Complete rectal prolapse - Evolution of management and results

Optional treatment for complete rectal prolapse remains controversial. PURP OSE: We reviewed our experience over a 19-year period to assess trends in c hoice of operation, recurrence rates, and functional results. METHODS: We i dentified 372 patients who underwent surgery for complete rectal prolapse b etween 1976 and 1994. Charts were reviewed and follow-up (median, 64; range , 12-231 months) was obtained by mailed questionnaire (149 patients; 40 per cent) and telephone interview (35 patients; 9 percent). Functional results were obtained from 184 responders (49 percent). RESULTS: Median age of pati ents was 64 (11-100) years, and females outnumbered males by nine to one. O ne-hundred and eighty-eight patients (51 percent) were lost to follow-up, 1 83 patients (49 percent) underwent perineal rectosigmoidectomy, and 161 pat ients (43 percent) underwent abdominal rectopexy with bowel resection. The percentage of patients who underwent perineal rectosigmoidectomy increased from 22 percent in the first five years of the study to 79 percent in the m ost recent five years. Patients undergoing perineal rectosigmoidectomy were more likely to have associated medical problems as compared with patients undergoing abdominal rectopexy (61 vs 30 percent, P = 0.00001). There nas n o significant difference in morbidity, with 14 percent for perineal rectosi gmoidectomy us. 20 percent for abdominal rectopexy. Abdominal procedures we re associated with a longer length of stay as compared with perineal rectos igmoidectomy (8 vs. 5 days, P = 0.001). Perineal procedures, however, had a higher recurrence fate (16 vs. 5 percent, P = 0.002). Functional improveme nt was not significantly different, and most patients were satisfied with t reatment and outcome. CONCLUSIONS: We conclude that abdominal rectopexy wit h bowel resection is associated with low recurrence rates. Perineal rectosi gmoidectomy provides lower morbidity and shorter length of stay, but recurr ence rates are much higher. Despite this, perineal rectosigmoidectomy has a ppeal as a lesser procedure for elderly patients or those patients in the h igh surgical risk category. For younger patients, the benefits of perineal rectosigmoidectomy being a lesser procedure must be weighed against a highe r recurrence rate.