Abstract
Aims
This study evaluates patency and functional results of abdominal and perineal treatment approaches to prolapse of the rectum.
Methods
A database search identified patients operated upon for prolapse of the rectum. The operations were abdominal or perineal approaches. The patient’s records were reviewed, patients alive were contacted, and a self-report form evaluated functional results. Patients were followed until the prolapse recurred.
Results
A primary operation for prolapse of the rectum was performed in 56 patients. Median age was 59 years (range 20–87) and 78 (40–91) for abdominal and perineal approaches, respectively (p < 0.001). The average length of the prolapses was 8.7 cm (2–25) and 8.6 cm (2–15) for abdominal or perineal approaches. All prolapses treated with a Thiersch’s operation recurred within a few months and all prolapses treated with the Delorme’s operation recurred within 5 years, whereas the 5-year patency of the abdominal approach was 93% (p < 0.001). No prolapses recurred after mesh rectopexy and the 5-year patency of resection rectopexy was 86%. The abdominal approaches improved stool evacuation and constipation significantly, and anal leakage improved somewhat (p = 0.065). The median hospital stay was 11 (4–20) and 7 (2–155) days after abdominal and perineal approaches (p = 0.003). Complications occurred in 20% of patients.
Conclusions
The patency of abdominal approach to prolapse of the rectum is better than that of perineal repairs. The abdominal approaches also have a favorable effect on constipation and anal insufficiency. Perineal approaches should be reserved for patients with a very short life expectancy.
Similar content being viewed by others
References
Kairaluoma MV, Kellokumpu IH (2005) Epidemiologic aspects of complete rectal prolapse. Scand J Surg 94(3):207–210
Nicholls RJ, Banerjee A (1997) Rectal prolapse and solitary rectal ulcer syndrome. In: Nicholls RJ, Dozois RR (eds) Surgery of the colon and rectum. Churchill Livingstone, New York, pp 709–137
DiGiuro G, Ignjatovic D, Brogger J, Bergamaschi R (2006) How accurate are published recurrence rates after rectal prolapse surgery? A meta-analysis of individual patient data. Am J Surg 191:773–778
Knowles CH, Eccersley J, Scott M, Walker SM, Reeves B, Lunniss PJ (2000) Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Gastroenterology 118:A1181
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Madoff RD, Williams JG, Wong WD, Rothenberger DA, Goldberg SM (1992) Long-term functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterol 87:101–104
Watts JD, Rothenberger DA, Buls JG, Goldberg SM, Nivatvongs S (1985) The management of procidentia—30 years experience. Dis Colon Rectum 28:96–102
Yoshioka K, Heyen F, Keighley MRB (1989) Functional results after posterior abdominal rectopexy for rectal prolapse. Dis Colon Rectum 32:835–838
Roberts PL, Schoetz DJ Jr., Coller JA, Veidenheimer MC (1988) Ripstein procedure. Lahey Clinic experience: 1963–1985. Arch Surg 123:554–557
Jackaman FR, Francis JN, Hopkinson BR (1980) Silicone rubber band treatment of rectal prolapse. Ann R Coll Surg Engl 62:386–387
Monson JRT, Jones NAG, Vowden P, Brennan TG (1986) Delormes operation—the 1st choice in complete rectal prolapse. Ann R Coll Surg Engl 68:143–146
Uhlig BE, Sullivan ES (1979) The modified Delorme operation: its place in surgical treatment for massive rectal prolapse. Dis Colon Rectum 22:513–521
Marchal F, Bresler L, Ayav A, Zarnegar R, Brunaud L, Duchamp C, Boissel P (2005) Long-term results of Delorme’s procedure and Orr–Loygue rectopexy to treat complete rectal prolapse. Dis Colon Rectum 48:1785–1790
Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M (2003) Delorme’s procedure for rectal prolapse—clinical and physiological analysis. Dis Colon Rectum 46:1260–1265
Watts AMI, Thompson MR (2000) Evaluation of Delorme’s procedure as a treatment for full-thickness rectal prolapse. Br J Surg 87:218–222
Johnson E, Nygaard K, Bakka A (1993) Rectal prolapse. Experiences with rectopexy and Delorme’s operation. Tidsskr Nor Laegeforen 113(21):2693–2695
Sielezneff I, Malouf A, Cesari J, Brunet C, Sarles JC, Sastre B (1999) Selection criteria for internal rectal prolapse repair by Delorme’s transrectal excision. Dis Colon Rectum 42:367–373
Madiba TE, Baig MK, Wexner SD (2005) Surgical management of rectal prolapse. Arch Surg 140:63–73
Chun SW, Pikarsky AJ, You SY, Gervaz P, Efron J, Weiss E, Nogueras JJ, Wexner SD (2004) Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol 8:3–8
Boccasanta P, Venturi M, Barbieri S, Roviaro G (2006) Impact of new technologies on the clinical and functional outcome of Altemeier’s procedure: a randomized, controlled trial. Dis Colon Rectum 49:652–660
Boccasanta P, Venturi M, Stuto A, Bottini C, Caviglia A, Carriero A, Mascagni D, Mauri R, Sofo L, Landolfi V (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1296
Corman ML, Carriero A, Hager T, Herold A, Jayne DG, Lehur PA, Lomanto D, Longo A, Mellgren AF, Nicholls J, Nystrom PO, Senagore AJ, Stuto A, Wexner SD (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis 8:98–101
von Papen M, Ashari LH, Lumley JW, Stevenson AR, Stitz RW (2007) Functional results of laparoscopic resection rectopexy for symptomatic rectal intussusception. Dis Colon Rectum 50:50–55
Winde G, Reers B, Nottberg H, Berns T, Meyer J, Bunte H (1993) Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse. Eur J Surg 159:301–305
Purkayastha S, Tekkis P, Athanasiou T, Aziz O, Paraskevas P, Ziprin P, Darzi A (2005) A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum 48:1930–1940
Carpelan-Holmstrom M, Kruuna O, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hoel, A.T., Skarstein, A. & Ovrebo, K.K. Prolapse of the rectum, long-term results of surgical treatment. Int J Colorectal Dis 24, 201–207 (2009). https://doi.org/10.1007/s00384-008-0581-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-008-0581-2