Functional results of operative treatment of rectal prolapse over an 11-year period - Emphasis on transabdominal approach

PURPOSE: A variety of surgical procedures have been developed to treat rect al prolapse, but there is still no consensus on the operation of choice. Th e aim of this study was to evaluate the functional results of operative tre atment of rectal prolapse during an 11-year period in our department. METHO DS: All patients treated for complete rectal prolapse during an 11-year per iod, from 1985 to 1995, in a single university hospital were included. Of t he 123 patients, 22 were men, and the mean age was 59 (range, 15-88) years. The medical records of all patients were reviewed retrospectively, and a q uestionnaire on bowel symptoms before and after surgery was sent to all 95 living patients. RESULTS: The majority of the procedures (91 percent) were performed by abdominal approach, and the most frequently used open techniqu e was posterior rectopexy with mesh (78 percent). Of the incontinent patien ts, 35 (63 percent), all those less than 40 years of age and 64 percent of those 40 years or older, were continent postoperatively (P = 0.0001) after a median follow-up of five (range, 1-72) months. According to the questionn aire, after a median follow-up of 85 (range, 16-144) months, only 38 percen t of the incontinent patients in the mesh or suture group, 78 percent of pa tients less than 40 years of age (n = 18), and 52 percent of those 40 years or older (n = 47) claimed to be continent postoperatively. The proportion of patients with constipation was greater after the operation than preopera tively (P = 0.02) and more patients used medication for constipation after than before the operation (P = 0.0001). The overall complication rate was 1 5 percent, and the mortality rate was 1 percent (1/123). In the mesh or sut ure group there were 6 (6 percent) recurrent complete prolapses and 11 (12 percent) mucous prolapses. CONCLUSION: Posterior rectopexy with mesh gave g ood results in our hands. Older age and longer follow-up seem to have a neg ative effect on the functional outcome of the operation and on the recurren ce rate.