AN INVESTIGATION OF MODIFIED RIPSTEIN PROCEDURE

Abstract

Operative procedures for complete prolapse of the rectum can be divided into the perianal approach and transperitoneal approach. In recent years transperitoneal approach is common in Japan. Of the procedures, Ripstein procedure is increasingly employed among surgions, because it can be performed easily with less surgical invasion, and has a low recurrence rate of 10%, and favorable rate in improving incontinence of evacuation. However, it has been pointed out that the conventional procedure (1965), in which the whole-circumference of the rectum is anchored with mesh, is unavoidably associated with complications such as stricture and fecal impaction at the anchored site, in a frequency of approximately 10%. The Ripstein and his coworkers reported a modified procedure in 1987, where the posterior circumference of the rectum by 270 degrees anchored with mesh leaving the anterior open by 2-3 cm. This paper presents follow-up results of this modified procedure in 5 cases of complete prolapse of the rectum. In all 5 cases postoperative barium enema revealed a favorably retained stretch of the anterior wall of the rectum anchored. No any recurrence nor occurrence of complications such as stricture and fecal impaction which are often seen by the conventional procedure have not been observed in all cases including a case under the longest follow-up for 2 years and 11 months up to now.