Our Summary

This research paper is about a procedure called transanal transabdominal proctosigmoidectomy (TATA), which is an alternative to the more common operation known as abdominoperineal excision of the rectum (APR) for treating low rectal cancer. The researchers were particularly interested in studying a rare complication of the TATA procedure, called neorectal prolapse, where the rectum slips out of place.

The study was conducted at a major colorectal center and involved over a thousand patients who were treated for rectal cancer between 1984 and 2016. Of these patients, they focused on the 409 who had a procedure that preserved the sphincter muscle at the bottom of the rectum.

They found that neorectal prolapse occurred in 4.6% (19 patients) after the TATA procedure. Interestingly, the complication was more common in patients who had a minimally invasive surgical procedure (6.7%) compared to those who had open surgery (2.2%). Furthermore, it was more common in women (9.5%) than in men (2.5%).

Importantly, the researchers found that the rates of cancer recurrence were not different between patients who experienced neorectal prolapse and those who did not.

In conclusion, the study found that neorectal prolapse is a rare but possible complication of minimally invasive rectal cancer surgeries, particularly in women. However, it doesn’t affect the likelihood of the cancer coming back.

FAQs

  1. What is neorectal prolapse and how common is it after transanal transabdominal proctosigmoidectomy (TATA)?
  2. Are the rates of cancer recurrence different between patients who experienced neorectal prolapse and those who did not after TATA procedure?
  3. Does the type of surgery (minimally invasive or open surgery) or the patient’s sex impact the likelihood of experiencing neorectal prolapse after TATA procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about rectal prolapse surgery is to make sure to follow post-operative care instructions carefully to minimize the risk of complications such as neorectal prolapse. This may include maintaining a healthy diet, avoiding heavy lifting, and attending follow-up appointments with your healthcare provider. It’s also important to communicate any concerns or changes in symptoms to your doctor promptly.

Suitable For

Patients who are recommended for rectal prolapse surgery typically have severe symptoms related to the prolapse, such as:

  1. Chronic constipation or fecal incontinence
  2. Difficulty with bowel movements
  3. Pain or discomfort in the rectal area
  4. Visible protrusion of the rectum from the anus
  5. Recurrent prolapse despite conservative treatments

In some cases, patients with rectal prolapse may also have underlying conditions that contribute to the prolapse, such as pelvic floor weakness or connective tissue disorders. Additionally, patients who have failed to respond to non-surgical treatments for rectal prolapse, such as pelvic floor exercises or dietary changes, may also be recommended for surgical intervention.

It is important for patients to discuss their symptoms and treatment options with a colorectal surgeon or other healthcare provider to determine if rectal prolapse surgery is the best course of action for their specific situation.

Timeline

Before rectal prolapse surgery:

  • Patient will likely experience symptoms such as rectal bleeding, pain, constipation, or a feeling of a mass coming out of the rectum
  • Patient will undergo various diagnostic tests such as a physical exam, colonoscopy, or imaging studies to confirm the diagnosis of rectal prolapse
  • Patient will discuss treatment options with their healthcare provider, including surgery

After rectal prolapse surgery:

  • Patient will be monitored closely in the hospital for any complications or signs of infection
  • Patient may experience some pain, discomfort, or swelling in the rectal area after surgery
  • Patient will be given instructions on how to care for the surgical site, manage pain, and prevent constipation
  • Patient will have follow-up appointments with their healthcare provider to monitor their recovery and address any concerns or complications
  • Patient may need to make lifestyle changes, such as dietary modifications or pelvic floor exercises, to prevent recurrence of rectal prolapse

What to Ask Your Doctor

Some questions a patient should ask their doctor about rectal prolapse surgery include:

  1. What is the likelihood of developing neorectal prolapse after the TATA procedure?
  2. Are there any specific risk factors that may increase my chances of experiencing neorectal prolapse?
  3. How is neorectal prolapse treated if it does occur after surgery?
  4. What are the potential complications of neorectal prolapse and how are they managed?
  5. Will neorectal prolapse affect the long-term success of my rectal cancer treatment?
  6. Are there any lifestyle changes or precautions I should take to reduce the risk of neorectal prolapse?
  7. How frequently will I need follow-up appointments to monitor for any signs of neorectal prolapse or other complications?
  8. Are there alternative surgical procedures available that may reduce the risk of neorectal prolapse?
  9. What is the recovery process like after rectal prolapse surgery and how long can I expect to be out of work or restricted in my activities?
  10. Are there any specific questions or concerns related to my individual health history that I should discuss before undergoing rectal prolapse surgery?

Reference

Authors: Guraieb-Trueba M, Helber AR, Marks JH. Journal: Colorectal Dis. 2018 Jul;20(7):593-596. doi: 10.1111/codi.14030. PMID: 29363246