Outcome Analysis of Perineal Rectosigmoidectomy for the Treatment of Full Thickness Rectal Prolapse

Abstract

Purpose: Management of rectal prolapse remains controversial and unclear. Perineal and abdominal options have eager proponents. We reviewed our experience with perineal rectosigmoidectomy (PRS) for the treatment of full thickness rectal prolapse. Methods: Retrospective, descriptive, multicentre study. Results: From 1985 to 2005, 98 patients underwent PRS and coloanal anastomosis for full thickness rectal prolapse. The study population was 79 women/19 men, with an average age of 78 years. 88% of patients had comorbid medical conditions including: coronary artery disease, diabetes, hypertension, arthritis, scoliosis, and psychological disorders. 37% required a nursing home. 39% of these patients had undergone previous abdominal surgery: hysterectomy, appendectomy, cholecystectomy, and bowel resections. 13 had previous operations for repair of rectal prolapse: PRS; silastic mesh encirclement; rectal resection and rectopexy; DeLorme procedures; Thiersch wire; Ripstein procedure. Preoperative fecal incontinence was present in 72% of the patients. 30 underwent PRS without levatoroplasty (early experience) with the remainder receiving levatoroplasty as an adjunct to the procedure. 9/21 patients that had preoperative fecal incontinence and PRS alone had improved or regained full continence postoperatively. 41/49 patients with PRS and levatoroplasty had improved or regained full continence postoperatively (Fisher's Exact Test p= 0.0011[statistically significant]). Preoperative evaluation was carried out in 78% of patients: colonoscopy; anal manometry; pudendal nerve stimulation; defecography; Misc. (N = 22). The 30 day readmission rate was 3% and the mortality was 0%. Median length of hospital stay was 3.5 days days. Complications included: Misc. (N = 5); UTI (N = 4); postop hemorrhage (N = 3); infection (N = 2); stricture (N = 1). Follow up was erratic, 24 were lost to follow-up. The remaining patients have been followed from 11 to 101 months. 13 developed recurrent rectal prolapse. 8 underwent repeat PRS and 3 others: sigmoid resection/rectopexy (N = 2), Ripstein (N = 1). 4 were not reoperated upon. Conclusions: PRS is a safe, effective operation for the management of rectal prolapse. The addition of levatoroplasty to the procedure as an adjunct improves postoperative fecal incontinence that is often present in these patients. The perioperative morbidity and mortality is acceptable in all age ranges and the procedure is well tolerated.