PERINEAL RECTOSIGMOIDECTOMY IN THE ELDERLY

Between April 1989 and October 1991, 20 consecutive patients underwent perineal rectosigmoidectomy and coloanal anastomosis for full-thickne ss rectal prolapse. These 16 females and 4 males, with a mean age of 8 2 (range, 68-101) years, were evaluated by detailed functional assessm ent and physiologic testing. A grading scale from 0 to 24 was based up on the frequency and type of incontinence, 0 representing full contine nce. The mean preoperative continence score was 14.5, while the mean p ostoperative continence score was 8.4. The mean length of resected rec tosigmoid was 23 cm. There was one postoperative death and one signifi cant complication. a postoperative pelvic hematoma that required reope ration. There were no full-thickness recurrences at a mean follow-up o f 26 months. Six of the 10 patients who underwent preoperative pudenda l nerve terminal motor latency (PNTML) testing had evidence of severe neuropathy (latencies greater than 2.5 milliseconds). Prolonged PNTML, however, was not shown to be an accurate predictor of postoperative i ncontinence because four of the six patients with neuropathy regained excellent to good control. In conclusion, perineal rectosigmoidectomy is a safe operation for the treatment of full-thickness rectal prolaps e in the elderly patient. Improved postoperative continence was noted in 90 percent of patients, with improvement seen even in those patient s with severe pudendal neuropathy.