing prolapse. This study aimed to compare fibulin-5 expression in the skin of patients with and without rectal prolapse. Between January 2013 and February 2014, skin specimens were obtained during surgery from 20 patients with rectal prolapse and from 21 without prolapse undergoing surgery for other indications. Fibroblasts from the skin were cultured and the level of fibulin-5 expression was determined on cultured fibroblasts, isolated from these specimens by quantitative real-time polymerase chain reaction. Immunohistochemistry was performed on fixed tissue specimens to assess fibulin-5 expression. Orcein staining measured expression levels of elastin in the skin, and Image J. Tensile tests were performed using the Zwick Roell device, with custom ceramic clamps. For statistical analysis, Student's t test was used. Fibulin-5 mRNA expression and fibulin-5 staining intensity were significantly lower in young male patients with rectal prolapse compared with age matched controls [fibulin-5 mean _ SD mRNA relative units, 1.1 _ 0.41 vs 0.53 _ 0.22, P = 0.001; intensity score, median (range), 2 (0-3) vs 1 (0-3), P = 0.05]. There were no significant differences in the expression of fibulin-5 in women with rectal prolapse compared with controls. Histological analysis of prolapse vs control showed percentage dermal elastin fibres of 9 vs 5.8 % (p=0.001) in males and 6.5 vs 5.3 % (p=0.05) in females. Patients with more severe prolapse (external) had a significantly (p=0.05) higher percentage dermal elastin fibres 6.9 vs 6.1 % than internal prolapse. Young's modulus of patients with prolapse was lower in males (3.3 vs 2.8, p=0.05) and females (3.1 vs 2.7, p=0.05). Patients with prolapse have a higher concentration of elastin fibres in the skin, and these differences are quantitatively demonstrated through mechanical testing. This suggests that the aetiology may be a result of a dysfunction of elastin fibre assembly. Fibulin-5 may be implicated in the aetiology of rectal prolapse in a subgroup of young male patients.

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19

Smyth, Edward A. E. "Connective tissue changes in patients with rectal prolapse." Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.669913.

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20

Schultz, Inkeri. "Rectal prolapse, internal rectal intussusception and the Ripstein rectopexy : a clinical, physiological and radiological study /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3225-5/.

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21

Arévalo, Suarez Fernando, Vela Irene Cárdenas, Rodríguez Kriss Rodríguez, Narrea María Teresa Pérez, Vargas Omar Rodríguez, Teves Pedro Montes, and Salgado Eduardo Monge. "Síndrome de prolapso de mucosa rectal: estudio de casos. Hospital Daniel A Carrión,Lima, Perú. 2010-2013." Universidad Peruana de Ciencias Aplicadas (UPC), 2014. http://hdl.handle.net/10757/323460.

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Objective: to describe the clinical, endoscopic, and histological characteristics of rectal mucosal prolapse syndrome, formerly known as Solitary rectal ulcer, in patients from a general hospital. Material and methods: All patient diagnosed as rectal mucosal prolapse syndrome during 2010-2013 was selected; the medical history war reviewed and the histological slides were reevaluated by two pathologists. Results: 17 cases of rectal mucosal prolapse syndrome were selected, the majority were males under 50 years, the most common clinical findings were rectal bleeding (82%) and constipation (65%), the endocopic findings were heterogeneous,: erythema (41%), ulcers (35%) and elevated lesions (29%). All cases presented fibromuscular hyperplasia in lamina propia and crypt distortion in the microscopic evaluation. Conclusion: In our study of rectal mucosal prolapse syndrome. The most common clinical findings were rectal bleeding and constipation. Erythematous mucosa was the most common endoscopic finding.
Objetivo: Describir el espectro clínico endoscópico e histológico de síndrome de prolapso de mucosa rectal, antes llamado ulcera rectal solitaria, en pacientes de un hospital general. Material y métodos: Se recolectaron los casos diagnosticados como síndrome de prolapso de mucosa rectal durante los años 2010-2013. Las historias clínicas fueron revisadas y las láminas fueron reevaluadas por 2 patólogos. Resultados: Se seleccionaron 17 casos de prolapso de mucosa rectal, la mayoría en varones menores de 50 años, los hallazgos clínicos más frecuentes fueron rectorragia (82%) y constipación (65%), con hallazgos endoscópicos muy variables que incluyó eritema (41%), ulceras (35%) y lesiones elevadas (29%). Todos los casos presentaron hiperplasia fibromuscular en lámina propia y distorsión de criptas en la evaluación histológica Conclusión: En nuestro estudio de síndrome de prolapso de mucosa rectal la rectorragia y la constipación fueron los hallazgos clínicos más frecuentes. El eritema mucoso fue la presentación endoscópica más frecuente.

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22

Moussu, Philippe. "La statique ano-rectale chez la femme ayant un prolapsus urogénital : à propos de 52 cas." Montpellier 1, 1995. http://www.theses.fr/1995MON11126.

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23

Jamet, Fabrice. "Intérêt de la défécographie dans le bilan des prolapsus gynécologiques." Montpellier 1, 1996. http://www.theses.fr/1996MON11048.

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24

Faulkner, Gemma. "The relationship between connective tissue abnormality and pelvic floor dysfunction." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/the-relationship-between-connective-tissue-abnormality-and-pelvic-floor-dysfunction(d79df4c1-60b8-4546-ac07-b715ea017f56).html.

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Perineal descent (PD) is a sign of connective tissue weakness of the pelvic floor, it can be measured mechanically or radiologically. Joint hypermobility can be a sign of a generalised connective tissue abnormality, there is an increased incidence of pelvic organ prolapse and faecal incontinence amongst patients with heritable connective tissues diseases. To explore the relevance of PD and the relationship between connective tissue abnormality and pelvic floor dysfunction five studies were performed.A new mechanical device for the measurement of PD, the laser commode, and the established mechanical device, the perineometer were compared to the current gold standard method of measurement, defaecating proctography in 68 subjects. The laser commode provided a mean overall PD measurement closer to that of proctography than the perineometer but the repeatability and reproducibility of the measurements were not accurate enough for the laser commode to be used either in the subsequent parts of this research project or in a clinical setting.Perineal descent was measured using proctography and joint hypermobility was measured using the Beighton score in 70 females with pelvic floor dysfunction. No correlation was found between PD and joint mobility.A review of 323 proctograms of females with pelvic floor dysfunction found an association between PD and rectal prolapse but no association between either PD and rectocele formation or PD and rectal intussusception. The Pelvic Floor Distress Inventory questionnaires of 133 females were correlated with their proctography findings. There was no association between PD and any of the clinical symptoms. Biopsies from the rectus sheath and pelvic floor fascia of 19 females with rectal prolapse were compared to those of 8 normal controls. There was no difference in collagen or elastin content between the groups but participant numbers were small. The pelvic floor fascia of the rectal prolapse group showed a higher percentage of well organised elastin than that of the control group but this did not reach statistical significance. Perineal descent does not appear to be a consistent indicator of severe pelvic floor connective tissue abnormality or injury. This study has furthered our understanding of perineal descent and the relationships between this finding and other pelvic floor disorders caused by connective tissue weakness. Future work will focus on further histological analysis of tissue from patients with rectal prolapse in combination with the use of more sensitive methods to establish the presence of an underlying connective tissue abnormality.

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25

Leal, Vilmar Moura. "AvaliaÃÃo clÃnica e funcional no prÃ e pÃs-operatÃrio de pacientes portadoras de defecaÃÃo obstruÃda por retocele e prolapso mucoso retal, submetidas ao procedimento âtrremsâ." Universidade Federal do CearÃ, 2009. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=4686.

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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
SÃndrome de DefecaÃÃo ObstruÃda (SDO) pode ser produzida por alteraÃÃo funcional (anismus) ou por alteraÃÃes anatÃmicas, especialmente retocele e prolapso mucoso retal. VÃrias tÃcnicas cirÃrgicas vÃm sendo utilizadas no tratamento da retocele, com vias de acesso transvaginal, perineal ou transanal, aquelas mais utilizadas por ginecologistas e a transanal por coloproctologistas, isto em funÃÃo das pacientes recorrerem a especialistas diferentes, dependendo da predominÃncia dos sintomas, sendo apresentados resultados semelhantes. O objetivo deste estudo foi avaliar os resultados do tratamento cirÃrgico de pacientes portadoras de SDO por retocele e prolapso mucoso retal, submetidas Ã ressecÃÃo transanal da retocele e mucosectomia com um grampeador (procedimento âTRREMSâ. Foram avaliadas 35 pacientes, sendo uma nulÃpara e as demais multÃparas, com idade mÃdia de 47,5 Â10,83 anos (31 â 67), portadoras de retocele e prolapso mucoso retal interno, sendo 13 (37,10%) com grau II e 22 (62,90%) com grau III. Os parÃmetros avaliados foram os escores de defecaÃÃo obstruÃda e de constipaÃÃo, o Ãndice funcional para continÃncia assim como a avaliaÃÃo da dor, satisfaÃÃo com o resultado e com a funÃÃo sexual e realizaÃÃo de defecografia no prÃ e no pÃs-operatÃrio. O escore mÃdio de SDO de 10,63 no prÃ-operatÃrio reduziu significativamente para 2,91 no pÃs-operatÃrio (p = 0,000). O escore mÃdio de constipaÃÃo de 15,23 no prÃ-operatÃrio reduziu significativamente para 4,46 no pÃs-operatÃrio (p = 0,000). O Ãndice funcional mÃdio para continÃncia, de 2,77 no prÃ-operatÃrio reduziu significativamente para 1,71 no pÃs-operatÃrio (p = 0,000). A dor no primeiro dia pÃs-operatÃrio, avaliada atravÃs da escala visual analÃgica (EVA) apresentou valor mÃdio de 5,23 reduzindo para 1,20 no oitavo dia (p = 0,000). A satisfaÃÃo com o resultado do tratamento, avaliada tambÃm atravÃs da EVA, ao final do primeiro mÃs foi 79,97, no terceiro 86,54, no sexto 87,65 e no dÃcimo segundo 88,06. TambÃm se obteve elevaÃÃo significativa, entre os valores mÃdios de 42,91 no prÃ-operatÃrio e 70,41 no sexto mÃs de pÃs-operatÃrio, para a satisfaÃÃo sexual avaliada atravÃs da EVA (p = 0,000). A defecografia demonstrou reduÃÃo significativa do tamanho mÃdio da retocele de 19,23 mm Â 8,84 (3 â 42) para 6,68 mm Â 3,65 (0 â 17) na fase de repouso e de 34,89 mm Â 12,30 (20 â 70) para 10,94 mm Â 5,97 (0 â 25) na fase evacuatÃria quando comparado o prÃ com o pÃs-operatÃrio (p = 0,000) (P=0,000) respectivamente. Procedimento âTRREMSâ Ã uma tÃcnica segura, eficiente e produziu resultados anatÃmicos e funcionais satisfatÃrios e nÃveis reduzidos de complicaÃÃes pÃs-operatÃrias
Obstructed defecation syndrome (ODS) can be induced by functional changes (anismus) or anatomical abnormalities, especially rectocele and rectal mucosal prolapse (RMP). Several surgical techniques with transvaginal, perineal or transanal access have been used in the treatment of rectocele. The first two are more commonly used by gynecologists, the last one is favored by proctologists. Depending on the prevalence of symptoms, patients may go to either specialist with the same result. The objective of the present study was to make a clinical and functional evaluation of patients submitted to the TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with a single circular stapler) as treatment for ODS caused by rectocele and RMP. The study included 35 female patients (34 of whom multiparous) aged 47.5Â10.83 years (31â67) diagnosed with ODS caused by RMP-associated rectocele grade II (n=13; 37.1%) or grade III (n=22; 62.9%). The study parameters included SDO and constipation scores, functional continence index, sexual function and treatment outcome satisfaction and pre- and postoperative defecographic measures. The average preoperative ODS score (10.63) was significantly reduced after surgery (2.91) (p=0.000). The average constipation score fell from 15.23 to 4.46 (p=0.000). The average functional continence score decreased from 2.77 to 1.71 (p=0.000). Between the first and the eighth postoperative day, the average visual analog scale pain score fell from 5.23 to 1.20 (p=0.000). Using the same scale, satisfaction with the treatment outcome was 79.97, 86.54, 87.65 and 88.06 at 1, 3, 6 and 12 months, respectively, and the average sexual function satisfaction was 42.91 (19â70) and 70.41 (39â97) before and after surgery, respectively (p=0.000). On defecography, average reductions in rectocele size were from 19.23Â8.84 mm (3â42) to 6.68Â3.65 mm (0â17) at rest and from 34.89Â12.30 mm (20â70) to 10.94Â5.97 mm (0â25) during evacuation (both p=0.000). The TRREMS procedure is a safe, efficient technique associated with satisfactory anatomical and functional results and reduced levels of postoperative pain and complications.

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26

Gimeno, Solsona Fausto. "Defecografía en el estudio del compartimento posterior del suelo de la pelvis en mujeres con prolapso genital, La." Doctoral thesis, Universitat de Barcelona, 2005. http://hdl.handle.net/10803/2460.

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La defecografía es una exploración que realizada con la preparación y la técnica adecuadas, de forma cuidadosa y con las máximas medidas de higiene y privacidad, no provoca molestias significativas siendo aceptada sin problemas por las pacientes.

La técnica de la defecografía debe realizarse con la paciente sentada en una silla radiotransparente, el contraste rectal ha de ser pasta de bario densa en cantidad no inferior a los 300 ml, la opacificación por vía oral del intestino delgado con la ingesta previa de 400 ml de bario líquido es obligatoria y resulta imprescindible la realización de proyecciones con esfuerzo al final de la evacuación del contraste rectal.

La línea pubococcígea y la línea de las tuberosidades isquiáticas son de difícil valoración y la determinación de los ángulos anorrectales en reposo y durante la defecación carece de interés por su falta de relevancia en el diagnóstico del prolapso.

El rectocele y el enterocele se identifican sin dificultad durante el desarrollo de la defecografía. La valoración precisa de ambas alteraciones, muchas veces sincrónicas, permite la elección de la técnica quirúrgica adecuada.

La intususcepción rectal que puede acompañar al rectocele y que debe persistir durante la evacuación del contraste nos parece una alteración funcional no obstructiva que influye en la sensación de defecación incompleta cuya causa principal es la existencia de residuo en la porción vaginal del rectocele al final de la evacuación.

El estudio de la incontinencia fecal en la mujer debe comprender la ecografía endoanal para valoración de los esfínteres y la defecografía para descartar las alteraciones asociadas que pueden favorecer su aparición.

La defecografía es útil en el estudio del estreñimiento sobre todo si muestra la existencia de rectocele y/o sigmoidocele en pacientes con clínica de "obstrucción distal" (outlet obstruction) y debe unirse al enema opaco y a la determinación del tiempo de tránsito colónico con marcadores. En la valoración del anismo, la defecografía confirma el diagnóstico obtenido con la manometría anorrectal.

Los términos "perineo descendido" y "descenso del suelo de la pelvis" deberían sustituirse por el concepto "combinación de patologías del suelo de la pelvis" que define de una manera más clara la existencia de alteraciones sincrónicas del mismo compartimento (rectocele y enterocele) o la combinación de patologías de los compartimentos urinario, ginecológico y digestivo.

La RM pelviana se ha revelado como una técnica de gran utilidad en el diagnóstico de las alteraciones del suelo de la pelvis. Permite las reconstrucciones multiplanares, la valoración de los músculos y el diagnóstico del peritoneocele. No comporta radiación pero puede estar contraindicada si existen clips metálicos y/o claustrofobia. Salvo en RM abiertas en las que es posible la posición sentada, la exploración se realiza en decúbito supino, posición que limita el descenso de las vísceras pelvianas y dificulta las maniobras de esfuerzo realizadas por la paciente.
SUMMARY
When perfomed gently with the convenient preparation, technique and maximum measures of hygiene and privacy, defecography may cause no significant inconveniences and therefore is a procedure that is easily accepted by the patients.

Defecography's technique requires the patient to be seated on a radiotransparent commode, the rectum to be filled with thick barium paste in a quantity not under 300 ml, small bowel opacification with 400 ml of previously taken liquid barium is a must and is essential to take images at the end of the contrast evacuation as the patient squeezes.

Rectocele and enterocele are easily demonstrated during the procedure. Precise evaluation of both disorders, very often sincronic, allows choosing convenient surgery.

We consider rectal intussuceptium that may appear retocele and which must last contrast evacuation long as a non obstructive functional disorder that contributes to incomplete defecation sensation, which is primarily due to the existence of a remnant in the vafginal portion of rectocele at the end of the evacuation.

Faecal incontinence imaging in woman must include both endoanal ultrasound to asses sphincters and defecography to rule out associated abnormalities that may ease its presence.

Defecography plays a role in constipation evaluation specially if it demonstrates rectocele and/or sigmoidocele in patients with clinical outlet obstruction and must be associated with barium enema and time of transist determination with markers. In anism evaluation defecography confirms diagnosis.

The terms "descending perineum" and "pelvic floor descent" should be substituted by "combination of pelvis floor disorders" concept which better defines the presence on sincronic alterations of the same compartement (rectocele and enterocele) or the combination of urinary, gynaecologic and digestive compartements disorders.

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27

Plaskett, Jeremy John. "The incidence of recurrence after Delorme's procedure for full thickness rectal prolapse - a retrospective private-public cohort study." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22826.

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Background: Delorme's perineal repair has remained a procedure reserved for full-thickness rectal prolapse in elderly or co-morbid patients due to its low morbidity and complications. Reported recurrence rates are higher than in abdominal approaches. Aim: The study assesses long-term outcomes after Delorme's procedure (DP), specifically recurrence and postoperative bowel function, in both a multi-surgeon public hospital and a single surgeon cohort in the private sector (Groote Schuur Hospital and Kingsbury Hospital). Patients and Methods: This retrospective cohort study includes all patients who underwent DP between February 2001 and March 2014 at both study sites. The primary outcome was absence of recurrence. Secondary outcomes were bowel function (incontinence and constipation), postoperative mortality and morbidity and length of hospital stay. Patient data was collected from electronic records (Kingsbury Hospital) and paper folders/op notes (Groote Schuur Hospital) and current status was acquired by telephonic interview with either the patient, a family member or caregiver, as appropriate. Results: Seventy patients underwent DP: 37 private and 33 public, mean age 71yrs. There were 16 (23%) recurrences (7 private, 9 public), of which 8 (11%) underwent reoperation. Mean time to recurrence was 30 months (48 private; 15 public). There were 2 postoperative deaths (pneumonia, myocardial infarction), 6 major complications (rectal bleeding requiring transfusion or reoperation, bowel obstruction, pneumonia, myocardial infarction), and 6 minor complications (rectal pain, rectal bleeding not requiring reoperation or transfusion, urinary retention, confusion, hyponatraemia). The mean postoperative hospital stay was 4 days. Conclusion: Long-term outcome from this large series compares favorably with most other published series, specifically a low recurrence rate. Proposed reasons for this will be presented, within the context of the published literature.

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28

Mäkelä-Kaikkonen, J. (Johanna). "Robotic-assisted and laparoscopic ventral rectopexy in the treatment of posterior pelvic floor procidentia." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526221977.

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Abstract:

Abstract Rectal prolapse and internal rectal prolapse with symptoms of obstructed defecation and/or faecal incontinence are debilitating conditions. Often, symptoms coexist from other pelvic compartments, reducing quality of life. Robot-assisted surgery with its advanced features may offer better conditions in narrow pelvic space to correct rectal prolapses with rectopexy operation. In this thesis, we compared robot-assisted and laparoscopic techniques during the early learning curve in a ‘matched-pairs’ feasibility study (n = 30, follow-up three months) and in a prospective randomized series (n = 33, follow-up 24 months). The long-term functional results were assessed in a retrospective multicenter study with cross-sectional questionnaire assessment (n = 508, median follow-up 44 months). In the randomised series, as demonstrated with MR defecography, ventral rectopexy corrects the posterior compartment defects, external and internal rectal prolapses and recto-enteroceles. The operation restores the posterior and middle compartment anatomy and reduces pelvic organ mobility with a minor impact on the anterior compartment. Pelvic floor dysfunction and symptom-specific quality of life is improved after rectopexy; specifically, the colorectal-anal and the pelvic organ prolapse subscales in the questionnaires showed improvement. We found equality between robot-assisted rectopexy and laparoscopic rectopexy in most relevant outcome measures, which does not justify the added cost of the routine use of robots in rectopexy operations. The health-related quality of life and cost-utility analysis in our cohort indicated, however, that in long-term the technique may be cost-effective. The functional results are retained in the long term. The rate of recurrences (7.1%) and complications (10%) are acceptable and mesh-related complications (1.4%) are rare. Denovo symptoms, such as the urge to defecate or urinary incontinence, may arise, while urinary symptoms may be alleviated. In the long-run, patients with external rectal prolapse benefit more than patients with internal rectal prolapse. In part, the results of this thesis support using a multidisciplinary approach in examining patients with posterior pelvic floor dysfunction. Furthermore, the indications for robotic use in rectopexy operations need to be explored in larger patient samples
Tiivistelmä Rektumprolapsi ja peräsuolen sisäinen tuppeuma eli interni prolapsi aiheuttavat hankalia oireita, kuten ulostusvaikeuksia, ulosteinkontinenssia ja lantion kipua. Elämänlaatua heikentäviä oireita esiintyy usein samanaikaisesti myös muissa lantion osissa. Robottiavusteinen kirurgia tarjoaa paremmat leikkausolosuhteet lantion ahtaassa tilassa tehtävään rektopeksialeikkaukseen ja mahdollisesti edut voivat näkyä leikkaustuloksessa. Tässä väitöskirjassa vertailimme robottiavusteista ja laparoskooppista leikkaustekniikkaa oppimiskäyrän alkuvaiheessa käyttökelpoisuustutkimuksessa kaltaistetussa parivertailuasetelmassa (n = 40, seuranta-aika 3 kk) sekä prospektiivisessa randomoidussa tutkimussarjassa (n = 33, seuranta-aika 24 kk). Monikeskustutkimuksessa (n = 508, seuranta-ajan mediaani 44 kk) selvitimme laajassa aineistossa laparoskooppisen ventraalisen rektopeksian pitkäaikaistuloksia liittämällä aineiston analyysiin poikkileikkauskyselytutkimuksen tulokset. Randomoidussa sarjassa MR-defekografialla todennettiin, että rektopeksialeikkauksen jälkeen peräsuolen sisäinen tuppeuma, rektoseele ja enteroseele korjaantuvat. Rektopeksialeikkaus palauttaa lantion taka- ja keskiosan anatomian, vähentää elinten dynaamista liikkuvuutta ja parantaa lantionpohjan toimintaa sekä oireisiin liittyvää elämänlaatua, erityisesti suolioireiden ja gynekologisten laskeumaoireiden osalta. Robottiavusteinen ja laparoskooppinen tekniikka olivat samanvertaisia perioperatiivisten parametrien, komplikaatioiden, anatomisten ja toiminnallisten tulosten suhteen. Vaikka kustannusvertailussa kalliimpi robottikirurgia voi osoittautua kustannustehokkaaksi pitkäaikaisseurannassa, yhdenvertaiset tulokset eivät oikeuta menetelmää rutiinikäyttöön. Retrospektiivisen tutkimuksen poikkileikkauskyselyn mukaan toiminnalliset tulokset säilyvät pitkäaikaisseurannassa, residiivien (7,1 %) ja komplikaatioiden (10 %) määrä on hyväksyttävä ja verkkoon liittyviä komplikaatioita esiintyy vähän (1,4 %). Leikkauksen jälkeen ilmenee myös uusia oireita, kuten ulostuspakkoa tai virtsankarkailua. Toisaalta virtsankarkailuoire voi korjaantuakin. Pitkäaikaisseurannassa totaalin rektumprolapsin vuoksi leikatut potilaat hyötyvät leikkauksesta enemmän kuin oireisen internin prolapsin vuoksi leikatut. Osa väitöskirjatyön tuloksista tukee moniammatillisen lähestymistavan käyttöä potilaiden arvioinnissa. Jatkossa robottikirurgian käytön indikaatioita rektopeksialeikkauksissa tulisi arvioida isommissa potilasaineistoissa

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Dissertations / Theses on the topic 'Prolapsus rectal'

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