Annals of Coloproctology

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Anorectal physiology & pelvic floor disorder

Laparoscopic ventral mesh rectopexy with and without transverse perineal support using biological mesh for rectal prolapse and perineal descent: postoperative course and functional outcomes: Maria Clelia Gervasi, Giorgio Brancato, Lorenzo Crepaz, Ahmad Tfaily, Alberto Di Leo; Ann Coloproctol. 2025;41(5):453-461. Published online October 28, 2025; DOI: https://doi.org/10.3393/ac.2025.00080.0011

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1 Citations

Purpose
Laparoscopic ventral mesh rectopexy (LVMR) is effective for the treatment of rectal prolapse. However, descending perineal syndrome may impair the outcomes of LVMR. The aim of this study was to assess the safety and functional outcomes of LVMR performed with and without transverse perineal support (TPS).
Methods
This was a retrospective study of 143 consecutive female patients treated with LVMR with or without TPS between 2018 and 2022. Patients with rectal prolapse and perineal descent who underwent surgery were included. Obstructed defecation syndrome and fecal incontinence were evaluated using the Cleveland Constipation Score (Wexner score) and St. Mark’s Incontinence Score, respectively. Perineal descent was defined using defecography. Biological meshes were utilized in all cases.
Results
No significant differences were recorded between with- and without-TPS groups at baseline. TPS was performed in 110 patients (76.9%). Surgical morbidity was higher in the with-TPS group (12.7% vs. 0%, P=0.047), primarily due to seroma formation. Almost all complications were mild (Clavien-Dindo grades I–II). In both groups, digital aid for defecation (P<0.001), prolonged straining (P=0.004), and hematochezia (P<0.001) nearly disappeared postoperatively, though constipation and laxative/enema use persisted in 22.4%. Fecal incontinence significantly decreased from 43.4% to 11.2% (P<0.001). TPS appears to have a potentially favorable effect in reducing the constipation score. Both constipation and incontinence scores remained low up to 24 months after surgery. Operative time was significantly longer in the LVMR with-TPS group (P<0.001).
Conclusion
LVMR with TPS appears safe and feasible. TPS may provide better surgical outcomes compared to LVMR alone for patients with symptomatic rectoceles and descending perineum syndrome.

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Beyond stapled transanal rectal resection vs ventral rectopexy dichotomy: Toward a phenotype-guided surgical paradigm for obstructed defecation syndrome
Michele Schiano di Visconte, Sonia Sarnari
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef

The Unresolved Case of Sacral Chordoma: From Misdiagnosis to Challenging Surgery and Medical Therapy Resistance: Fabio Garofalo, Dimitrios Christoforidis, Pietro G. di Summa, Béatrice Gay, Stéphane Cherix, Wassim Raffoul, Nicolas Demartines, Maurice Matter; Ann Coloproctol. 2014;30(3):122-131. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.122

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6 Web of Science
7 Citations

Abstract PDF

Purpose

A sacral chordoma is a rare, slow-growing, primary bone tumor, arising from embryonic notochordal remnants. Radical surgery is the only hope for cure. The aim of our present study is to analyse our experience with the challenging treatment of this rare tumor, to review current treatment modalities and to assess the outcome based on R status.

Methods

Eight patients were treated in our institution between 2001 and 2011. All patients were discussed by a multidisciplinary tumor board, and an en bloc surgical resection by posterior perineal access only or by combined anterior/posterior accesses was planned based on tumor extension.

Results

Seven patients underwent radical surgery, and one was treated by using local cryotherapy alone due to low performance status. Three misdiagnosed patients had primary surgery at another hospital with R1 margins. Reresection margins in our institution were R1 in two and R0 in one, and all three recurred. Four patients were primarily operated on at our institution and had en bloc surgery with R0 resection margins. One had local recurrence after 18 months. The overall morbidity rate was 86% (6/7 patients) and was mostly related to the perineal wound. Overall, 3 out of 7 resected patients were disease-free at a median follow-up of 2.9 years (range, 1.6-8.0 years).

Conclusion

Our experience confirms the importance of early correct diagnosis and of an R0 resection for a sacral chordoma invading pelvic structures. It is a rare disease that requires a challenging multidisciplinary treatment, which should ideally be performed in a tertiary referral center.

Citations

Citations to this article as recorded by

Comparative outcomes of anterior-posterior versus posterior-only approaches for lumbosacral chordoma: A meta-analysis of recurrence, survival, and complications
Seyed Amir Asef Agah, Farbod Yousefi, Mohammad Mehdi Hosseini, Moein Ghasemi, Hossein Kaviani Charati, Arash Mansoori Nia, Mohammad Hadi Akbarizadeh Mashkani, Neda Azarpey, Ashkan Azizi, Behnam Amini
Neurosurgical Review.2026;[Epub] CrossRef
Gas Plasma Technology and Immunogenic Cell Death: Implications for Chordoma Treatment
Sander Bekeschus, Karl Roessler, Oliver Kepp, Eric Freund
Cancers.2025; 17(4): 681. CrossRef
Comparison of combined anterior–posterior and posterior-only approaches for lumbosacral chordomas: a systematic review and meta-analysis of surgical and clinical outcomes
Quintino Giorgio D’Alessandris, Martina Offi, Valerio Maria Caccavella, Martina Giordano, Eduardo Fernandez, Liverana Lauretti, Roberto Pallini, Alessandro Olivi, Nicola Montano
Neurosurgical Review.2022; 45(3): 2005. CrossRef
Behandlungsalternativen für sakrale Chordome
Darius Kalasauskas, Florian Ringel
Die Wirbelsäule.2022; 06(04): 233. CrossRef
Durable Response of Spinal Chordoma to Combined Inhibition of IGF-1R and EGFR
Tamara Aleksic, Lisa Browning, Martha Woodward, Rachel Phillips, Suzanne Page, Shirley Henderson, Nicholas Athanasou, Olaf Ansorge, Duncan Whitwell, Sarah Pratap, A. Bassim Hassan, Mark R. Middleton, Valentine M. Macaulay
Frontiers in Oncology.2016;[Epub] CrossRef
Multidisciplinary approach of lumbo‐sacral chordoma: From oncological treatment to reconstructive surgery
Fabio Garofalo, Pietro G. di Summa, Dimitrios Christoforidis, Marc Pracht, Pietro Laudato, Stéphane Cherix, Hanan Bouchaab, Wassim Raffoul, Nicolas Demartines, Maurice Matter
Journal of Surgical Oncology.2015; 112(5): 544. CrossRef
Sacral Chordoma: Challenging for Resection Margin
Seung-Hyun Lee, Byung-Kwon Ahn
Annals of Coloproctology.2014; 30(3): 104. CrossRef

An Analysis of Factors Associated with Increased Perineal Descent in Women: Jina Chang, Soon Sup Chung; J Korean Soc Coloproctol. 2012;28(4):195-200. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.195

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60 Download
11 Citations

Abstract PDF

Purpose

Treatment of descending perineal syndrome is focused on personal etiology and on improving symptoms. However, the etiology of increased perineal descent (PD) is unclear. Therefore, the aim of the present study was to evaluate factors associated with increased resting and dynamic PD in women.

Methods

From January 2004 to August 2010, defecographic findings in 201 female patients were reviewed retrospectively. Patient's age, surgical history, manometric results and defecographic findings were compared with resting and dynamic PD.

Results

Age (P < 0.01), number of vaginal deliveries (P < 0.01) and resting anorectal angle (P < 0.01) were correlated with increased resting PD. Also, findings of rectoceles (P < 0.05) and intussusceptions (P < 0.05) were significantly correlated with increased resting PD. On the other hand, increased dynamic PD was correlated with age (P < 0.05), resting anal pressure (P < 0.01) and sigmoidoceles (P < 0.05). No significant correlation existed between non-relaxing puborectalis, history of pelvic surgery and increased PD. Also, no significant differences in PD according to the symptoms were observed.

Conclusion

Increased number of vaginal deliveries and increased resting rectoanal angle are associated with increased resting PD whereas increased resting anal pressure is correlated with increased dynamic PD. Older age correlates with both resting and dynamic PD. Defecographic findings, such as rectoceles and intussusceptions, are associated with resting PD, and sigmoidoceles correlated with dynamic PD. These results can serve as foundational research for understanding the pathophysiology and causes of increasing PD in women better and for finding a fundamental method of treatment.

Citations

Citations to this article as recorded by

Evaluation of Perineal Descent Measurements on Pelvic Floor Imaging
Isabelle M. A. van Gruting, Kirsten Kluivers, Aleksandra Stankiewicz, Joanna IntHout, Kim W. M. van Delft, Ranee Thakar, Abdul H. Sultan
Journal of Clinical Medicine.2025; 14(2): 548. CrossRef
Enhancing clinical practice: The role of digital rectal examination in diagnosing functional defecation disorders
Lian-Jun Zhu, Xing-Lin Zeng, Xiang-Dong Yang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Imaging and clinical assessment of functional defecatory disorders with emphasis on defecography
Neeraj Lalwani, Rania Farouk El Sayed, Amita Kamath, Sara Lewis, Hina Arif, Victoria Chernyak
Abdominal Radiology.2021; 46(4): 1323. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Diseases of the Colon & Rectum.2021; 64(1): 31. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdom
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Female Pelvic Medicine & Reconstructive Surgery.2021; 27(1): e1. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Techniques in Coloproctology.2021; 25(1): 3. CrossRef
Descending Perineum Associated With Pelvic Organ Prolapse Treated by Sacral Colpoperineopexy and Retrorectal Mesh Fixation: Preliminary Results
Aude Nessi, Aminata Kane, Etienne Vincens, Delphine Salet-Lizée, Karine Lepigeon, Richard Villet
Frontiers in Surgery.2018;[Epub] CrossRef
Descending perineum syndrome: a review of the presentation, diagnosis, and management
Zaid Chaudhry, Christopher Tarnay
International Urogynecology Journal.2016; 27(8): 1149. CrossRef
Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms
Sthela M. Murad-Regadas, Francisco Sergio Pinheiro Regadas, Lusmar V. Rodrigues, Adjra da Silva Vilarinho, Guilherme Buchen, Livia Olinda Borges, Lara B. Veras, Mariana Murad da Cruz
Diseases of the Colon & Rectum.2016; 59(12): 1191. CrossRef
Descending perineum syndrome: new perspectives
F. Pucciani
Techniques in Coloproctology.2015; 19(8): 443. CrossRef
A theory of progression from obstructed defecation to fecal incontinence
F. Pucciani
Techniques in Coloproctology.2015; 19(12): 713. CrossRef

Outcome and Predictors of Success of Biofeedback for Descending Perineum Syndrome.: Hur, Le Na , Hwang, Yong Hee , Jung, Yong Hwan; J Korean Soc Coloproctol. 2007;23(3):145-151.; DOI: https://doi.org/10.3393/jksc.2007.23.3.145

2,976 View
24 Download
2 Citations

Abstract PDF

Purpose
To determine the outcome and identify predictors of success of biofeedback for descending perineum syndrome (DPS). Methods: 103 patients diagnosed with DPS by defecography were evaluated by standardized questionnaire, before, immediately after treatment, and at follow-up. Clinical bowel symptoms and anorectal physiological studies were also analyzed. Results: At post- biofeedback, 81 patients felt improvement in symptoms, including 29 with complete symptom relief. At follow-up (median: 13 months, n=82), 58 patients felt improvement in symptoms, including 12 with complete symptom relief. There was a significant reduction in difficult defecation (from 78 to 34, 37%, from pre-biofeedback to post-biofeedback, and at follow-up respectively; P<0.001), incomplete defecation (from 88 to 44, 41%; P<0.001), hard stool (from 63 to 25, 0%; P<0.01), small caliber stool (from 63 to 0,0%; P<0.001, P<0.005), fecal incontinence (from 10 to 1,1%; P<0,01), anal pain (from 21 to 2, 6%; P<0.001, P<0.05), laxative use (from 30 to 11, 6%; P<0.001), enema use (from 16 to 0, 1%; P<0.001) and digitation (from 11 to 1%, from pre-biofeedback to at follow-up; P<0.05). Normal spontaneous bowel movement was increased from 47% pre-biofeedback to 79% post-biofeedback (P<0.001), 86% at follow-up (P<0.001). Difficult defecation predict poor outcome (96 vs. 66%; failure vs. success, P<0.01). Positive mean pressure change predict good outcome (69 vs. 35%; success vs. failure, P<0.05). Conclusions: Biofeedback is an effective option for DPS.

Citations

Citations to this article as recorded by

An Analysis of Factors Associated with Increased Perineal Descent in Women
Jina Chang, Soon Sup Chung
Journal of the Korean Society of Coloproctology.2012; 28(4): 195. CrossRef
The Roles of Anorectal Physiologic Tests and Treatment of Chronic Constipation
Yong Hee Hwang
Journal of the Korean Society of Coloproctology.2008; 24(2): 148. CrossRef

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