RESULTS OF THE SURGICAL-MANAGEMENT OF REC TAL PROLAPSE IN ADULTS - 21YEARS EXPERIENCE

Between 1971 and 1992, 89 patients (57 women, 32 men; mean age: 61 yea rs) underwent surgical treatment for total rectal prolapse. 68.5% were constipated, and 12.3% had a solitary rectal ulcer, 46% were incontin ent (3 grades 2, 11 grades 3, 27 grades 4). Twelve patients (21%) had been previously but unsuccessfully operated. Manometry showed low rest ing pressures in the upper part of the anal canal, particularly in inc ontinent patients. Voluntary contraction was lower in incontinent pati ents. The resting anorectal angle was obtuse (113 degrees). Orr-Loygue operation (n = 53), modified rectopexy (n = 22), rectopexy to the lef t inguinal ligament (n = 6), Delorme operation (n = 4), and posterior rectopexy (n = 4) were performed. There was no operative mortality. In traoperative and postoperative morbidity rates were 3.4% (n = 3) and 2 9%. Rectal prolapse recurred in 3 cases (3.4%). Solitary rectal ulcer healed in all patients. Only 8 patients were incontinent after operati on, but control was better in 6 cases; in other both patients, preoper ative electromyography showed grade III denervation. Bowel habit was p ostoperatively better (68.5% of patients were constipated before opera tion, 51.7% after operation). Resting pressures increased in preoperat ively incontinent patients in the upper part of the anal canal; restin g external sphincter pressures always increased. There was no change i n the resting anorectal angle (112 degrees).