RIPSTEIN PROCEDURE IS AN EFFECTIVE TREATMENT FOR RECTAL PROLAPSE WITHOUT CONSTIPATION

The operation of choice for complete rectal prolapse is controversial. We reviewed 169 patients undergoing 185 surgical procedures for recta l prolapse over a 27-year period. The most common surgical procedure e mployed was the Ripstein procedure (n = 142) and is the focus of this report. Other surgical procedures used included resection rectopexy (n = 18), anterior resection (n = 7), Altemeier's (n = 9), Delorme's (n = 2), and anal encirclement (n = 7). The median age was 59 years (rang e, 12-94 years), and the female-to-male ratio was 5:1. The incidence o f fecal incontinence, solitary rectal ulcer syndrome, and prior surger y elsewhere for rectal prolapse was 40 percent, 12 percent, and 19 per cent, respectively. Operative mortality was 0.6 percent; morbidity was , 16 percent. Median follow-up was 4.2 years (range, 1-15 years). Comp lete recurrence of prolapse after the Ripstein procedure was 8 percent ; one-third of these patients recurred 3 to 14 years after surgery. Fe cal incontinence improved after the Ripstein procedure or resection re ctopexy in about half the patients. Persistence of prior constipation was more common after the Ripstein procedure than after resection rect opexy (57 percent vs. 17 percent; P = 0.03, chi-squared). Fifteen pati ents developed constipation for the first time after the Ripstein proc edure. About one in three patients, irrespective of surgical procedure s, remained dissatisfied with the final outcome despite anatomic corre ction of the prolapse. The Ripstein procedure has proven to be a safe procedure with good anatomic repair of the prolapse and may improve co ntinence. In the presence of constipation, procedures other than the R ipstein procedure may be preferable.