Traitement du prolapsus rectal complet par rectopexie au plancher pelvien avec prothèse et résection du sigmoïde. Résultats anatomocliniques d'une étude prospective

Abstract

Background, aim of the study Full thickness rectal prolapse in young adults with normal perineal structures is a disease of the rectum which is exceedingly long and mobile. Surgical treatment should correct both anatomical defects by combined rectopexy and colonic resection, expected to be less constipating than rectopexy alone. The aim of this study was to describe an original procedure of rectopexy to the pelvic floor with prosthetic material combined with sigmoid resection, and to evaluate prospectively anatomical and functional results. Patients and methods Twenty patients (16 women and four men) of median age 41 years were operated on for full thickness rectal prolapse with normal perineal structures. The rectum was mobilised posteriorly without division of the lateral ligaments and attached to the pelvic floor previously repaired, with a semi-absorbable prosthesis. The sigmoid colon was resected with hand-sewn anastomosis. Clinical results were assessed by a questionnaire. Results There were no deaths or any septic or anastomotic complications. Small bowel obstruction was corrected laparoscopically in one patient. Mean hospital stay was 8.7 days. Mean follow up was 30 (range 9–75) months. No recurrence was seen. Pre-operatively, 18 patients (90%) complained of constipation mainly with emptying problems (15 patients) and 13 patients (65%) were incontinent. Post-operatively, no constipated or incontinent patient's condition worsened. Rectal emptying was restored in 13 patients (86.5%). Eight incontinent patients (61.5%) regained full continence. On the other hand, two patients with normal bowel function worsened and one patient with an altered rectal compliance after Delorme's operation became incontinent. Conclusions In young adults with rectal prolapse and normal perineal structures undergoing prosthetic rectopexy and sigmoid resection: a) morbidity was low, b) anatomical control was obtained in all cases, c) emptying problems were corrected, d) deleterious effects are likely to occur if they had no constipation before operation or if rectal compliance was previously altered.