PROCTOGRAPHIC CHANGES AFTER RECTOPEXY FOR SOLITARY RECTAL ULCER SYNDROME AND PREOPERATIVE PREDICTIVE FACTORS FOR A SUCCESSFUL OUTCOME

Rectopexy is advocated as treatment for solitary rectal ulcer syndrome despite variable outcome. Sixteen patients with this condition, who r emained symptomatic after surgery, were examined before and after oper ation by evacuation proctography and compared with a matched group of seven patients whose symptoms had been relieved, to investigate the ef fect of rectopexy on rectal configuration or emptying, or both, and to identify any preoperative factor associated with a good outcome. Rect al prolapse, demonstrated in 19 of 23 patients before operation (inter nal in 12, external in seven), was seen in only one patient after surg ery. The rectal axis became more vertical at rest (median 44 degrees b efore operation versus 35 degrees after surgery, P = 0.006) and on eva cuation (median 38 degrees versus 31 degrees, P = 0.023). Preoperative evacuation time was increased in patients with poor outcome (median ( range) 22 (8-60)s versus 10 (5-15) s, P = 0.008). Rectopexy successful ly treats rectal prolapse in patients with solitary rectal ulcer syndr ome and alters rectal configuration. These features, however, are unre lated to outcome. Prolonged preoperative evacuation time, suggesting a defaecatory disorder, may predict poor symptomatic outocme.