Perineal Rectal Prolapse Repair
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Perineal Rectal Prolapse Repair
Rectal Prolapse, Perineal Repair (Perineal Rectosigmoidectomy: Altemeier Procedure)- Abdominal vs. perineal rectal prolapse repair (including mesh rectopexy)
Pelvic Floor- A 59-year-old woman presents with full-thickness rectal prolapse 6 years after sigmoid resection and rectopexy. She complains of significant discomfort and fecal urgency. Dynamic magnetic resonance imaging defecography demonstrates full-thickness rectal prolapse without anterior or middle compartment involvement. Which of the following procedures is contraindicated in the management of this patient’s rectal prolapse?
- A 73-year-old woman presents with a history of constipation, fecal soiling, and a mass protruding from her rectum. Examination reveals a complete rectal prolapse, and the patient undergoes a transabdominal surgical repair. Six months later, she returns with severe constipation. Which surgical maneuver may have contributed to this patient’s recurrent constipation?
- An 80-year-old woman with multiple comorbidities presents with chronic, full-thickness rectal prolapse. The patient recognizes the need for surgery and inquires about the durability of surgical repair. Which repair option is associated with the highest rate of recurrent rectal prolapse?
- A 75-year-old woman with chronic rectal prolapse wishes to discuss surgical treatment planning. She has prolapsing tissue with defecation, which is lifestyle limiting due to bleeding, fecal smearing, and pain. On physical examination, she has a 1.5-cm segment of circumferential prolapsing rectal mucosa with a focal anterior ulcer, no rectocele, and moderate baseline tone. She is frail, with a medical history significant for coronary artery disease after stent placement, receives dual antiplatelet therapy, and has a caretaker to assist with daily activities. What is the best surgical approach for repair of this patient’s prolapse?
Rectal Prolapse- Treatment of Rectal Prolapse (2017)
- Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus
Pelvic Floor- A 45-year-old patient, gravida 4, para 4, who has no comorbidities presents with full-thickness rectal prolapse. She has not undergone prior anorectal surgery and has had a normal colonoscopy. She reports regular bowel movements without straining and no history of chronic constipation. What is the best next approach in her management?
- An 89-year old with multiple comorbidities presents with recurrent rectal prolapse after prior sigmoid resection and rectopexy for rectal prolapse and chronic constipation. Which of the following carries the highest risk for bowel ischemia?
- A 67-year-old female patient presents with full-thickness rectal prolapse. Other than this condition, she is healthy. Dynamic pelvic magnetic resonance imaging (MRI) shows a 4-cm rectocele with incomplete evacuation of contrast and the known full-thickness rectal prolapse. What is the best surgical option for her?
- A 65-year-old woman presents with a 4-month history of progressively worsening fecal incontinence. The patient initially noted the intermittent uncontrolled passage of gas and liquid stools. However, she now reports daily uncontrolled passage of solid stools. She notes that this has been debilitating, preventing her from interacting with friends and family during her usual activities. The patient reports three vaginal births, with a grade 3 perineal tear occurring during her last delivery requiring repair. The best modality to evaluate her fecal incontinence is
- An 89-year-old woman with end-stage Parkinson’s disease is admitted to the hospital with fecal impaction. Computed tomography demonstrates a transition point at the anus. The patient’s caretaker reports she had an operation last month for rectal prolapse. Which of the following techniques is most likely to have contributed to her current presentation?
- A 54-year-old healthy woman, gravida 3, para 3, with morbid obesity is seen in the clinic for a recurrent rectal prolapse 1 year after posterior suture rectopexy. She reports a bulge in the vagina for many years that has not changed with the rectopexy. Colonoscopy shows a redundant sigmoid colon. Which of the following most likely contributed to the recurrence of rectal prolapse?
- Development of a Consensus-Derived Synoptic Operative Report for Rectal Prolapse: A Report From the Pelvic Floor Disorders Consortium
- Middle and Anterior Pelvic Compartment: Issues for the Colorectal Surgeon
- Pediatric Colorectal Disorders
- Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
- Treatment of a Large Enterocele by Laparoscopic Ventral Rectopexy
- Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders
- Video Mentorship Series
- Treatment of Difficult/Obstructive Defecation
- Evaluation and Management of Chronic Constipation (2024)
- Consensus Definitions and Interpretation Templates for Dynamic Ultrasound Imaging of Defecatory Pelvic Floor Disorders
- Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula (2022)
- Management of Fecal Incontinence (2023)
- Common Tests for the Pelvic Floor