LONG-TERM CLINICAL OUTCOME OF SURGERY FOR SOLITARY RECTAL ULCER SYNDROME

Background When severe symptoms of solitary rectal ulcer syndrome pers ist despite medical management, surgery may be necessary. Methods A re trospective review was carried out of 81 patients undergoing surgery f or solitary rectal ulcer syndrome in the 10-year period from 1984 to 1 993 to determine the long-term outcome at a minimum follow-up of 12 mo nths. Of the 81 patients, 15 were excluded from further analysis (11 w ere followed up for less than 12 months, two died and two were lost to follow-up). Sixty-six patients were studied (median age 38 (range 15- 77) years; 53 female). Of these, 49 underwent rectopexy, nine Delorme' s operation, two anterior resection and four creation of a stoma as th e initial operation. Results At a median follow-up of 90 (range 12-177 ) months, the rectopexy had failed in 22 of 49 patients; 19 of these p atients underwent further surgery, including rectal resection with col oanal anastomosis (four with three failures), colostomy (11) and other procedures (four). Ultimately, 14 required a stoma. Constipation was the indication for a stoma in nine of the 11 patients who had colostom y as the first procedure after failure of rectopexy. Nine patients had Delorme's operation as the first procedure. At median follow-up of 38 (range 19-107) months, there were four failures. Two of these ultimat ely required a stoma. Of the seven patients who underwent anterior res ection as the initial or subsequent procedure, a stoma was finally nec essary in four. Anterior resection used as a salvage procedure was not successful. The overall stoma rate was 30 per cent (20 patients). Of 11 symptoms assessed before operation only incontinence and incomplete evacuation were related to a poor outcome following surgery. Conclusi on Antiprolapse operations result in a satisfactory long-term outcome in about 55-60 per cent of patients having surgery for solitary rectal ulcer syndrome. Results of anterior resection are disappointing.