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Abnormalities, a deep pouch of douglas, redundant sigmoid colon, patulous anus, long lateral rectal stalks, concurrent pelvic genital prolapse, associated urinary and/or fecal incontinence, severe constipation, and rectoceles. buy viagra Length of the prolapse, patient's age, associated medical conditions, and clinical status must always be considered. Abdominal procedures were associated with a lower recurrence rate than perineal ones. buy viagra online 10,12,13 however, abdominal procedures are associated with higher rates of morbidity and are preferred for younger patients with few associated medical conditions. where can i buy viagra gel 4,10 this may explain the difference observed in our series, where the mean age of the 36 patients that underwent abdominal procedures was 51. viagra results women 3 years versus 67. 9 years in the group of 15 perineal procedures. During the execution of presacral rectopexy, posterior mobilization of the rectum down to the level of the tip of the coccyx until the levator muscles are clearly identified is important. To prevent inadvertent bleeding, this dissection should be carried out in front of the sacral nerves and should not be done blindly. We usually do not perform either anterior or lateral mobilization of the rectum. The presacral fixation must be accomplished with nonabsorbable sutures, usually with 4 to 5 points stitches at different levels in the midline of the sacrum and the rectum, where at least a 1 cm length of the fascia and muscular wall must be included. buy cheap viagra One point that must be emphasized in the selection of type of procedure is the complaint of severe constipation and the presence of a redundant sigmoid colon. In these patients, a concomitant sigmoidectomy should be associated with the rectopexy, as was done in 5 patients in our series. Preoperative investigation of constipation may be done using colonic transit, electromanometry, and defecography. cheap viagra Bowel resection under these circumstances is usually associated with improvement in bowel function. online pharmacy viagra Perineal procedures represent a good surgical option for elderly and high-risk patients, since these procedures are associated with a low complication rate. viagra average dose 14,15 the mean age of the 15 patients who underwent perineal procedures in this study was 61. viagra online 7 years. Simple perineal procedures, like the thiersch anal encirclement that was performed on only 2 patients, are reserved for patients in very poor clinical condition because of a high recurrence rate and low grade of symptom control. generic vs brand viagra Twelve patients underwent perineal rectosigmoidectomy, which is a more complex perineal procedure than anal encirclement. viagra safe women 2010 Perineal. generic vs brand viagra generic vs brand viagra
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