Surgical options and trends in treating rectal prolapse: long-term results in a 19-year follow-up study
- 155 Downloads
Many different operations have been proposed for treating rectal prolapse, with varying recurrence rates and functional outcome. The main purpose of this study was to assess long-term results of surgery for prolapse of the rectum.
We carried out a retrospective study to evaluate changing trends in surgical strategies and outcome in all patients treated in our hospital over 19 years.
Ninety-three patients were operated and 30 (32%) experienced recurrence of external prolapse during a median (range) follow-up time of 82 (2–231) months. There were 37 reoperations for recurrence, bringing the total number of operations to 130.
From 1998 to 2010, laparoscopic posterior suture rectopexy was the preferred abdominal procedure with Delorme’s operation as the perineal alternative. Observed recurrence rates were 15/49 (31%) and 8/15 (53%) during a median observation time of 84 and 9 months, respectively.
From 2011 to 2017, these procedures were replaced by ventral mesh rectopexy and Altemeier’s rectosigmoidectomy. The observed recurrence rate for ventral mesh rectopexy was 3/22 (14%) during a median observation time of 29 months. The 30-day mortality rate was 3% and complication rate 14%.
The recurrence rates were high after all procedures, with no significant difference between posterior suture rectopexy and ventral mesh rectopexy, but the short observation time for the latter procedure is a limitation of the study. Both procedures had low complication rates, and ventral mesh rectopexy had no mortality.
KeywordsRectal prolapse Rectopexy Mesh repair Outcome measures
Authorship D. G. and W.A. W. initiator of project, substantial involvement in data acquisition, interpretation of data, drafting of article and approval of version to be published. Accountable for all aspects of the work; A. N. Substantial contribution to conception and design, statistical analysis and interpretation of data, structuring of article, critical revision and approval of version to be published. Accountable for all aspects of the work.
Compliance with ethical standards
All procedures were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Approval of ethics and study protocol was obtained from the Hospital Research Committee and the Data Protection Official for Research.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Miles WE (1933) Rectosigmoidectomy as method of treatment for procidentia recti. Proc R Soc Med 26:1445Google Scholar
- 3.Hampton BS (2009) Pelvic organ prolapse, Medicine and Health Rhode Island; Providence 92.1 (Jan 2009): 5–9Google Scholar
- 23.Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years` experience with the one-stage perineal repair of rectal prolapse. Ann Surg June 173(6)Google Scholar
- 24.Alam NN, Narang SK, Kőkerling F, Daniels IR, Smart NJ (2015) Rectopexy for rectal prolapse. Rev Front Surg 2:Article 54Google Scholar
- 26.Urogynecologic surgical mesh: update on the safety and Effectiveness of transvaginal placement for pelvic organ prolapse. FDA Public Health Notification, October 2008Google Scholar
- 32.Tou S, Brown SR, Nelson RL (2015) Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev (11):CD001758Google Scholar
- 34.Rothenhoefer S, Herrle F, Herold A, Joos A, Bussen D, Kieser M, Schiller P, Klose C, Seiler CM, Kienle P, Post S (2012) DeloRes trial: study protocol for a randomized trial comparing two standardized surgical approaches in rectal prolapse – Delorme’s procedure versus resection rectopexy. Trials 2012 13:155Google Scholar