Solitary rectal ulcer syndrome: a series of 13 patients operated with a mean follow-up of 4.5 years

Solitary rectal ulcer syndrome (SRUS) is an infrequent pathology often asso ciated with pelvic floor disorders. The aim of this retrospective study was to review the long-term results of a surgical series of SRUS. Between 1988 and 1998, 13 patients were operated on for SRUS. Seven patients had associ ated internal rectal prolapse (58%), two had associated total rectal prolap se (15%), and two had associated mucosal prolapse (15%). We performed simpl e resection of the SRUS in one case (8%), a stoma as primary operation in o ne (8%), three rectopexies according to Orr-Loygue (23%), and eight Delorme 's operations as modified by Berman (62%). Mean followup was 57 months (ran ge 15-112). Simple resection of the solitary rectal ulcer syndrome did not improve symptoms. Colostomy permitted relief of symptoms and healing of the SRUS. Two of the three rectopexies achieved good results, and the third pa tient relapsed at the 6th postoperative month. A secondary modified Delorme 's operation permitted relief of symptoms and healing of the SRUS. Five of the eight patients (62.5%) who received modified Delorme's operations had i mproved at a follow-up of 46 months. We conclude that, considering the high failure rate after surgery, operations should be performed only in patient s with total rectal prolapse or intractable symptoms not amenable to behavi oral therapy. Delorme's operation and abdominal rectopexy help in about 60% of cases.