Skip to main content
SpringerLink
Log in

Abdominal rectopexy for rectal prolapse

Influence of surgical technique on functional outcome

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex® mesh abdominal rectopexy. METHODS: The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment were performed before and at 3, 6, and 12 months after operation. RESULTS: Improvement of continence was similar. Bowel regulation problems which were unchanged after the Ripstein procedure increased significantly after the Wells procedure (P<0.01). Rectal volume became reduced in the group who received the Wells procedure (225 mlvs. 115 ml, P<0.05 at one year), but remained unchanged after receiving the Ripstein procedure. The pressure thresholds required to elicit sensation of rectal filling and defecation urge were increased after the Wells procedure (15 cm of H2Ovs. 25 cm of H2O, P<0.05 and 25 cm of H2O vs. 45 cm of H2O, P<0.05, respectively). In the Ripstein group there was only a slight increase of the threshold for urge (P<0.05). CONCLUSION: The Wells procedure was followed by severe rectal dysfunction accompanied by increased constipation and evacuation problems. The Ripstein procedure, preserving the lateral ligaments, appears not to affect such symptoms adversely. On the other hand, improvement is not likely to occur.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wells C. New operation for rectal prolapse. J R Soc Med 1959;52:602–3.

    Google Scholar 

  2. Goligher JG. Surgery of the anus, rectum and colon. 4th ed. London: Baillière Tindall, 1985:224–58.

    Google Scholar 

  3. Ripstein CB. Surgical care of massive rectal prolapse. Dis Colon Rectum 1965;8:34–8.

    Google Scholar 

  4. Morgon CN, Porter NH, Klugman DJ. Ivalon (polyvinyl alcohol) sponge in the repair of complete rectal prolapse. Br J Surg 1972;59:841–6.

    PubMed  Google Scholar 

  5. Gordon PH, Hoexter B. Complication of the Ripstein procedure. Dis Colon Rectum 1978;21:277–80.

    PubMed  Google Scholar 

  6. Holmström B, Brodén G, Dolk A. Results of the Ripstein operation in the treatment of rectal prolapse and internal rectal procidentia. Dis Colon Rectum 1986;29:845–8.

    Google Scholar 

  7. Keighley MR, Fielding JW, Alexander-Williams J. Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients. Br J Surg 1983;70:229–32.

    PubMed  Google Scholar 

  8. Delemarre JB, Goozen HG, Kruyt RH, Soebhag R, Maas Geesternaus A. The effect of posterior rectopexy on fecal continence. Dis Colon Rectum 1991;34:311–6.

    PubMed  Google Scholar 

  9. McCue JL, Thomsen JP. Clinical and functional results of abdominal rectopexy for complete rectal prolapse. Br J Surg 1991;78:921–3.

    PubMed  Google Scholar 

  10. Mann CV, Huffman C. Complete rectal prolapse: the anatomical and functional results of treatment by an extended abdominal rectopexy. Br J Surg 1988; 75:34–7.

    PubMed  Google Scholar 

  11. Speakman CT, Madden MV, Nicholls RJ, Kamm MA. Lateral ligament division during rectopexy causes constipation but prevents recurrences: results of a prospective, randomized study. Br J Surg 1991; 78:1431–3.

    PubMed  Google Scholar 

  12. Brodén G, Dolk A, Holmström B. Evacuation difficulties and other characteristics of rectal function associated with procidentia and the Ripstein operation. Dis Colon Rectum 1988;31:283–6.

    PubMed  Google Scholar 

  13. Johansson C, Ihre T, Ahlbäck SO. Disturbance in the defecation mechanism with special reference to intussusception of the rectum (internal procidentia). Dis Colon Rectum 1985;28:920–4.

    PubMed  Google Scholar 

  14. Åkervall S, Fasth S, Nordgren S, Öresland T, Hultén L. Manovolumetry—a new method for investigation of anorectal function. Gut 1988;29:614–23.

    PubMed  Google Scholar 

  15. Sayfan J, Pinho M, Alexander-Williams J, Keighley MR. Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse. Br J Surg 1990;77:143–5.

    PubMed  Google Scholar 

  16. Launer DP, Fazio VW, Weakley FL, Turnbull RJ Jr, Jagelman DG, Lavery IC. The Ripstein procedure: a 16-year experience. Dis Colon Rectum 1982;25: 41–5.

    PubMed  Google Scholar 

  17. Penfold JC, Hawley PR. Experiences of Ivalon-sponge implant for complete rectal prolapse at St. Marks's Hospital. Br J Surg 1972;59:846–8.

    PubMed  Google Scholar 

  18. Boutsis C, Ellis H. The Ivalon-sponge-wrap operations for rectal prolapse—an experience with 26 patients. Dis Colon Rectum 1974;17:21–7.

    PubMed  Google Scholar 

  19. Duthie GS, Bartolo DC. Abdominal rectopexy for rectal prolapse: a comparison of techniques. Br J Surg 1992;79:107–13.

    PubMed  Google Scholar 

  20. Ihre T, Seligson U. Intussusception of the rectuminternal procidentia: treatment and results in 90 patients. Dis Colon Rectum 1978;18:391–6.

    Google Scholar 

  21. Roe AM, Bartolo DC, Mortensen NJ,et al. Diagnosis and surgical treatment of intractable constipation. Br J Surg 1986;73:854–61.

    Google Scholar 

  22. Fasth S, Nordgren S, Hultén L. Evidence for a dual pelvic nerve influence on large bowel motility in the cat. J Physiol 1980;298:159–69.

    PubMed  Google Scholar 

  23. Smith AN, Varma JS, Binnie WR, Papachrystomou M. Disordered colorectal motility in intractable constipation following hysterectomy. Br J Surg 1990; 77:1361–6.

    PubMed  Google Scholar 

  24. Åkervall S, Fasth S, Nordgren S, Öresland T, Hultén L. Rectal reservoir and sensory function studied by graded isobaric distension in normal man. Gut 1989;30:496–502.

    PubMed  Google Scholar 

  25. Dolk A, Brodén G, Holmström B, Johansson C, Nilsson BY. Slow transit of the colon associated with severe constipation after the Ripstein operation. Dis Colon Rectum 1990;33:786–90.

    Article  PubMed  Google Scholar 

  26. Frykman HM, Goldberg SM. The surgical treatment of rectal procidentia. Surg Gynecol Obstet 1969;129:1225–30.

    PubMed  Google Scholar 

  27. Williams JG, Wong WD, Jensen L, Rothenberg DA, Goldberg SM. Incontinence and rectal prolapse: a prospective manometric study. Dis Colon Rectum 1991;34:209–16.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Colorectal Unit, University of Göteborg, Göteborg, Sweden

    Marco Scaglia M.D., Stig Fasth M.D., Ph.D., Thomas Hallgren M.D., Svante Nordgren M.D., Ph.D., Tom Öresland M.D., Ph.D. & Leif Hultén M.D., Ph.D.

Authors
  1. Marco Scaglia M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stig Fasth M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Hallgren M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Svante Nordgren M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tom Öresland M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leif Hultén M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by grants from the Swedish Medical Research Council (17X-03117), University of Gothenburg, Gothenburg Medical Society, and Assar Gabrielsson's Fund.

About this article

Cite this article

Scaglia, M., Fasth, S., Hallgren, T. et al. Abdominal rectopexy for rectal prolapse. Dis Colon Rectum 37, 805–813 (1994). https://doi.org/10.1007/BF02050146

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02050146

Key words

Search

Navigation