Surgical treatment of complete rectal prolapse: Results of abdominal and perineal approaches

This retrospective study reports the results of our 5-year experience in th e diagnosis and treatment of rectal prolapse with fecal incontinence by the abdominal (laparotomy or laparoscopy) and perineal approaches. Twenty-five patients (group A; 22 women and 3 men; mean age 57.3 years; range 22-76 ye ars) were operated on by the abdominal approach and ten (group B; 8 women a nd 2 men; mean age 68.9 years; range 58-84 years) by the perineal approach. All patients were evaluated by clinical examination, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry, and ana l electromyography preparatory to surgery. In patients of group A, we perfo rmed an abdominal rectopexy in 19 cases (7 by laparoscopy) and in the remai ning 6 cases, a sigmoid resection-rectopexy (3 of which were by laparoscopy ). All patients of group B were treated by a perineal operation using Delor me's mucosectomy in 4 cases and Altemeier's rectosigmoidectomy with total p erineoplasty in 6 cases. The mean follow-up was 38.8 months in group A and 25.7 months in group B. The postoperative complication rate was 8% (two cas es) in group A, whereas no significant complications occurred in group B. D yschezia and fecal incontinence improved significantly in both groups (P < 0.05 in group A and P < 0.005 in group B), whereas anoperineal pain was not significantly reduced. At 1-year follow-up, the recurrences rates were 8% in group A and 30% in group B. Rectopexy or resection-rectopexy proved to b e a safe and effective procedure for external prolapse, without a discernib le difference between the laparotomic and laparoscopic techniques. In selec ted cases, the perineal approach gives good results regarding fecal inconti nence without complications, even if in these patients, the likelihood of r ecurrence is high.