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Journal of Gastrointestinal Surgery

, Volume 12, Issue 8, pp 1446–1451 | Cite as

Recurrence and Quality of Life Following Perineal Proctectomy for Rectal Prolapse

  • Sean C. Glasgow
  • Elisa H. Birnbaum
  • Ira J. Kodner
  • James W. FleshmanJr.
  • David W. DietzEmail author
Article

Abstract

Background

Surgical outcome and quality of life (QOL) following perineal proctectomy for rectal prolapse remain poorly documented.

Methods

From 1994 to 2004, patients with full-thickness rectal prolapse were treated exclusively with perineal proctectomy independent of age or comorbidities. Subjective patient assessments and recurrences were determined retrospectively from hospital and clinic records. Consenting patients completed the gastrointestinal quality of life index (GIQLI).

Results

Perineal proctectomy was performed in 103 consecutive patients with a median age of 75 years (range 30–94). Most patients underwent concurrent levatorplasty (anterior 85.8%, posterior 67.9%). Durable results were obtained in all patients; the recurrence rate was 8.5% over a mean follow-up of 36 months. Preoperatively, 75.5% of patients reported fecal incontinence, and 32.1% had obstructed defecation. Incontinence significantly improved post-proctectomy (41.5%, p < 0.001), as did constipation (10.4%, p < 0.001). GIQLI respondents reported satisfaction following proctectomy with 63% scoring within one standard deviation of healthy controls. Patients with recurrent prolapse reported a lower QOL. Risk factors for recurrence included duration of prolapse, need for posterior levatorplasty, and prior anorectal surgery.

Conclusions

Perineal proctectomy provides significant relief from fecal incontinence and obstructive symptoms caused by rectal prolapse, with an acceptable recurrence rate and low morbidity.

Keywords

Procidentia Rectal prolapse Proctectomy Quality of life Incontinence 

Notes

Acknowledgements

The authors appreciate the assistance of Ken Schechtman, PhD, for statistical analysis and interpretation.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Sean C. Glasgow
    • 1
  • Elisa H. Birnbaum
    • 1
  • Ira J. Kodner
    • 1
  • James W. FleshmanJr.
    • 1
  • David W. Dietz
    • 2
    Email author
  1. 1.Department of Surgery, Section of Colon and Rectal SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of Colorectal SurgeryCleveland ClinicClevelandUSA

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