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The incidence of obesity has steadily climbed to epidemic proportions in the United States. To provide optimal surgical care for the growing number of obese surgical patients, surgeons and other healthcare personnel must often modify routine procedures and standard treatment protocols. Psychological support of obese patients is an additional factor that frequently must be addressed during the perioperative period.

A logical, reasoned approach is essential to the successful management of gastrointestinal hemorrhage. This article describes the approach used by the staff of the Ochsner Clinic Foundation's Department of Colon and Rectal Surgery to evaluate and manage lower gastrointestinal hemorrhage, along with the evidence and experience that guided its development. Following resuscitation, diagnostic studies localize the presence and source of hemorrhage, while management options (non-operative and operative) control the bleeding.

Purpose: To compare perineal to abdominal procedures for rectal prolapse over a 10-year period at a single tertiary care institution., Methods: Between May 1, 1995, and January 1, 2005, 75 patients underwent surgical intervention for primary rectal prolapse at a tertiary referral center. Surgical techniques included perineal-based repairs (Altemeier and Delorme procedures) and abdominal procedures (open and laparoscopic resection and/or rectopexy). Medical records were abstracted for data pertaining to patient characteristics, signs and symptoms at presentation, surgical procedure, postoperative length of hospitalization, morbidity and mortality, and recurrence of rectal prolapse., Results: Seventy-five patients underwent surgical intervention for rectal prolapse during the study period. The average patient age was 60.8 years. Sixty-two patients (82.7%) underwent perineal-based repair (Altemeier n = 48, Delorme n = 14); eight patients (10.7%) underwent open abdominal procedures (resection and rectopexy n = 4, rectopexy only n = 4); and five patients (6.7%) underwent laparoscopic repair (laparoscopic LAR n = 3, laparoscopic resection and rectopexy n = 2). Average hospitalization was shorter with perineal procedures (2.6 days) than with abdominal procedures (4.8 days) (p < 0.0031). Postoperative complications were observed in 13.3% of cases. With a median follow-up of 39 months (range 6-123 months), there was no mortality for primary repair, a postoperative morbidity occurred in 13% of patients, and the overall rate of recurrent prolapse was 16% (16.1% for perineal-based repairs, 15.4% for abdominal procedures)., Conclusion: Perineal resections were more common, performed in significantly older patients, and resulted in a shorter hospital stay. Their minimal morbidity and similar recurrence rates make perineal procedures the preferred option.