Perineal Rectosigmoidectomy

Perineal rectosigmoidectomy was first described by Mikulicz in 1889. Renewed interest in this procedure, particularly in the United States, can be attributed to W.A. Altemeier, whose 1971 report claimed only 3 recurrences in a series of 106 patients. A few series have recurrence rates comparable to those seen after abdominal repairs, but several reports have considerably higher recurrence rates. The variability in results reported by different centers stands in contrast to the marked uniformity and predictability of success seen after abdominal repairs.

Perineal rectosigmoidectomy can be done under regional or regional anesthesia in the lithotomy or prone position. The rectum is externalized as far as possible, and an incision is made approximately 1 to 2 cm from the dentate line. The incision is made full thickness through the outer bowel wall, entering the space between the external and internal bowel tubes of the prolapsed rectum. The rectal and sigmoid mesenteric vessels are divided with ligatures or using a harmonic scalpel and the prolapsed segment of rectum is folded down as far as possible. Resection of 20 to 40 cm of rectum and sigmoid colon is not uncommon. After mobilizing the maximum length of bowel, the prolapsed segment is resected and an anastomosis is sutured.

Addition of a levatoroplasty to the procedure might influence recurrence rates by tightening the levator hiatus and providing a new anorectal angle that contrasts with the "straight" rectal contour typically seen in prolapse patients (Williams et al, 1992; Agachan et al, 1997).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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