Long-term results and functional outcome after Ripstein rectopexy

PURPOSE: The aim of this study was to evaluate operative mortality, morbidi ty, and functional results after Ripstein rectopexy for rectal prolapse and internal rectal intussusception. METHODS: Sixty-nine patients with rectal prolapse and 43 with internal rectal intussusception were included. All pat ient records were studied and complications registered. Long-term follow-up was possible in 105 patients and performed by clinical examination and sta ndardized interview, telephone: interview, or patient records. Seventy-six patients were prospectively evaluated, comparing bowel function before and after rectopexy. RESULTS: There nas no operative mortality. Operative morbi dity was 33 percent, and most complications were minor. Severe early compli cations included one large-bowel obstruction and one transient ureteric ste nosis. Median time of follow-up was seven years in patients with rectal pro lapse and 5.4 years in patients with internal rectal intussusception. Late complications included two rectovaginal fistulas and one lethal sigmoid fec aloma. Five patients underwent subtotal colectomy for severe constipation. There was one recurrent prolapse (1.6 percent). Functional evaluation showe d that incontinence improved (P = 0.049), whereas the number of bowel movem ents per week decreased (P < 0.001). Frequency of emptying difficulties did not change significantly in patients with rectal prolapse but increased in patients with internal rectal intussusception (P = 0.038). CONCLUSION: Rip stein rectopexy can be performed with low mortality and recurrence rate, bu t with a high early complication rate. There were also some serious late co m plications. Continence was improved, although increased constipation was a problem in some patients, especially among those with internal rectal int ussusception.