International Journal of Colorectal Disease

, Volume 24, Issue 2, pp 201–207 | Cite as

Prolapse of the rectum, long-term results of surgical treatment

  • Anders T. Hoel
  • Arne Skarstein
  • Kjell K. OvreboEmail author
Original Article



This study evaluates patency and functional results of abdominal and perineal treatment approaches to prolapse of the rectum.


A database search identified patients operated upon for prolapse of the rectum. The operations were abdominal or perineal approaches. The patient’s records were reviewed, patients alive were contacted, and a self-report form evaluated functional results. Patients were followed until the prolapse recurred.


A primary operation for prolapse of the rectum was performed in 56 patients. Median age was 59 years (range 20–87) and 78 (40–91) for abdominal and perineal approaches, respectively (p < 0.001). The average length of the prolapses was 8.7 cm (2–25) and 8.6 cm (2–15) for abdominal or perineal approaches. All prolapses treated with a Thiersch’s operation recurred within a few months and all prolapses treated with the Delorme’s operation recurred within 5 years, whereas the 5-year patency of the abdominal approach was 93% (p < 0.001). No prolapses recurred after mesh rectopexy and the 5-year patency of resection rectopexy was 86%. The abdominal approaches improved stool evacuation and constipation significantly, and anal leakage improved somewhat (p = 0.065). The median hospital stay was 11 (4–20) and 7 (2–155) days after abdominal and perineal approaches (p = 0.003). Complications occurred in 20% of patients.


The patency of abdominal approach to prolapse of the rectum is better than that of perineal repairs. The abdominal approaches also have a favorable effect on constipation and anal insufficiency. Perineal approaches should be reserved for patients with a very short life expectancy.


Rectal prolapse Surgery Constipation Fecal incontinence Rectum 


  1. 1.
    Kairaluoma MV, Kellokumpu IH (2005) Epidemiologic aspects of complete rectal prolapse. Scand J Surg 94(3):207–210PubMedGoogle Scholar
  2. 2.
    Nicholls RJ, Banerjee A (1997) Rectal prolapse and solitary rectal ulcer syndrome. In: Nicholls RJ, Dozois RR (eds) Surgery of the colon and rectum. Churchill Livingstone, New York, pp 709–137Google Scholar
  3. 3.
    DiGiuro G, Ignjatovic D, Brogger J, Bergamaschi R (2006) How accurate are published recurrence rates after rectal prolapse surgery? A meta-analysis of individual patient data. Am J Surg 191:773–778PubMedCrossRefGoogle Scholar
  4. 4.
    Knowles CH, Eccersley J, Scott M, Walker SM, Reeves B, Lunniss PJ (2000) Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Gastroenterology 118:A1181Google Scholar
  5. 5.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRefGoogle Scholar
  6. 6.
    Madoff RD, Williams JG, Wong WD, Rothenberger DA, Goldberg SM (1992) Long-term functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterol 87:101–104PubMedGoogle Scholar
  7. 7.
    Watts JD, Rothenberger DA, Buls JG, Goldberg SM, Nivatvongs S (1985) The management of procidentia—30 years experience. Dis Colon Rectum 28:96–102PubMedCrossRefGoogle Scholar
  8. 8.
    Yoshioka K, Heyen F, Keighley MRB (1989) Functional results after posterior abdominal rectopexy for rectal prolapse. Dis Colon Rectum 32:835–838PubMedCrossRefGoogle Scholar
  9. 9.
    Roberts PL, Schoetz DJ Jr., Coller JA, Veidenheimer MC (1988) Ripstein procedure. Lahey Clinic experience: 1963–1985. Arch Surg 123:554–557PubMedGoogle Scholar
  10. 10.
    Jackaman FR, Francis JN, Hopkinson BR (1980) Silicone rubber band treatment of rectal prolapse. Ann R Coll Surg Engl 62:386–387PubMedGoogle Scholar
  11. 11.
    Monson JRT, Jones NAG, Vowden P, Brennan TG (1986) Delormes operation—the 1st choice in complete rectal prolapse. Ann R Coll Surg Engl 68:143–146PubMedGoogle Scholar
  12. 12.
    Uhlig BE, Sullivan ES (1979) The modified Delorme operation: its place in surgical treatment for massive rectal prolapse. Dis Colon Rectum 22:513–521PubMedCrossRefGoogle Scholar
  13. 13.
    Marchal F, Bresler L, Ayav A, Zarnegar R, Brunaud L, Duchamp C, Boissel P (2005) Long-term results of Delorme’s procedure and Orr–Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48:1785–1790PubMedCrossRefGoogle Scholar
  14. 14.
    Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M (2003) Delorme’s procedure for rectal prolapse—clinical and physiological analysis. Dis Colon Rectum 46:1260–1265PubMedCrossRefGoogle Scholar
  15. 15.
    Watts AMI, Thompson MR (2000) Evaluation of Delorme’s procedure as a treatment for full-thickness rectal prolapse. Br J Surg 87:218–222PubMedCrossRefGoogle Scholar
  16. 16.
    Johnson E, Nygaard K, Bakka A (1993) Rectal prolapse. Experiences with rectopexy and Delorme’s operation. Tidsskr Nor Laegeforen 113(21):2693–2695PubMedGoogle Scholar
  17. 17.
    Sielezneff I, Malouf A, Cesari J, Brunet C, Sarles JC, Sastre B (1999) Selection criteria for internal rectal prolapse repair by Delorme’s transrectal excision. Dis Colon Rectum 42:367–373PubMedCrossRefGoogle Scholar
  18. 18.
    Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73PubMedCrossRefGoogle Scholar
  19. 19.
    Chun SW, Pikarsky AJ, You SY, Gervaz P, Efron J, Weiss E, Nogueras JJ, Wexner SD (2004) Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol 8:3–8PubMedCrossRefGoogle Scholar
  20. 20.
    Boccasanta P, Venturi M, Barbieri S, Roviaro G (2006) Impact of new technologies on the clinical and functional outcome of Altemeier’s procedure: a randomized, controlled trial. Dis Colon Rectum 49:652–660PubMedCrossRefGoogle Scholar
  21. 21.
    Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296PubMedCrossRefGoogle Scholar
  22. 22.
    Corman ML, Carriero A, Hager T, Herold A, Jayne DG, Lehur PA, Lomanto D, Longo A, Mellgren AF, Nicholls J, Nystrom PO, Senagore AJ, Stuto A, Wexner SD (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis 8:98–101PubMedCrossRefGoogle Scholar
  23. 23.
    von Papen M, Ashari LH, Lumley JW, Stevenson AR, Stitz RW (2007) Functional results of laparoscopic resection rectopexy for symptomatic rectal intussusception. Dis Colon Rectum 50:50–55CrossRefGoogle Scholar
  24. 24.
    Winde G, Reers B, Nottberg H, Berns T, Meyer J, Bunte H (1993) Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse. Eur J Surg 159:301–305PubMedGoogle Scholar
  25. 25.
    Purkayastha S, Tekkis P, Athanasiou T, Aziz O, Paraskevas P, Ziprin P, Darzi A (2005) A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum 48:1930–1940PubMedCrossRefGoogle Scholar
  26. 26.
    Carpelan-Holmstrom M, Kruuna O, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Anders T. Hoel
    • 1
  • Arne Skarstein
    • 1
    • 2
  • Kjell K. Ovrebo
    • 1
    Email author
  1. 1.Department of SurgeryHaukeland University HospitalBergenNorway
  2. 2.Department of Surgical SciencesHaukeland University HospitalBergenNorway

Personalised recommendations