CONTINENCE IS IMPROVED AFTER THE RIPSTEIN RECTOPEXY - DIFFERENT MECHANISMS IN RECTAL PROLAPSE AND RECTAL INTUSSUSCEPTION

PURPOSE: This study was undertaken to evaluate anal manometric changes after Ripstein's operation for rectal prolapse and rectal intussuscep tion and to study the clinical outcome following the operation, with s pecial reference to anal incontinence. METHODS: Forty-two patients wit h rectal prolapse or rectal intussusception were subjected to anorecta l manometry preoperatively and seven days and six months postoperative ly, A derailed history was obtained from each patient preoperatively a nd six months postoperatively. RESULTS: Preoperatively, patients with rectal intussusception had higher maximum resting pressure (MRP) (52 /- 23 mmHg) than patients with rectal prolapse (34 +/- 20 mmHg; P < 0. 01). In the group of patients with rectal prolapse, there was a postop erative increase in MRP after six months (P < 0.001) but not after sev en days. Maximum squeeze pressure (MSP) did not increase. Neither MRP nor MSP increased postoperatively in patients with internal rectal pro cidentia. Continence was improved postoperatively both in patients wit h rectal prolapse (P < 0.01) and rectal intussusception (P < 0.01). Th ere was no postoperative increase in rectal emptying difficulties. CON CLUSION: Ripstein's operation often improved anal continence in patien ts with rectal prolapse and rectal intussusception. This improvement w as accompanied by increased MRP in patients with rectal prolapse, indi cating recovery of internal anal sphincter function. No postoperative increase in MRP was found in patients with rectal intussusception. Thi s suggests an alternate mechanism of improvement in patients with rect al intussusception.