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Levator ani hernia

Stefan B Albrich, K Welker, B Wolpert, J Steetskamp, S Porta, A Hasenburg, C Skala
INTRODUCTION: Pelvic floor ultrasound plays a major role in urogynecologic diagnostics. Using 3D ultrasound we can identify integrity of levator ani and measure hiatal area in the axial plane. The main goal of our study was to measure hiatal area on Valsalva in a cohort of urogynecological patients. Furthermore, we aimed to correlate hiatal area with urogynecological symptoms, levator integrity and evaluate cut-off values for pelvic organ prolapse. MATERIALS AND METHODS: In a retrospective analysis, we included 246 patients seen for urogynecological problems in our tertiary urogynecological unit...
January 2017: Archives of Gynecology and Obstetrics
Puneet Singh, Edward Teng, Lisa M Cannon, Brian L Bello, David H Song, Konstantin Umanskiy
BACKGROUND: Extralevator abdominoperineal excision for distal rectal cancers involves cylindrical excision of the mesorectum with wide division of the levator ani muscles. Although this technique has been shown to decrease local cancer recurrence and improve survival, it leaves the patient with a considerable pelvic floor defect that may require reconstruction. OBJECTIVE: We developed an innovative technique of robotic extralevator abdominoperineal excision combined with robotic harvest of the rectus abdominis muscle flap for immediate reconstruction of the pelvic floor defect...
September 2015: Diseases of the Colon and Rectum
Adam Dinnewitzer, Matthias Meissnitzer, Thomas Meissnitzer, Clemens Nawara, Christoph Augschöll, Selina Buchner, Franz Mayer, Dietmar Öfner
PURPOSE: Extra-levator abdominoperineal excision for rectal cancer includes resection of the levator ani muscle and therefore makes pelvic reconstruction advisable. The aim of our study was to evaluate morphologic and functional long-term results of pelvic floor augmentation with porcine dermal collagen mesh by dynamic magnetic resonance imaging and clinical examination. METHODS: Twenty consecutive patients underwent perineal reconstruction with porcine dermal collagen mesh following extra-levator abdominoperineal excision for primary rectal adenocarcinoma with curative intent between 2009 and 2012...
April 2015: International Journal of Colorectal Disease
C M Durnea, A S Khashan, L C Kenny, U A Durnea, M M Smyth, B A O'Reilly
INTRODUCTION: The natural history of pelvic organ prolapse (POP) is poorly understood. We investigated the prevalence and risk factors of postnatal POP in premenopausal primiparous women and the associated effect of mode of delivery. METHODS: We conducted a prospective cohort study in a tertiary teaching hospital attending 9,000 deliveries annually. Collagen-diseases history and clinical assessment was performed in 202 primiparae at ≥ 1 year postnatally. Assessment included Pelvic Organ Prolapse Quantification (POP-Q) system, Beighton mobility score, 2/3D-transperineal ultrasound (US) and quantification of collagen type III levels...
November 2014: International Urogynecology Journal
Kurumboor Prakash, Palanisami N Kamalesh
Primary perineal hernia is a rare clinical condition wherein herniation of viscera occurs through pelvic diaphragm. They are usually mistaken for sciatic hernia, rectal prolapse or other diseases in the perineum. Correct identification of the type of hernia by imaging is crucial for planning treatment. We present a case of primary posterior herniation of urinary bladder and rectal wall through levator ani repaired laparoscopically using a mesh repair.
July 2013: Journal of Minimal Access Surgery
Ifeanyi Anusionwu, Aylin Tekes, Andrew A Stec, John P Gearhart, E James Wright
UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Several studies in the paediatric literature have characterized the pelvic musculoskeletal anatomy of infants and children with bladder exstrophy using MRI and three-dimensional CT. The pelvic floor anatomy of female patients with bladder exstrophy who have undergone somatic growth and puberty is less well described. This study uses MRI to characterize comprehensively the pelvic anatomy of postpubertal females with classic bladder exstrophy by measuring 15 pelvic floor variables previously described in younger children with bladder exstrophy...
July 2013: BJU International
Costas Apostolis, Karen Wallace, Pierre Sasson, Michele R Hacker, Eman Elkadry, Peter L Rosenblatt
OBJECTIVE: This study aimed to describe magnetic resonance imaging (MRI) findings in women with defecatory dysfunction who perform manual splinting. METHODS: This is a retrospective study of 29 patients from a single urogynecology center who presented with complaints of defecatory dysfunction and who reported manual splinting to assist with bowel movements. Patients were scheduled for an MRI study with a novel "splinting" protocol to evaluate the effects of their manual splinting on the pelvic floor...
January 2012: Female Pelvic Medicine & Reconstructive Surgery
J F Pérez-Gutiérrez, J C Argüelles, M Iglesias-Núñez, K S Oliveira, M Sánchez De La Muela
OBJECTIVES: To perform a histological and immunohistochemical study of epidermal growth factor, transforming growth factor-alpha and their receptor, as well as the apoptotic signal active caspase-3 in the levator ani muscle of dogs with and without perineal hernia. METHODS: Biopsy specimens of the levator ani muscle were obtained from 25 dogs with perineal hernia and 4 non-affected dogs and were processed for Masson and immunohistochemical staining. RESULTS: The affected dogs exhibited myopathological features, internalised nuclei, destruction and abnormal size of muscle fibres, which were replaced by collagen...
July 2011: Journal of Small Animal Practice
Cun-Chuan Wang, Yi-Xing Ren, You-Zhu Hu, Jun Chen, Yun-Long Pan
OBJECTIVE: To evaluate the clinical practice of laparoscopic rectopexy in the treatment of severe rectal prolapse. METHODS: From March 1998 to February 2007, 4 cases of complete rectal prolapse, including 1 male and 3 female,ranged 21-82 years old, were treated by laparoscopic rectopexy. In one case, the posterior wall of rectum was freed and elevated, and pre-rectal introcession was closed by silk suture, then the posterior wall was suspended and fixed on sacral promontory fascia, finally the sigmoid colon was fixed by sutures on the fascia of left psoas major...
November 2007: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
E P Miranda, A L Anderson, A S Dosanjh, C K Lee
OBJECTIVE: Little data exist about the optimal management of the rare coccygeal hernia. A novel method of repair is reported. METHODS: A 46-year-old woman presented with a symptomatic coccygeal hernia after resection of the coccyx for a tumour. She had previously been reconstructed with an on-lay polytetrafluorethylene (PTFE) mesh but subsequently developed a hernia. A de-epithelialised vertical rectus abdominis musculocutaneous flap was elevated and passed through the hernia defect...
January 2009: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Peter L Dwyer
Surgery is an evolving science in the attempt to make surgical procedures more effective, safer, and less invasive. Recurrence and subsequent re-operation for stress incontinence and prolapse has been reported to be necessary in one of three patients, so there is a need for improvement [1]. In reconstructive pelvic surgery (RPS), the use of biological and synthetic grafts for the transabdominal and transvaginal treatment of pelvic organ prolapse (POP) or stress urinary incontinence (SI) has improved long-term support and function after surgery...
June 2006: International Urogynecology Journal and Pelvic Floor Dysfunction
Ronit Merchav, Yonatan Feuermann, Avi Shamay, Eyal Ranen, Uri Stein, Dudley E Johnston, Ron Shahar
OBJECTIVES: To compare the expression of canine relaxin, relaxin-like factor (RLF), and relaxin receptors within the muscles of the pelvic diaphragm of dogs with perineal hernia (PH) and clinically normal dogs. STUDY DESIGN: In vivo comparative study. ANIMALS: Fifteen client-owned intact male dogs with PH were studied. Four mature intact male dogs with no evidence of perineal pathology served as controls. METHODS: Biopsy samples from the levator ani, coccygeus, and internal obturator muscles were obtained...
September 2005: Veterinary Surgery: VS
M Galanty
Cases of perineal hernias in three cats are described. All the cats were male (2 castrated, 1 intact). The hernias were situated between the external anal sphincter and the levator ani muscle. The hernial sac contained a dilated rectum filled with fecal content (2 cats) as well as a small amount of retroperitoneal fatty tissue (2 cats) and urinary bladder (1 cat). A standard perineal herniorrhaphy in two cats, and herniorrhaphy via elevation of the internal obturator muscle in one cat were performed. No recurrence of the problem was observed in two cats during 9 months following the surgery...
2005: Polish Journal of Veterinary Sciences
R Bergamaschi, K Lovvik, R Marvik
Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use however has been limited due to fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During 30 months data on 33 selected patients with CRP were prospectively collected...
2004: Acta Chirurgica Iugoslavica
Susan L Gearhart, Harpreet K Pannu, Geoffrey W Cundiff, Jerome L Buller, David A Bluemke, Howard S Kaufman
PURPOSE: Patients with symptomatic pelvic organ prolapse often have multifocal pelvic floor defects that are not always evident of physical examination. In this study, dynamic magnetic resonance imaging of symptomatic patients with pelvic floor prolapse demonstrated unsuspected levator ani hernia. This study was designed to identify any specific symptoms and/or physical findings associated with these hernias. METHODS: Eighty consecutive patients with pelvic organ prolapse, fecal and/or urinary incontinence, or chronic constipation received standardized questionnaires, physical examination, and dynamic magnetic resonance imaging...
August 2004: Diseases of the Colon and Rectum
Roberto Bergamaschi, Kari Lovvik, Ronald Marvik
Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use, however, has been limited because of fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP. During a 30-month period, data on 33 selected patients with CRP were prospectively collected...
December 2003: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Melissa R Stoll, James L Cook, Eric R Pope, William L Carson, John M Kreeger
OBJECTIVES: To develop an in vivo perineal hernia model, to develop a technique for using small intestinal submucosa (SIS) in perineal hernia repair, to further elucidate the biological behavior of SIS, and to compare SIS herniorrhaphy with the internal obturator muscle transposition (IOT) technique. STUDY DESIGN: Prospective evaluation comparing SIS herniorrhaphy with IOT. ANIMALS: Twelve adult castrated male, large-breed dogs. METHODS: All dogs had bilateral pelvic diaphragm defects created by complete excision of the levator ani muscle...
July 2002: Veterinary Surgery: VS
R Yiou, V Delmas, P Carmeliet, R K Gherardi, G Barlovatz-Meimon, D K Chopin, C C Abbou, J P Lefaucheur
The muscle changes related to pelvic floor disorders are poorly understood. We conducted an anatomical and histological study of the perineum of the normal mouse and of a transgenic mouse strain deficient in urokinase-type plasminogen activator (uPA-/-) that was previously reported to develop a high incidence of rectal prolapse. We could clearly identify the iliococcygeus (ILC) and pubococcygeus (PC) muscles and anal (SPA) and urethral (SPU) sphincters in male and female mice. The bulbocavernosus (BC), ischiocavernosus (ISC) and levator ani (LA) muscles could be found only in male mice...
November 2001: Journal of Anatomy
H S Kaufman, J L Buller, J R Thompson, H K Pannu, S L DeMeester, R R Genadry, D A Bluemke, B Jones, J L Rychcik, G W Cundiff
PURPOSE: Pelvic organ prolapse results in a spectrum of progressively disabling disorders. Despite attempts to standardize the clinical examination, a variety of imaging techniques are used. The purpose of this study was to evaluate dynamic pelvic magnetic resonance imaging and dynamic cystocolpoproctography in the surgical management of females with complex pelvic floor disorders. METHODS: Twenty-two patients were identified from The Johns Hopkins Pelvic Floor Disorders Center database who had symptoms of complex pelvic organ prolapse and underwent dynamic magnetic resonance, dynamic cystocolpoproctography, and subsequent multidisciplinary review and operative repair...
November 2001: Diseases of the Colon and Rectum
M C Rochat, F A Mann
A sexually intact, male Chihuahua and a spayed female poodle were presented with left perineal masses. The masses were identified as perineal hernias by rectal palpation. Surgical exploration of the perineal region in each dog revealed retroperitoneal fat protruding between the sacrotuberous ligament and the coccygeus muscle (sciatic perineal hernia). The hernias were repaired using modifications of the standard or internal obturator flap herniorrhaphies. The levator ani muscle was grossly and histologically normal in the Chihuahua and grossly normal in the poodle...
May 1998: Journal of Small Animal Practice
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