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BackgroundSurgical treatment of recurrent rectal prolapse is associated with unique technical challenges, partially determined by the surgical approach used for the index operation. Success rates are variable, and data to determine the best approach in patients with recurring prolapse are lacking.ObjectiveThe study aimed to assess current surgical approaches to patients with prior rectal prolapse repairs and to compare short-term outcomes of de novo and redo procedures, including recurrence of rectal prolapse.DesignRetrospective analysis of a prospective database.SettingsThe Multicenter Pelvic Floor Disorders Consortium Prospective Quality Improvement database. De-identified surgeons at more than 25 sites (81% high volume) self-reported patient demographics, prior repairs, symptoms of incontinence and obstructed defecation, and operative details, including history of concomitant repairs and prior prolapse repairs.PatientsPatients who were offered surgery for full thickness rectal prolapse.InterventionsIncidence and type of repair used for prior rectal prolapse surgery were recorded. Primary and secondary outcomes of index and redo operations were calculated. Patients undergoing rectal prolapse re-repair (redo) were compared with patients undergoing first (de novo) rectal prolapse repair. The incidence of rectal prolapse recurrence in de novo and redo operations was quantified.OutcomesThe primary outcome of rectal prolapse recurrence in de novo and redo settings.ResultsEighty-nine (19.3%) of 461 patients underwent redo rectal prolapse repair. On short-term follow-up, redo patients had prolapse recurrence rates similar to those undergoing de novo repair. However, patients undergoing redo procedures rarely had the same operation as their index procedure.LimitationsSelf-reported, de-identified data.ConclusionOur results suggest that recurrent rectal prolapse surgery is feasible and can offer adequate rates of rectal prolapse durability in the short term but may argue for a change in surgical approach for redo procedures when clinically feasible. See Video Abstract .Los enfoques duraderos para la reparacin del prolapso rectal recurrente pueden requerir evitar el procedimiento ndiceANTECEDENTES:El tratamiento quirúrgico del prolapso rectal recurrente se asocia con desafíos técnicos únicos, determinados en parte por el abordaje quirúrgico utilizado para la operación inicial. Las tasas de éxito son variables y faltan datos para determinar el mejor abordaje en pacientes con prolapso recurrente.OBJETIVO:Evaluar los enfoques quirúrgicos actuales para pacientes con reparaciones previas de prolapso rectal y comparar los resultados a corto plazo de los procedimientos de novo y rehacer, incluida la recurrencia del prolapso rectal.DISEÑO:Análisis retrospectivo de una base de datos prospectiva.AJUSTE:Base de datos de mejora prospectiva de la calidad del Consorcio multicéntrico de trastornos del suelo pélvico. Cirujanos no identificados en más de 25 sitios (81% de alto volumen) informaron datos demográficos de los pacientes, reparaciones previas, síntomas de incontinencia y defecación obstruida y detalles operativos, incluido el historial de reparaciones concomitantes y reparaciones previas de prolapso.INTERVENCIONES:Se registro la incidencia y el tipo de reparación utilizada para la cirugía de prolapso rectal previa. Se calcularon los resultados primarios y secundarios de las operaciones de índice y reoperacion. Se compararon los pacientes sometidos a una nueva reparación (reoperacion) de prolapso rectal con pacientes sometidos a una primera reparación (de novo) de prolapso rectal. Se cuantificó la incidencia de recurrencia del prolapso rectal en operaciones de novo y rehacer.RESULTADOS:El resultado primario de recurrencia del prolapso rectal en entornos de novo y redo. Ochenta y nueve (19,3%) de 461 pacientes se sometieron a una nueva reparación del prolapso rectal. En el seguimiento a corto plazo, los pacientes reoperados tuvieron tasas de recurrencia de prolapso similares a los de los sometidos a reparación de novo. Sin embargo, los pacientes sometidos a procedimientos de rehacer rara vez tuvieron la misma operación que su procedimiento índice.LIMITACIONES:Datos no identificados y autoinformados.CONCLUSIONES/DISCUSIÓN:Nuestros resultados sugieren que la cirugía de prolapso rectal recurrente es factible y puede ofrecer tasas adecuadas de durabilidad del prolapso rectal en el corto plazo, pero puede abogar por un cambio en el enfoque quirúrgico para rehacer los procedimientos cuando sea clínicamente factible. (Traducción-Dr. Mauricio Santamaria ).

Introduction: Rectal prolapse is prevalent in children and the elderly, impacting quality of life significantly. Traditional surgical interventions carry risks, especially in pediatric patients. Ethanol sclerotherapy offers a less invasive alternative, inducing fibrosis and thickening of the rectal wall. Despite its potential benefits, procedural complications are possible, emphasizing the need for careful patient selection and procedural expertise. This study aims to evaluate the safety and efficacy of sclerotherapy in treating rectal prolapse in a tertiary referral center in southern Iran. Methods: Patient records from Nemazee Hospital covering January 2014 to December 2023 were retrospectively analyzed. Pediatric patients undergoing ethanol sclerotherapy for rectal prolapse were included. Data on demographics, presentation, procedures, and outcomes were collected. Ethical approval was obtained, and specific inclusion/exclusion criteria were applied. Statistical analyses were conducted using SPSS version 26. Results: One hundred thirty patients were evaluated, with a mean age of 10.74 ± 5.320 years. Most patients experienced constipation (56.9%). 74.2% responded well to sclerotherapy, with 12.9% needing a second injection. Complications were minimal, with bleeding being the most common (4.6%). Recurrence occurred in 18.6% of cases. Male patients showed a higher total complication rate (P = 0.010). Diarrhea-dominant patients had no recurrences post-sclerotherapy. Age significantly influenced treatment response and recurrence (P = 0.017, P = 0.035). Conclusion: Male predominance contradicted global pediatric rectal prolapse ratios, possibly influenced by cultural factors. Sclerotherapy remains effective, though response rates vary. Older age correlated with lower response rates and higher recurrence. Constipation-dominant prolapse was associated with increased recurrence risk. Male patients had a higher complication rate, highlighting the need for tailored management strategies. [ABSTRACT FROM AUTHOR]

Faecal incontinence is a hidden problem that is often under-reported, under-diagnosed, under-investigated and under-treated. Faecal incontinence is more common in women and older people. Its prevalence also increases with age. Faecal incontinence occurs because of a complex interplay of contributing factors, some of which can be reversed in primary care without the need for specialist investigations and treatment. This article explores the reasons why adults develop faecal incontinence and how to identify and treat reversible causes in primary care. It also provides information on specialist treatment and the management of intractable faecal incontinence. A structured approach to assessment and management is key in identifying problems and offering primary care for timely treatment. [ABSTRACT FROM AUTHOR]

• POPS is a new surgical procedure that uses a prosthetic mesh for 1-stage treatment of multicompartmental POP. • POPS relapses show posterior vaginal wall recurrences associated with obstructed defaecation. • Multidisciplinary teams and highly specialized centres are recommended to treat patients with POPS relapse. • Ventral rectopexy with sacral colpopexy appears to be a promising treatment in this setting. To investigate pelvic organ prolapse (POP) after a novel abdominal prosthetic surgical technique – 'pelvic organ prolapse suspension' (POPS) – that has been proposed recently as an easily reproducible laparoscopic technique for the treatment of multicompartmental POP and rectal prolapse. This study also aimed to analyse treatment strategies of recurrent POP after POPS, reporting on anatomical, subjective and functional outcomes following recurrence surgery. Patients with a symptomatic prolapse relapse after POPS were collected and analysed prospectively at a single tertiary care institution. Each patient was offered a multidisciplinary clinical and radiological evaluation pre-operatively. Twenty-five women with a median age of 59 [interquartile range (IQR) 49–73] years were enrolled in the study. Of these, 88 % were menopausal. All patients had high-grade (Pelvic Organ Prolapse Quantification System stage > 2) recurrent posterior vaginal wall-predominant prolapse after POPS. Multicompartmental prolapse was found in 64 % of patients. All women complained of vaginal bulging associated with obstructed defaecation syndrome (ODS) symptoms. Surgical treatment consisted of laparoscopic ventral rectopexy (VR) in all 25 cases (100 %), and concomitant sacral colpopexy (SCP) with previous mesh removal in 16 cases (64 %). No anatomical recurrences were observed after median follow-up of 12 (IQR 3–18) months. Overall subjective improvement after surgery was high in all patients (Patient Global Improvement Index ≤ 2). Recurrent POP following POPS appears to predominantly involve the posterior vaginal wall, with associated ODS symptoms. A multidisciplinary approach is advisable for treatment of these patients. Minimally invasive VR alone or in combination with SCP seems to represent an effective treatment. [ABSTRACT FROM AUTHOR]

Background: The International Anorectal Physiology Working Group (IAPWG) suggests a standardized protocol to perform high-resolution anorectal manometry. The applicability and possible limitations of the IAPWG protocol in performing three-dimensional high-definition anorectal manometry (3D-ARM) have still to be extensively evaluated. Methods: The IAPWG protocol was applied in performing 3D-ARM. Anorectal manometry (ARM) and a balloon expulsion test (BET) were performed according to IAPGW protocol in 290 patients. Key Results: A total of 84 males and 206 females (mean age 57.1 ± 15.7 years) were enrolled in six Italian centers. The reasons for which the patients were sent to perform 3D-ARM were: constipation (53.1%), fecal incontinence (26.9%), anal pain (3.1%), postsurgical (3.8%) and presurgical evaluation (4.8%), prolapse (3.4%), anal fissure (2.8%), and other (2.1%). Due to organic and functional conditions (low rectal anterior resections, rectal prolapses, and J-pouch after colectomy), we were unable to perform a complete 3D-ARM on six patients. Overall, a complete 3D-ARM and BET following IAPWG protocol was carried out in 284 patients (97.9%). The following were recorded: rest pressure (81.9 ± 32.0 mmHg) and length of the anal sphincter (37.0 ± 6.2 cm), maximum anal squeeze pressure (201.6 ± 81.3 mmHg), squeeze duration (22.0 ± 8.8 s), maximum rectal (48.7 ± 41.0 mmHg) and minimum anal pressure (73.3 ± 36.5 mmHg) during push, presence/absence of a dyssynergic pattern, cough reflex and rectal sensations (first constant sensation 48.4 ± 29.5 mL, desire to defecate 83.7 ± 52.1 mL, and maximum tolerated volume 149.5 ± 72.6 mL), and presence/absence of rectoanal inhibitory reflex. Mean 3D-ARM registration time was 14 min 7 s ± 3 min 12 s. Conclusions: This is the first multicentric study that evaluates the applicability of the IAPWG protocol in 3D-ARM performed in different manometric laboratories (both gastroenterological and surgical). The IAPWG protocol was easy to perform and was not time consuming. A diagnosis according to the London Classification was easily obtained in most patients in which 3D-ARM was carried out. No clear limitations to the applicability of the IAPWG protocol were detected. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low “take‐off”.A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit. Clinical data, AAR, and conventional anal manometry were analysed according to the Oxford prolapse grade.A total of 108 (102 [94%] female, median age 62 years [range: 26–95]) patients were recruited into three groups according to prolapse grade: Oxford grades I and II (intrarectal RI, n = 34), Oxford grades III and IV (intra‐anal RI, n = 35) and Oxford grade V (ERP, n = 39). As the grade of prolapse increased, resting AAR measurements of opening pressure, opening elastance, closing pressure, and closing elastance decreased (p < 0.001). Maximum resting pressure with manometry was reduced in ERP and intra‐anal RI compared to intrarectal RI (p < 0.001). However, incremental squeeze function was not different between the three groups with either AAR or manometry (p > 0.05).There were no differences in AAR or manometry variables between grade IV RI (n = 18) and high take‐off ERP (n = 20) (p > 0.05). By contrast, opening pressure (p = 0.010), closing pressure (p = 0.019) and elastance (p = 0.022) were reduced in low take‐off ERP (n = 19).Increasing rectal prolapse grade is associated with reduced anal sphincter function at rest indicating internal anal sphincter dysfunction. Physiological differences exist between high and low take‐off ERP with sphincter function in the former similar to that seen in grade IV RI. [ABSTRACT FROM AUTHOR]

Background: Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus, which, if not properly managed, may become incarcerated and pose a risk of strangulation. This pathology is rarely a medical emergency unless a complication is encountered. Such complications include infection, necrosis, perforation, incarceration, and uncontrolled pain. Case Presentation: We report a case of an elderly patient with pain associated with chronic rectal prolapse. Surgical intervention had been ruled out, and there had been no pain relief after using systemic analgesics. Case Management: Based on increasing reports of analgesic properties, topical methylene blue (MB) 0.1% was applied externally at the prolapsed organ, obtaining pain relief. Case Outcome: The patient experienced immediate and long-lasting pain relief; MB applications were continued every 12 hours as needed. After this therapy, the patient was no longer in need of systemic analgesics. No side effects were reported. Conclusion: Topical MB may be an effective analgesic for the management of pain associated with chronic rectal prolapse. This treatment might be extrapolated to other clinical scenarios of tegumentary pain. Similar use has been shown to be safe and effective in other pathologies, including pain in oral mucositis associated with cancer therapy. [ABSTRACT FROM AUTHOR]

Background: The goal of our research is to demonstrate how the combination of Rectal wall Plication (RP) and robotic Ventral Mesh Rectopexy (VMR) results in a safe and effective operation that provides superior outcomes for patients with Obstructed Defecation Syndrome (ODS). Methods: In a total of 78 women with ODS with posterior compartment prolapse, 30 had VMR whereas 33 received VMR plus RP. We assessed VMR and VMR + RP's efficacy and safety, as well as their influence on quality of life and sexual function. Results: At the median follow-up, both groups' POP-Q categorization scores for the posterior compartment decreased (p < 0.001). In terms of quality of life, the PISQ-12 showed an increase in sexual quality (30.12 ± 7.12 vs. 35.98 ± 5.98 in the VMR group and 29.65 ± 6.45 vs. 29.65 ± 6.45 in the VMR + RP group, p = 0.041). In the VMR + RP group, the number of sexually active patients with at least two sexual interactions per month rose (p = 0.033). At the median follow-up, the ODS score values differed significantly (7.11 ± 1.65 vs. 1.88 ± 1.89, p = 0.013). Conclusions: The combination of rectal wall plication and ventral mesh rectopexy may result in improved bowel function and quality of life. [ABSTRACT FROM AUTHOR]

Aim Patients and methods Results Conclusion Very few studies have compared laparoscopic pelvic organ prolapse suspension (POPS) and laparoscopic ventral mesh rectopexy (LVMR) in the treatment of rectal prolapse, particularly regarding the comparison of improvement rates in obstructed defecation syndrome (ODS). This study aimed to compare the anatomical and functional outcomes of these two methods over a long‐term follow‐up period.This retrospective study was conducted on 120 female patients diagnosed with rectal prolapse who underwent surgery at the Colorectal Surgery Department of Shahid Faqihi Hospital in Shiraz, Iran, between October 2015 and October 2022. The patients were categorised into two groups based on their surgical procedures: 58 underwent LVMR in the first group, and 62 underwent POPS in the second group.Recurrence of prolapse occurred in 7 (12.1%) patients in the LVMR group and 5 (8.1%) patients in the POPS group (P = .550). The mean operation time, mean length of hospital stay, Visual Analogue Scale score, early and late post‐operative complications, Cleveland Clinic Incontinence Score, ODS symptoms, and Wexner Constipation Scores did not differ significantly between the two groups.Both laparoscopic POPS and LVMR techniques significantly improved the anatomical and functional outcomes in the treatment of rectal prolapse and obstructed defecation. LVMR and POPS can each be considered first‐line treatment options for rectal prolapse, depending on the specific case. [ABSTRACT FROM AUTHOR]

This document contains summaries of several articles related to colorectal disease. The first article discusses the adoption of a hybrid alternative to single-use laparoscopic ports in order to reduce the carbon footprint of laparoscopic surgery. The second article explores surgeons' experiences and practices in the primary repair of obstetric anal sphincter injuries. The third article introduces an AI-powered endoscopic analysis tool that improves the detection of precancerous lesions in colorectal cancer screening. The fourth article examines the impact of colonoscopy key performance indicators on the risk of colorectal cancer and advanced polyps. The fifth article investigates the association between psoas sarcopenia and mortality in patients with per rectal bleeding. The sixth article outlines a Phase III study evaluating the efficacy and safety of perioperative dostarlimab monotherapy in patients with resectable colon adenocarcinoma. The seventh article assesses the incidence, healthcare resource use, and costs associated with incisional hernia repair. The final article discusses the use of innovative techniques in restorative prophylactic surgery for familial adenomatous polyposis. [Extracted from the article]

Background: Laparoscopic rectopexy is an established treatment option for full-thickness rectal prolapse. Recently, reduced port surgery (RPS) has emerged as a novel concept, offering reduced postoperative pain and improved cosmetic outcomes compared with conventional multiport surgery (MPS). This study aimed to evaluate the feasibility and safety of RPS for full-thickness rectal prolapse. Methods: From October 2012 to December 2018, 37 patients (MPS: 10 cases, RPS: 27 cases) underwent laparoscopic rectopexy for full-thickness rectal prolapse. Laparoscopic posterior mesh rectopexy (Wells procedure) is the standard technique for full-thickness rectal prolapse at our hospital. RPS was performed using a multi-channel access device, with an additional 12-mm right-hand port. Short-term outcomes were retrospectively compared between MPS and RPS. Results: No significant differences were observed between MPS and RPS in the median operative time, the median blood loss volume, the postoperative complication rates, and median hospital stay duration after surgery. Conclusion: Reduced port laparoscopic posterior mesh rectopexy may serve as an effective therapeutic option for full-thickness rectal prolapse. However, to establish the superiority of RPS over MPS, a prospective, randomized, controlled trial is warranted. [ABSTRACT FROM AUTHOR]

Indroduction: Hemorrhoids often cause pain, and achieving painless outcomes through surgery is challenging. Hemorrhoidal Laser Ablation, a method for treating severe hemorrhoids, has limited documentation in clinical trials. Aim: This retrospective study aimed to present our experience with Hemorrhoidal Laser Ablation in symptomatic grade II, III, and IV internal hemorrhoids and evaluate the efficacy and safety of this relatively recent technique. Material and methods: The cohort included 138 patients with symptomatic hemorrhoids who underwent Hemorrhoidal Laser Ablation at three different medical centers in 2017–2022. Patients were treated with a 1470 nm diode laser. Data were collected on clinical and perioperative characteristics and outcomes. Results: No evidence of intraoperative complications occurred. There was no rectal tenesmus or alteration of defecation habits. Early mild postoperative symptoms were observed for an average of one week after the operation. The plateau of symptom resolution and downgrading of hemorrhoid size reached approximately six months post-procedure. The short- -term recurrence rate was 0.8% within roughly a month after the laser surgery, while the long-term recurrence rate was 5% over up to five years of follow-up. The overall satisfaction rate was 95% with symptomatic relief. Conclusions: Hemorrhoidal Laser Ablation is a painless outpatient technique that does not require general anesthesia. It is an easy-to-perform, convenient, safe, and efficient modality in reducing symptoms and complications of grades II, III, and IV internal hemorrhoids. Hemorrhoidal Laser Ablation limits postoperative discomfort and allows the patient to return to daily routines quickly. [ABSTRACT FROM AUTHOR]

Abstract Introduction Rectal prolapse is prevalent in children and the elderly, impacting quality of life significantly. Traditional surgical interventions carry risks, especially in pediatric patients. Ethanol sclerotherapy offers a less invasive alternative, inducing fibrosis and thickening of the rectal wall. Despite its potential benefits, procedural complications are possible, emphasizing the need for careful patient selection and procedural expertise. This study aims to evaluate the safety and efficacy of sclerotherapy in treating rectal prolapse in a tertiary referral center in southern Iran. Methods Patient records from Nemazee Hospital covering January 2014 to December 2023 were retrospectively analyzed. Pediatric patients undergoing ethanol sclerotherapy for rectal prolapse were included. Data on demographics, presentation, procedures, and outcomes were collected. Ethical approval was obtained, and specific inclusion/exclusion criteria were applied. Statistical analyses were conducted using SPSS version 26. Results One hundred thirty patients were evaluated, with a mean age of 10.74 ± 5.320 years. Most patients experienced constipation (56.9%). 74.2% responded well to sclerotherapy, with 12.9% needing a second injection. Complications were minimal, with bleeding being the most common (4.6%). Recurrence occurred in 18.6% of cases. Male patients showed a higher total complication rate (P = 0.010). Diarrhea-dominant patients had no recurrences post-sclerotherapy. Age significantly influenced treatment response and recurrence (P = 0.017, P = 0.035). Conclusion Male predominance contradicted global pediatric rectal prolapse ratios, possibly influenced by cultural factors. Sclerotherapy remains effective, though response rates vary. Older age correlated with lower response rates and higher recurrence. Constipation-dominant prolapse was associated with increased recurrence risk. Male patients had a higher complication rate, highlighting the need for tailored management strategies.

Pelvic organ prolapse refers to the descent of pelvic floor organs resulting from the weakening of pelvic muscles, fascia and connective tissue. The overall prevalence of pelvic organ prolapse is approximately 41%, including bladder prolapse (25%–34%), uterine prolapse (4%–14%) and rectal prolapse (13%–19%). Various methods are currently employed to repair damaged structures and improve patient symptoms, consequently enhancing their quality of life. This report focuses on a 94-year-old female diagnosed with pelvic organ prolapse, specifically Grade 3 bladder prolapse, Grade 3 uterine prolapse and complete rectal prolapse. A comprehensive surgical treatment was carried out to repair the pelvic organs on all three levels (rectum, uterus and bladder) by combining the Delorme procedure with synthetic graft implants. The surgical outcomes were good, illustrating immediate improvement in symptoms without early complications. A multispeciality approach helps functionally repair pelvic organ prolapse while preserving structural integrity.

Objectives Methods Results Conclusion The aim of this study was to determine the prevalence of pelvic floor disorders (PFDs) and associated risk factors among parous Ugandan women.We performed a cross‐sectional study of parous Ugandan women. Demographics and assessment for PFD were obtained. The presence of PFD was defined by participant symptom report, standardized questionnaires, and standard physical examination (pelvic organ prolapse quantification [POP‐Q] and cough stress test [CST]).A total of 159 women were enrolled in the study between June 2022 and June 2023. The median age was 35 years and median parity was 4. Forty‐four (28%) women in the cohort reported symptoms of urinary incontinence. No women reported symptoms of pelvic organ prolapse or anal incontinence. Seventy‐two (46%) participants had a positive CST and 93 (58.3%) had stage II or greater prolapse based on the POP‐Q. Cesarean section was found to have a protective effect for the development of PFD (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.07–0.59, P = 0.004).PFDs are prevalent among parous Ugandan women at rates similar to cohorts in other low‐ and middle‐income countries. Cesarean section seems to be a protective factor against developing PFDs. [ABSTRACT FROM AUTHOR]

This study aimed to investigate genetic parameters for sow pelvic organ prolapse in purebred and crossbred herds. Pelvic organ prolapse was recorded as normal or prolapsed on the individual sow level across 32 purebred and 8 crossbred farms. In total, 75,162 purebred Landrace sows from a single maternal line were recorded between 2018 and 2023, while 18,988 commercial two-way crossbred (Landrace x Large White) sows were available between 2020 and 2023. There were 5,122,005 animals included in the pedigree. The prolapse in purebreds and crossbreds was considered two different traits in the model. Pedigrees of the crossbred sows were determined based on genotypes through parentage assignment. The average incidence rates were 1.81% and 3.93% for purebreds and crossbreds, respectively. The bivariate model incorporated fixed effects of parity group and region with random effects of contemporary group (farm and mating year and month at the first parity), additive genetic, and residual. Genetic parameter estimates were obtained using BLUPF90+ with the AIREML option. The estimated additive variance was larger in crossbreds than in purebreds. Estimates of heritability in the observed scale were 0.09 (0.006) for purebreds and 0.11 (0.014) for crossbreds, with a genetic correlation of 0.83 using a linear model. Results suggested that including data from crossbreds with higher incidence rate is beneficial and selection to reduce the prolapse incidence in purebred sow herds would also benefit commercial crossbred sow herds. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the results of Gant-Miwa-Thiersch (GMT) rectal prolapse repair using an artificial ligament in elderly patients. Subjects and Methods: We investigated the perioperative and postoperative outcomes of 35 patients aged 85 years or older with rectal prolapse who underwent radical surgery at our hospital from January 2012 to December 2022. Results: The median age of the patients was 88 years, and all were female. The median length of bowel evacuation was 7 cm, and the median operative time was 37 minutes. There was one perioperative complication including infection of the artificial ligament. There was two cases of recurrence, but neither recurrence occurred after additional transperineal surgery. Fecal incontinence was present preoperatively in 23 patients, but improved postoperatively in 11. Constipation was well controlled with oral medication, and there were no cases of long-term difficulty of defecation. Conclusion: GMT using an artificial ligament may be the first choice for rectal prolapse repair in very elderly patients. [ABSTRACT FROM AUTHOR]

Aim: Solitary rectal ulcer syndrome (SRUS) is a benign and poorly understood disorder with complex management. Typical symptoms include straining during defaecation, rectal bleeding, tenesmus, mucoid secretion, anal pain and a sense of incomplete evacuation. Diagnosis is based on characteristic clinical symptoms and endoscopic/histological findings. Several treatments have been reported in the literature with variable ulcer healing rates. This study aimed to evaluate the efficacy of different treatments for SRUS. Materials and methods: A systematic review and network meta‐analysis were performed according to the PRISMA guidelines. Studies in English, French and Spanish languages were included. Papers written in other languages were excluded. Other exclusion criteria were reviews, case reports or clinical series enrolling less than five patients, study duplications, no clinical data of interest and no article available. A systematic literature search was conducted from January 2000 to March 2024 using the following databases: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus. The biases of the studies were assessed using the Newcastle–Ottawa scale or the Jadad scale when appropriate. Types of treatment and their efficacy for the cure of SRUS were collected and critically assessed. The study's primary outcome was to estimate the rate of patients with ulcer healing. Results: A total of 22 studies with 911 patients (men 361, women 550) diagnosed with SRUS were analysed in the final meta‐analysis. The pooled effect estimates of treatment efficacy revealed that surgery showed the highest ulcer healing rate (70.5%; 95% CI 0.57–0.83). Surgery was superior in the cure of ulcers with respect to medical therapies and biofeedback (OR 0.09 and OR 0.14). Conclusion: Solitary rectal ulcer syndrome is a challenging clinical entity to manage. Proficient results have been reported with the surgical approach, suggesting its positive role in cases refractory to medical and biofeedback therapy. Further studies in homogeneous populations are required to evaluate the efficacy of surgery in this setting. (PROSPERO registration number CRD42022331422). [ABSTRACT FROM AUTHOR]

• Vaginal mesh for the treatment of pelvic organ prolapse is recommended in highly individualized cases. • This is so because serious complications have been described with its use, at first even indiscriminate. • The extrusion of vaginal mesh posterior to the rectum is a serious complication that requires multidisciplinary management, and sometimes a multiway approach and repeated surgeries. • After mesh removal, an ischiorectal fistula refractory to multiple interventions persisted. • A non-invasive and regenerative therapy is postulated for the management of these complex fistulas. Vaginal mesh has been used for years to try to improve the results of pelvic organ prolapse surgery, but current evidence does not confirm this improvement and instead describes serious and frequent adverse events. 64-year-old patient with rectal extrusion of posterior vaginal mesh placed 8 years earlier, and persistent left ischiorectal fistula refractory to surgery. She required 5 surgeries, carried out jointly between gynecology and general surgery, to solve, firstly, the bilateral perianal abscess secondary to extrusion of the posterior vaginal mesh into the rectum and then the persistent left ischiorectal fistula, despite the removal of the material prosthetic. Finally, the fistula was solved by injection of platelet-rich plasma. Vaginal mesh complications often need a multidisciplinary approach, and treatment may require multiple approaches and more than one surgical procedure. In the case of a persistent fistula refractory to surgery, after removing the mesh, non-invasive regenerative therapies that promote vascular growth and tissue regeneration could be considered such as platelet-rich plasma. [ABSTRACT FROM AUTHOR]

The study's goal was to evaluate patient demographics, related abnormalities, atresia location, operational management, postoperative care, and results of patients with gastrointestinal atresia and compare them with other research. Methods: A 5-year retrospective study in cases with gastrointestinal atresia at a tertiary hospital in Mogadishu, Somalia, was carried out by the pediatric surgery department from January 2017 to January 2022. Results: A165 cases were operated due to gastrointestinal atresia in five-year period., 105 were male (63.6%) and 60 were female (36.4%), giving the male to female ratio of 1.75:1. According to the age group of the study population, the majority of cases (48.5%) were aged less than 1 month. The esophageal atresia, duodenal atresia, high jejunal atresia, jejunoileal atresia, and colon atresia, anorectal malformations were 9.7%, 9.1%, 0.6%, 7.3%, 73.3%, respectively; the anorectal malformations has resulted in the majority of cases (73.3%). 20 % of cases had no follow-up, while 80% arrived as planned. 52.1% got well and had no complications and some developed different complications like peristomal skin irritation (14%), rectal and urethral fistula (4.8%), rectal prolapse (1.8%), rectal stenosis (2.4%), rectal adhesions (1.2%), esophageal stricture (1.2%), wound infection (3.6%), anastomosis dehiscence (0.6%), abdominal distension (0.6%), recto-perineal fistula (1.2%), urethral damage and urinary retention (0.6%). Mortality for this study was 24.8% (41 patients). Conclusion: Children with gastrointestinal atresia present late in the course of their illness, with substantial morbidity and death due to poor economic conditions, poor nutrition, surgical problems, and likely related anomalies, rather than surgical morbidity alone. [ABSTRACT FROM AUTHOR]

Simple Summary: Three cats with recurrent rectal prolapses were successfully treated using total laparoscopic colopexy (TLC). Minimally invasive procedures are increasingly popular in veterinary medicine because of their low postoperative morbidity and quicker recovery. The TLC technique, inspired by laparoscopic-assisted colopexy, involves strategically placed portals to minimize wound complications and ensure effective adhesion of the colon to the abdominal wall. In these cases, non-incisional colopexy using thermal injury was employed to enhance fibrous adhesion, reducing bleeding and avoiding luminal penetration risks. Barbed sutures, used in a continuous single row, facilitated the procedure by eliminating the need for intracorporeal knots, thus reducing surgical time to 30 min. No complications or recurrences were noted during follow-ups. In one case, a viable colopexy was confirmed during a subsequent laparoscopic procedure, demonstrating the technique's success. Overall, TLC was found to be a feasible, safe, and effective method for treating recurrent rectal prolapses in cats, although further studies with larger sample sizes are necessary to validate these findings. The use of minimally invasive methods has grown in popularity due to decreased postoperative morbidity and a quicker recovery. Colopexy is a surgical method that includes the permanent adhesion of the colonic seromuscular layer to the abdominal wall to avoid rectal prolapses in cats and dogs with viable prolapsed tissues. In this case series, we describe the treatment of three cats with total laparoscopic colopexy (TLC) for recurrent rectal prolapses. A non-incisional colopexy was created by suturing the colon to the abdominal wall with a barbed suture. There were no intraoperative complications and a 6-month follow-up revealed no prolapse recurrence. Our study demonstrates that TLC approaches are feasible, safe, and free of problems when used to treat recurrent rectal prolapses in cats, although a larger caseload is required to validate the results obtained from our reported cases. [ABSTRACT FROM AUTHOR]

This document contains abstracts from the 10th SICCR National Congress, covering various topics related to colorectal surgery. The abstracts provide brief summaries of studies and presentations on topics such as the use of chlorphenamine as a substitute for opioids in sedating patients during colonoscopy, risk factors for mortality and complications in colorectal cancer surgery, different surgical approaches for rectal cancer, and outcomes of laparoscopic surgery for colon cancer. The studies emphasize the importance of individualized treatment plans and multidisciplinary approaches for optimal outcomes. The document also includes abstracts on other proctological conditions and procedures, such as hemorrhoids and anal fistulas. [Extracted from the article]

Objectives: To assess the evolution of levator ani muscle (LAM) avulsion from 1 year to 8 years after first delivery in women with and those without subsequent vaginal delivery. In addition, to assess whether women with full or partial avulsion 8 years after first delivery have larger LAM hiatal area and more symptoms of pelvic organ prolapse compared to women with normal LAM insertion. Methods: In this single‐center longitudinal study, 195 women who were primiparous at the start of the study were included and underwent transperineal ultrasound examination 1 year and 8 years after first delivery. Muscle insertion was assessed by tomographic ultrasound imaging in the axial plane. Full LAM avulsion was defined as abnormal muscle insertion in all three central slices. Partial LAM avulsion was defined as abnormal muscle insertion in one or two central slices. Eight years after the first delivery, LAM hiatal area was assessed at rest, during maximum pelvic floor muscle contraction and on maximum Valsalva maneuver. To assess symptoms of pelvic organ prolapse, the vaginal symptoms module of the International Consultation on Incontinence Questionnaire was used. Results: At 1‐year follow‐up, 25 (12.8%) women showed signs of LAM avulsion, of whom 20 fulfilled the sonographic criteria of full avulsion and five of partial avulsion. Eight years after the first delivery, 35 (17.9%) women were diagnosed with avulsion, of whom 25 were diagnosed with full avulsion and 10 with partial avulsion. No woman with partial or full avulsion at 1 year had improved avulsion status at 8‐year follow‐up. Of the 150 women who had subsequent vaginal delivery, 21 (14.0%) women were diagnosed with partial or full LAM avulsion 1 year after first delivery, and 31 (20.7%) women were diagnosed with partial or full avulsion 8 years after first delivery. Of the 45 women without subsequent vaginal delivery, one woman with partial avulsion 1 year after first delivery was diagnosed with full avulsion at 8‐year follow‐up. All women with full avulsion at 1‐year follow‐up were diagnosed with full avulsion at 8‐year follow‐up regardless of whether they had subsequent vaginal delivery. At 8‐year follow‐up, women with full avulsion had statistically significantly larger LAM hiatal area compared to women with normal muscle insertion. Mean ± SD vaginal symptom scores ranged between 5.5 ± 5.7 and 6.0 ± 4.0 and vaginal symptom quality of life scores ranged between 0.9 ± 1.4 and 1.5 ± 2.2 and did not differ significantly between women with normal muscle insertion and women with partial or full avulsion at 8‐year follow‐up. Conclusions: More LAM avulsions were present 8 years compared with 1 year after first delivery in women with subsequent vaginal delivery. Except for one primipara, all women without subsequent vaginal delivery had unchanged LAM avulsion status between 1 year and 8 years after their first delivery. Larger LAM hiatal area was found in women with full avulsion compared to those with normal muscle insertion at 8‐year follow‐up. Vaginal symptoms scores were low and did not differ between women with normal muscle insertion and those with partial or full avulsion at 8‐year follow‐up. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Rectosigmoid solitary juvenile polyps are benign lesions, relatively frequent in childhood. The clinical debut of a pediatric polyp with bleeding is relatively frequent, but there are very few reports of rectal prolapse of polyps. We present the case of a 7-year-old female patient with no previous history who presented with rectal prolapse of a polyp with acute bleeding. An urgent endoscopic examination was performed and 2 rectosigmoid polypoid lesions were found and resected. The anatomopathological study showed that these were 2 hamartomatous polyps with mild dysplasia. The patient is asymptomatic and is being followed up. The literature concerning rectal prolapse of polyps in the pediatric population is scarce. In a pediatric patient with a rectal prolapse, this entity should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Patient selection is extremely important in obstructed defecation syndrome (ODS) and rectal prolapse (RP) surgery. This study assessed factors that guided the indications for ODS and RP surgery and their specific role in our decision-making process using a machine learning approach. Methods: This is a retrospective analysis of a long-term prospective observational study on female patients reporting symptoms of ODS who underwent a complete diagnostic workup from January 2010 to December 2021 at an academic tertiary referral center. Clinical, defecographic, and other functional tests data were assessed. A supervised machine learning algorithm using a classification tree model was performed and tested. Results: A total of 400 patients were included. The factors associated with a significantly higher probability of undergoing surgery were follows: as symptoms, perineal splinting, anal or vaginal self-digitations, sensation of external RP, episodes of fecal incontinence and soiling; as physical examination features, evidence of internal and external RP, rectocele, enterocele, or anterior/middle pelvic organs prolapse; as defecographic findings, intra-anal and external RP, rectocele, incomplete rectocele emptying, enterocele, cystocele, and colpo-hysterocele. Surgery was less indicated in patients with dyssynergia, severe anxiety and depression. All these factors were included in a supervised machine learning algorithm. The model showed high accuracy on the test dataset (79%, p < 0.001). Conclusions: Symptoms assessment and physical examination proved to be fundamental, but other functional tests should also be considered. By adopting a machine learning model in further ODS and RP centers, indications for surgery could be more easily and reliably identified and shared. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this video case series is to demonstrate our experience of the clinical findings and the surgical management of the rapid onset de novo rectal prolapse (RP) following colpocleisis Methods: This is a case series of three patients who developed de novo RP within 1 month after colpocleisis, which was repaired by laparoscopic ventral mesh rectopexy (LVMR). The video shows the physical, radiological, and intraoperative findings of these patients. A retrospective review of our surgical cases of RP was also performed to analyze the onset timing of de novo RP after various pelvic organ prolapse (POP) procedures. Results: The pathological condition of all three patients' RP was evacuation enterocele, and LVMR was feasible without postoperative complications or recurrences. In the retrospective case review of 158 RP surgeries in our institution (June 2015 to September 2023), 18 cases (11.4%) occurred following POP surgery. De novo RP following colpocleisis developed significantly earlier than those following other procedures (average: 6.1 vs 66.4 months, p = 0.010). Conclusions: Although de novo RP following colpocleisis is relatively rare, this complication could have a detrimental effect on patients' quality of life. Preoperative informed consent may be advisable before planning colpocleisis. [ABSTRACT FROM AUTHOR]

Background: The gastrointestinal (GI) tract represents one of the main targets of typical hemolytic uremic syndrome (HUS) in children. In this observational study, we tried to establish (1) the main features of GI complications during STEC-HUS and (2) the relationship between Escherichia coli serotypes and Shiga toxin (Stx) variants with hepatopancreatic involvement. Methods: A total of 79 STEC-HUS patients were admitted to our pediatric nephrology department between January 2012 and June 2021. Evidence of intestinal, hepatobiliary, and pancreatic involvements was reported for each patient, alongside demographic, clinical, and laboratory features. Frequency of gastrointestinal complications across groups of patients infected by specific E. coli serotypes and Stx gene variants was evaluated. Results: Six patients developed a bowel complication: two developed rectal prolapse, and four developed bowel perforation which resulted in death for three of them and in bowel stenosis in one patient. Acute pancreatitis was diagnosed in 13 patients. An isolated increase in pancreatic enzymes and/or liver transaminases was observed in 41 and 15 patients, respectively. Biliary sludge was detected in three, cholelithiasis in one. Forty-seven patients developed direct hyperbilirubinemia. Neither E. coli serotypes nor Shiga toxin variants correlated with hepatic or pancreatic involvement. Conclusions: During STEC-HUS, GI complications are common, ranging from self-limited elevation of laboratory markers to bowel perforation, a severe complication with a relevant impact on morbidity and mortality. Hepatopancreatic involvement is frequent, but usually short-lasting and self-limiting. [ABSTRACT FROM AUTHOR]

Objective: To present the data of children with anorectal malformations treated with a staged approach, including the complications of each stage. Study Design: Prospective longitudinal Study Place and Duration of Study: Paediatric Surgery Departments, Combined Military Hospital, Malir and Multan, Pakistan from Jan 2017 to Jun 2019 and Jul 2019 to Jul 2022, respectively. Methodology: Twenty-four children with anorectal malformations were included. Al were treated with a staged approach. The complications encountered during each approach were documented. Results: A total of 24 patients were operated on. Fourteen (58.3%) were female, whereas 10 (41.7%) were male patients. The age range was 1-4 years, with a mean of 2.00 ± 0.97 years. Female patients had an ARM with a rectovestibular fistula. Two (20%) of the male patients had rectal atresia, a recto-urethral bulbar fistula, a recto-urethral prostatic fistula, a recto-bladder neck fistula, or a perineal fistula. Two (8.3%), three (12.5%), two (8.3%), and one (4.1%) patients who had stage 1 had stomal stenosis or retraction, wound dehiscence, wound infection, and stoma prolapse respectively. In the second stage, two patients (8.3% of al patients) had an infection, a wound dehiscence, a dehiscence of the perineal body, and anal stenosis. In the other patient, one (4.1%) had an anal mucosal prolapse and severe urethral injury. After stage 3, only one patient (4.1%) had a wound infection. Conclusion: Patients with ARM are generaly treated with a multistaged approach, and each stage of treatment has its own complications. [ABSTRACT FROM AUTHOR]

A 2‐year‐10‐month‐old, male, neutered French bulldog presented with a rectal prolapse, rectal bleeding, weight loss and anaemia with left hindlimb oedema. Biopsies of the recto‐anal junction identified moderate neutrophilic and lymphoplasmacytic erosive proctitis, with moderate vascular hyperaemia and moderately ectatic vessels in the rectal submucosa. Abdominal computed tomography identified intra‐abdominal arteriovenous malformations involving the mesenteric arteries, colic arteries, the vertebral venous plexus and femoral veins causing concurrent left hindlimb oedema. The malformations were too extensive to allow for surgical resection of the affected area of intestine. The patient's clinical signs initially responded to immunosuppressive therapy with corticosteroids. However, the patient's clinical signs progressed, and the dog was euthanased 4 months after initial presentation. To the authors' knowledge, this is the first report of such extensive arteriovenous anomalies also involving rectal prolapse and suspected colonic ectasia in a dog. [ABSTRACT FROM AUTHOR]

Disorders related to defaecation are widely common in the population and are often overlooked. Patients may present with a wide variety of symptoms such as constipation, faecal incontinence, painful defaecation, incomplete defaecation, hard stools, rectal bleeding, and mass per rectum. Complete clinical examination with radiological imaging, using dynamic MR Defaecography, can help in assessing, grading, and managing posterior compartment pelvic floor disorders and complex dysfunctions. The cases reveal a spectrum of pelvic floor disorders and complex dysfunctions including spastic pelvic floor syndrome, Grade 3 anorectal descent with rectocoele and cystocoele, tri-compartmental descent with obstructed defaecation syndrome, complete external rectal prolapse with Grade 3 abnormal anorectal descent and rectal intussusception. Contribution: This case series emphasises the importance of understanding the correlation of clinical and radiological imaging findings in posterior compartment pelvic floor dysfunctions through a series of cases presenting with clinical complaints related to defaecation.

Many technical propositions have been incorporated to the surgical management of hemorrhoidal disease during the recent decades. Besides that, escisional techniques are still considered the best option to control symptoms and reduce recurrence. The present manuscript aims to propose a technical modification of the classical closed hemorrhoidectomy described by Ferguson in America. Our proposition is to perform two sutures to close the wound resulting from hemorrhoidal resection. The first one consists of an anchored continuous suture using a very thin (4–0 or 5–0) monofilamentar thread coming from inside to the outside skin. After tying the stitch, a simple continuous second suture is made over the previous suture only for mucosal approximation, from outside to inside. Finally, the stich that initiated the first suture is tied up to the stich used for the second suture, and the knot remains located above the dentate line, not to disturb the patient. The confection of two layers aims to reinforce the closing of the wound and avoid dehiscence. The idea is that this modification influences postoperative outcomes by reducing symptoms such as wound discharge and pain, and thus improving healing and esthetics. In a next step research, a comparison with the classical technique may bring new insights to this issue.

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