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Complete rectal prolapse

Evolution of management and results

Diseases of the Colon & Rectum volume 42, pages 460–466 (1999)Cite this article

Abstract

Optional treatment for complete rectal prolapse remains controversial. PURPOSE: We reviewed our experience over a 19-year period to assess trends in choice of operation, recurrence rates, and functional results. METHODS: We identified 372 patients who underwent surgery for complete rectal prolapse between 1976 and 1994. Charts were reviewed and follow-up (median, 64; range, 12–231 months) was obtained by mailed questionnaire (149 patients; 40 percent) and telephone interview (35 patients; 9 percent). Functional results were obtained from 184 responders (49 percent). RESULTS: Median age of patients was 64 (11–100) years, and females outnumbered males by nine to one. One-hundred and eighty-eight patients (51 percent) were lost to follow-up; 183 patients (49 percent) underwent perineal rectosigmoidectomy, and 161 patients (43 percent) underwent abdominal rectopexy with bowel resection. The percentage of patients who underwent perineal rectosigmoidectomy increased from 22 percent in the first five years of the study to 79 percent in the most recent five years. Patients undergoing perineal rectosigmoidectomy were more likely to have associated medical problems as compared with patients undergoing abdominal rectopexy (61vs. 30 percent,P=0.00001). There was no significant difference in morbidity, with 14 percent for perineal rectosigmoidectomyvs. 20 percent for abdominal rectopexy. Abdominal procedures were associated with a longer length of stay as compared with perineal rectosigmoidectomy (8vs. 5 days,P=0.001). Perineal procedures, however, had a higher recurrence rate (16vs. 5 percent,P=0.002). Functional improvement was not significantly different, and most patients were satisfied with treatment and outcome. CONCLUSIONS: We conclude that abdominal rectopexy with bowel resection is associated with low recurrence rates. Perineal rectosigmoidectomy provides lower morbidity and shorter length of stay, but recurrence rates are much higher. Despite this, perineal rectosigmoidectomy has appeal as a lesser procedure for elderly patients or those patients in the high surgical risk category. For younger patients, the benefits of perineal rectosigmoidectomy being a lesser procedure must be weighed against a higher recurrence rate.

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References

  1. Johansen OB, Wexner SD, Daniel N, Nogueras JJ, Jagelman DG. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum 1993;36:767–72.

    PubMed  Google Scholar 

  2. Ramanujam PS, Venkatesh KS. Perineal excision of rectal prolapse with posterior levator ani repair in elderly high-risk patients. Dis Colon Rectum 1988;31:704–6.

    PubMed  Google Scholar 

  3. Finlay IG, Aitchison M. Perineal excision of the rectum for prolapse in the elderly. Br J Surg 1991;78:687–9.

    PubMed  Google Scholar 

  4. Williams JG, Rothenberger DA, Madoff RD, Goldberg SM. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. DiS Colon Rectum 1992;35:830–4.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  6. Frykman, HM. Abdominal rectopexy and primary sigmoid resection for rectal procidentia. Am J Surg 1955;90:780–9.

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  8. Madoff RD, Williams JG, Wong WD, Rothenberger DA, Goldberg SM. Long-term functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterol 1992;87:101–4.

    PubMed  Google Scholar 

  9. Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen years' experience with the one-stage perineal repair of rectal prolapse. Ann Surg 1971;173:993–1006.

    PubMed  Google Scholar 

  10. Bennett BH, Geelhoed GW. A stapler modification of the altemeier procedure for rectal prolapse. Experimental and clinical evaluation. Am Surg 1985;51:116–20.

    PubMed  Google Scholar 

  11. Vermeulen FD, Nivatvongs S, Fang DT, Balcos EG, Goldberg SM. A technique for perineal rectosigmoidectomy using autosuture devices. Surg Gynecol Obstet 1983;156:84–6.

    PubMed  Google Scholar 

  12. Watts JD, Rothenberger DA, Buls JG, Goldberg SM, Nivatvongs S. The management of procidentia: 30 years' experience. Dis Colon Rectum 1985;28:96–102.

    PubMed  Google Scholar 

  13. Husa A, Sainio P, von Smitten K. Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse. Acta Chir Scand 1988;154:221–4.

    PubMed  Google Scholar 

  14. Huber FT, Stein H, Siewert JR. Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection. World J Surg 1995;19:138–43.

    PubMed  Google Scholar 

  15. Mann C. Rectal prolapse. In: Morson BC, Heinemann W, eds. Diseases of the colon, rectum and anus. London: Medical Books, 1969:238–50.

    Google Scholar 

  16. Kupfer CA, Goligher JC. One hundred consecutive cases of complete prolapse of the rectum treated by operation. Br J Surg 1970;57:482–7.

    PubMed  Google Scholar 

  17. Mikulicz J. Zur operativen betiandlung des prolapsus recti et coli invaginati. Arch Klin Chir 1889;38:74–97.

    Google Scholar 

  18. Gopal KA, Amshel AL, Shonberg IL, Eftaiha M. Rectal procidentia in elderly and debilitated patients. Experience with the Altemeier procedure. Dis Colon Rectum 1984;27:376–81.

    PubMed  Google Scholar 

  19. Oliver GC, Vachon D, Eisenstat TE, Rubin RJ, Salvati EP. Delorme's procedure for complete rectal prolapse in severely debilitated patients. An analysis of 41 cases. Dis Colon Rectum 1994;37:461–7.

    PubMed  Google Scholar 

  20. Ramanujam PS, Venkatesh KT, Fietz MJ. Perineal excision of rectal procidentia in elderly high-risk patients. A ten-year experience. Dis Colon Rectum 1994;37:1027–30.

    PubMed  Google Scholar 

  21. Thorne MC, Polglase AL. Perineal proctectomy for rectal prolapse in elderly and debilitated patients. Aust N Z J Surg 1992;62:791–4.

    PubMed  Google Scholar 

  22. Prasad ML, Pearl RK, Abcarian H, Orsay CP, Nelson RL. Perineal proctectomy, posterior rectopexy, and postanal levator repair for the treatment of rectal prolapse. Dis Colon Rectum 1986;29:547–52.

    PubMed  Google Scholar 

  23. Friedman R, Muggia-Sulam M, Freund HR. Experience with the one-stage perineal repair of rectal prolapse. Dis Colon Rectum 1983;26:789–91.

    PubMed  Google Scholar 

  24. Hughes ESR. Discussion on rectal prolapse. Proc R Soc Med 1949;42:1007–11.

    Google Scholar 

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

    PubMed  Google Scholar 

  26. Allen-Mersh TG, Turner MJ, Mann CV. Effect of a abdominal Ivalon rectopexy on bowel habit and rectal wall. Dis Colon Rectum 1990;33:550–3.

    Google Scholar 

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

    PubMed  Google Scholar 

  28. Scaglia M, Fasth S, Hallgren T, Nordgren S, Oresland T, Hulten L. Abdominal rectopexy for rectal prolapse: influence of surgical technique on functional outcome [see comments]. Dis Colon Rectum 1994;37:805–13.

    PubMed  Google Scholar 

  29. Farouk R, Duthie GS, Bartolo DC, MacGregor AB. Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram. Br J Surg 1992;79:439–40.

    PubMed  Google Scholar 

  30. Bartolo DC, Duthie GS. The physiological evaluation of operative repair for incontinence and prolapse. Ciba Found Symp 1990;151:223–45.

    Google Scholar 

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Authors and Affiliations

  1. From the Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota

    Do-Sun Kim M.D., Charles B. S. Tsang M.D. (F.R.C.S.(Edinb.), F.R.C.S.(Glasg.), W. Douglas Wong M.D. (F.R.C.S.(C), Ann C. Lowry M.D., Stanley M. Goldberg M.D. (Hon.F.R.A.C.S., Hon.F.R.C.S.(Engl.), Hon.A.F.C.(Fr.), Hon.F.R.C.P.S.(Glasg.), Hon.R.S.M.(Engl.) &  Robert D. Madoff M.D.

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  1. Do-Sun Kim M.D.
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  2. Charles B. S. Tsang M.D.
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  3. W. Douglas Wong M.D.
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  4. Ann C. Lowry M.D.
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  5. Stanley M. Goldberg M.D.
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  6. Robert D. Madoff M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996, and at the Tripartite Meeting, London, United Kingdom, July 8 to 10, 1996.

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Kim, DS., Tsang, C.B.S., Wong, W.D. et al. Complete rectal prolapse. Dis Colon Rectum 42, 460–466 (1999). https://doi.org/10.1007/BF02234167

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  • DOI: https://doi.org/10.1007/BF02234167

Key words

  • Rectal prolapse
  • Recurrence
  • Abdominal rectopexy
  • Perineal rectosigmoidectomy
  • Fecal incontinence
  • Constipation
  • Patient satisfaction