The effect of abdominal rectopexy with mesh on anal sphincter and bowel function in patients with complete rectal prolapse; special reference to age of patient

Abstract

The main source of concern in patients with rectal prolapse is usually incontinence and constipation developing post-operatively. It has been claimed that sphincter pressures improve only after non-implant surgery. The aim of this study was to assess our own results after mesh rectopexy. We reviewed the results in 50 patients on whom posterior abdominal Marlex mesh rectopexy for complete rectal prolapse had been performed. These patients underwent pre- and post-operative anal manometry. Sixteen of them also underwent colon transit time study before and after the operation. They were followed clinically for a median of 5 months. Twenty-two of the 38 patients (58%) with preoperatively defective anal control regained full continence. Resting anal canal pressures improved significantly after surgery in all cases (P=0.001), including those who regained full continence (P=0.005). The change in continence in all patients correlated inversely with the preoperative (r=-0.43, P=0.003) and post-operative (r=-0.40, P=0.005) resting anal pressures. The change in resting anal pressures after surgery was significantly better in patients under 40 years of age (mean 19 cmH2 O) than in those 40 years or older (mean 4 cmH2 O) (P=0.01). All four preoperatively incontinent patients regained full continence in the younger group as opposed to only 50% (17/34) in the older group. Colon transit time normalized in three of the four patients with preoperatively slow transit time and five patients with preoperatively normal transit time developed slow transit. Internal sphincter pressures do improve after mesh rectopexy for rectal prolapse, and the change also correlates with the improvement in continence. Internal sphincter function and continence recover better in younger patients.