Summary
The surgical experience at the Mayo Clinic with 124 cases of rectal prolapse during the 16 years before December 31, 1967, has been presented. Anterior resection was performed in 28 patients, with one death and one recurrence (3.7 per cent); the Pemberton operation allowed recurrence in 22 of 68 cases (32.4 per cent); recurrence after the Altemeier procedure occurred in five of 13 cases (38.5 per cent). Other operations were of limited application. Combining a review of the surgical literature with our results allowed several conclusions about the efficacy of the various operations for this condition.
Anterior resection, with or without suspension procedures, is recommended for good-risk patients of all ages, reserving the Thiersch operation for older, debilitated, poor-risk patients. The Pemberton procedure with suture of rectal stalks to the sacral fascia may be used in intermediate-risk groups. Those procedures reported by Ripstein and Wells deserve consideration.
An attempt has been made to evaluate incontinence preoperatively and postoperatively, and to judge the efficacy of various operations in improving or preventing incontinence. This remains an enigma.
References
Altemeier, W. A., and W. R. Culbertson: Technique for perineal repair of rectal prolapse. Surgery.58: 758, 1965.
Altemeier, W. A., W. R. Culbertson, and J. W. Alexander: One-stage perineal repair of rectal prolapse: Twelve years' experience. Arch. Surg. (Chicago)89: 6, 1964.
Beahrs, O. H., D. J. Vandertoll, and N. H. Baker: Complete rectal prolapse: An evaluation of surgical treatment. Ann. Surg.161: 221, 1965.
Butler, E. C. B.: Intra-abdominal repair of rectal prolapse. Dis. Colon Rectum7: 546, 1964.
Devadhar, D. S. C.: A new concept of mechanism and treatment of rectal procidentia. Dis. Colon Rectum8: 75, 1965.
Dunphy, J. E., T. W. Botsford, and E. Savlov: Surgical treatment of procidentia of the rectum: An evaluation of combined abdominal and perineal repair. Amer. J. Surg.86: 605, 1953.
Frykman, H. M.: Rectal procidentia: surgical treatment. J. Lancet84: 122, 1964.
Gabriel, W. B.: The treatment of complete prolapse of the rectum by rectosigmoidectomy (Auffret-Mikulicz-Miles procedure). Dis. Colon Rectum1: 241, 1958.
Gabriel, W. B.: The Thiersch operation for rectal prolapse. Dis. Colon Rectum7: 383, 1964.
Goligher, J. C.: Surgery of the Anus, Rectum and Colon. Ed. 2, Springfield, Illinois, Charles C Thomas, Publisher, 1967, pp. 314–316.
Moschcowitz, A. V.: The pathogenesis, anatomy, and cure of prolapse of the rectum. Surg. Gynec. Obstet.15: 7, 1912.
Muir, E. G.: Treatment of complete rectal prolapse in the adult. Proc. Roy. Soc. Med.55: 1086, 1962.
Nigro, N. D.: Restoration of the levator sling in the treatment of rectal procidentia. Dis. Colon Rectum1: 123, 1958.
Orr, T. G.: A suspension operation for prolapse of the rectum. Ann. Surg.126: 833, 1947.
Pemberton, J. de J., P. C. Kiernan, and A. H. Pemberton. The results of the surgical treatment of complete rectal prolapse, with particular reference to the suspension-fixation operation. Ann. Surg.137: 478, 1953.
Porter, N. H.: A physiological study of the pelvic floor in rectal prolapse. Roy. Coll. Surg.31: 379, 1962.
Ripstein, C. B.: Treatment of massive rectal prolapse. Amer. J. Surg.83: 68, 1952.
Ripstein, C. B.: Surgical care of massive rectal prolapse. Dis. Colon Rectum8: 34, 1965.
Ripstein, C. B., and Lanter, B.: Etiology and surgical therapy of massive prolapse of the rectum. Ann. Surg.157: 259, 1963.
Shackelford, R. T.: Bickham-Callander Surgery of the Alimentary Tract. Philadelphia, W. B. Saunders Company, 1955, vol. 3, pp. 1913–1916.
Swinton, N. W., and D. M. McKee: Current surgical management of rectal procidentia. Surg. Clin. N. Amer.45: 657, 1965.
Theuerkauf, F. J., Jr., O. H. Beahrs, and J. R. Hill: Rectal prolapse: Causation and surgical treatment. Ann. Surg.171: 819, 1970.
Todd, I. P.: Prolapse of the rectum. Dis. Colon Rectum6: 94, 1963.
Wells, C.: New operation for rectal prolapse. Proc. Roy. Soc. Med.52: 602, 1959.
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Mayo Clinic and Mayo Foundation: Department of Surgery (Dr. Beahrs), Chief Resident Associate (Dr. Theuerkauf), and Section of Proctologic Surgery (Dr. Hill).
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Beahrs, O.H., Theuerkauf, F.J. & Hill, J.R. Procidentia: Surgical treatment. Dis Colon Rectum 15, 337–346 (1972). https://doi.org/10.1007/BF02587407
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DOI: https://doi.org/10.1007/BF02587407