The effectiveness of perineal rectosigmoidectomy for the treatment of rectal prolapse in elderly and high-risk patients

We report herein on the follow-up of ten consecutive patients who underwent perineal rectosigmoidectomy and discuss the indications, surgical techniqu e, and outcomes of this procedure. The median age of the patients was 79 ye ars, with a range of 26 to 85 years, and eight patients had com plicating m edical conditions. Of five patients who underwent this procedure for a recu rrent prolapse after another type of perineal procedure, four had previousl y undergone the Thiersch operation combined with the Gant-Miwa technique. T he mean length of the excised rectum and sigmoid colon was 22.1cm. Pain was minimal or absent in all patients and oral intake was commenced after 2 da ys. There were no mortalities, but anastomotic leakage occurred in one pati ent, The mean follow-up period was 3.5 years. Only one patient developed re current rectal prolapse 24 months after the operation. Of seven patients wh o underwent concomitant levatoroplasty for incontinence, five became fully continent within 3 weeks after the operation, while the remaining two impro ved after 2 months. We propose that perineal rectosigmoidectomy is indicate d for patients who have suffered an early recurrence of prolapse after anot her transperineal repair; elderly or highrisk patients with incontinence; m ale patients; and patients with an incarcerated or gangrenous prolapsed rec tal segment.