Bowel function following sutured abdominal rectopexy

Abstract

Aim of this investigation was to validate a previous pilot study which indicated that in properly selected patients with rectal prolapse, the simple sutured abdominal rectopexy adequately controls prolapse, improves continence and does not worsen constipation. Patients with overt procidentia recti without severe constipation and without redundant sigmoid colon were enrolled into the present study. Anatomical and functional outcomes were prospectively evaluated. The study group comprised 54 female and 3 male patients with overt, full-thickness rectal prolapse. The entry criteria excluded “slow transit” constipation and redundant sigmoid colon, but permitted mild or moderate “outlet obstruction” constipation. Among the patients, 75% also suffered also from different grades of incontinence. Abdominal rectopexy without prosthetic mesh and without resection was performed. The operation involved posterior and lateral mobilization of the rectum and direct suture of mesorectum to the presacral fascia. The mean follow-up was 38 months. Anatomical control was achieved in all patients. Fecal incontinence was present in 75% of the patients before the operation, but only in 30% following the operation. The overall number of constipated patients decreased after rectopexy from 65% to 40% and there was no deterioration to the severe type of constipation. In conclusion, sutured abdominal rectopexy is simple, safe and effective. It controls prolapse and significantly improves the associated incontinence. The anatomical and functional characteristics of the individual patient should guide the choice of the best operation for rectal prolapse.