RESULTS OF PERINEAL PROCEDURES FOR THE TREATMENT OF RECTAL PROLAPSE

The optimal surgical procedure for the management of rectal prolapse i s still under debate. Therefore, the aim of this study was to evaluate the short-term outcome of perineal procedures in patients with rectal prolapse. Between April 1989 and April 1995, all consecutive patients at the Cleveland Clinic Florida who underwent Delorme's procedure or perineal rectosigmoidectomy with or without levatoroplasty for full-th ickness rectal prolapse were evaluated. Clinical and physiological ass essments were performed before and after surgery. A standard continenc e scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence) was used to assess the r esults of each procedure. Additionally, morbidity and mortality, and c linical and functional outcomes were evaluated. Sixty-one patients und erwent perineal procedures for rectal prolapse; 16 patients died from comorbid conditions after undergoing postoperative physiologic assessm ent. These 55 females and 6 males, with a mean age of 75 (range, 48-10 1) years were studied. Patients were followed up for 27.2 (6-72) month s, and mean prolapse duration was 4.2 (0.2-30) years. Although mean pr eoperative incontinence score was 15.9 (8-20), it was 6.3 (range, 0-12 ) in postoperative course. Mean resection length of rectosigmoid was 2 3.3 (3-71) cm and in these patients, two (3.3%) coloanal anastomotic l eaks and four (6.5%) anastomotic strictures were observed. There was o ne postoperative death. There were statistically significant differenc es among the groups relative to short-term recurrence rates, postopera tive incontinence scores, mean resection length, coloanal anastomotic stricture, and leak (P < 0.001). However, pre- and postoperative anal manometry did not reveal statistically significant changes (P > 0.05) in each group or among the groups. Perineal procedures were found to b e safe and effective in eradicating rectal prolapse and improving feca l incontinence in the elderly.