Experience with Rectal Prolapse

Abstract

Background. The problem of complete rectal prolapse is formidable, with no clear predominant treatment of choice. In the present study, we review our experience with rectal prolapse. Mathod. From the 1993 to 2004, 18 patients with full-thickness rectal prolapse were treated with surgical procedures. The medical records were reviewed retrospectively. Results. There are 9 males and 9 females with a mean age of 49.9 years (Range 16-86). Five patients received suture rectopexy, four patients underwent open sigmoidectomy with suture rectopexy, three patients received laparoscopic colectomy with or without mesh rectopexy, two patients were treated with perineal rectosigmoidectomy, two patients received Delorme procedure, and two patients underwent Thiersch procedure. The median follow up times were 5.5 years. In the five patient received suture rectopexy, there was no complication but one patient recurred (20%). In the four patients received open sigmoidectomy with suture rectopexy, there was no complication or recurrence. In the group of laparoscopic colectomy with or without mesh rectopexy, no complication or recurrence occurred. In the perineal rectosigmoidectomy group, there was also no complication or recurrence. There was one complication of perianal infection in the Thiersch group and one recurrence in the Delorme group. Of the total 18 patients, the complication rate was 5.6% and the recurrence rate was 11.1% Conclusions. There is probably no single operation that is suitable for all patients and no operation will produce complete resolution of all symptoms. Abdominal procedures are ideal for young fit patients, whereas perineal procedures are reserved for older frail patients with significant comorbidities, because in our series and in reviewing the literature, abdominal procedures provide lower recurrence rates. Although the follow up time was not long enough for conclusions, laparoscopic operations offer a promising new option for the treatment of rectal prolapse.