Perineal Proctectomy Research Articles

Validity of task-specific metrics for assessment in perineal proctectomy.

Perineal proctectomy is a complex procedure that requires advanced skills. Currently, there are no simulators for training in this procedure. As part of our objective of developing a virtual reality simulator, our goal was to develop and validate task-specific metrics for the assessment of performance for this procedure. We conducted a three-phase study to establish task-specific metrics, obtain expert consensus on the appropriateness of the developed metrics, and establish the discriminant validity of the developed metrics. In phase I, we utilized hierarchical task analysis to formulate the metrics. In phase II, a survey involving expert colorectal surgeons determined the significance of the developed metrics. Phase III was aimed at establishing the discriminant validity for novices (PGY1-3) and experts (PGY4-5 and faculty). They performed a perineal proctectomy on a rectal prolapse model. Video recordings were independently assessed by two raters using global ratings and task-specific metrics for the procedure. Total scores for both metrics were computed and analyzed using the Kruskal-Wallis test. A Mann-Whitney U test with Benjamini-Hochberg correction was used to evaluate between-group differences. Spearman's rank correlation coefficient was computed to assess the correlation between global and task-specific scores. In phase II, a total of 23 colorectal surgeons were recruited and consensus was obtained on all the task-specific metrics. In phase III, participants (n = 22) included novices (n = 15) and experts (n = 7). There was a strong positive correlation between the global and task-specific scores (rs = 0.86; P < 0.001). Significant between-group differences were detected for both global (χ2 = 15.38; P < 0.001; df = 2) and task-specific (χ2 = 11.38; P = 0.003; df = 2) scores. Using a biotissue rectal prolapse model, this study documented high IRR and significant discriminant validity evidence in support of video-based assessment using task-specific metrics.

Development and Expert Consensus on Performance Metrics for Automated Assessment of Perineal Proctectomy for Rectal Prolapse

Development and Expert Consensus on Performance Metrics for Automated Assessment of Perineal Proctectomy for Rectal Prolapse

Surgical management of pediatric rectal prolapse: A survey of the American Pediatric Surgical Association (APSA)

IntroductionMany management options exist for the treatment of refractory rectal prolapse (RP) in children. Our goal was to characterize current practice patterns among active members of APSA. MethodsA 23-item questionnaire assessed the management of full-thickness RP for healthy children who have failed medical management. The survey was approved by our IRB and by the APSA Outcomes committee. Results236 surgeons participated. The respondents were geographically dispersed (44 states, 5 provinces). 32% of respondents had twenty or more years of clinical experience. 71% evaluated 1–5 RP patients in the last 2 years, while 5% evaluated >10. 71% performed 0–1 procedure (operation or local therapy [LT]) for RP over 2 years. 59% would treat a 2-year-old patient differently than a 6-year-old with the same presentation, and were more likely to offer up-front surgery to a 6-year-old (26% vs 15%, p = 0.04), less likely to continue medical management indefinitely (2% vs 7%, p=0.01), and more likely to perform resection with rectopexy (30% vs. 15%, p=0.01). 71% perform LT as an initial intervention: injection sclerotherapy (59%), anal encirclement (8%), and sclerotherapy + anal encirclement (5%). 70% consider LT a failure after 1–3 attempts. If LT fails, surgical management consists of transabdominal rectopexy (46%), perineal proctectomy or proctosigmoidectomy (22%), transabdominal sigmoidectomy + rectopexy (22%), and posterior sagittal rectopexy (9%). ConclusionsThere is wide variability in the surgical management of pediatric rectal prolapse. This suggests a need for development of processes to identify best practices and optimize outcomes for this condition.

Redo perineal rectosigmoidectomy with posterior levatorplasty for recurrent rectal prolapse

Rectal prolapse is an uncommon condition mostly affecting the elderly and women populations. Surgical repair is the recommended treatment of choice for those patients who develop full thickness rectal prolapse. The two most common surgical approaches are trans abdominal and perineal. Recurrences of prolapse occur in 5–30% of patients and are higher for perineal approaches. An 83-year-old female with a history of previous Altemeier perineal proctectomy and posterior levatorplasty three years prior presented with recurrent rectal prolapse associated with chronic diarrhea, tenesmus, and mild incontinence. She underwent an uncomplicated redo Altemeier perineal proctosigmoidectomy and posterior levatorplasty. The patient recovered well and was prolapse free at one-year follow-up with significantly reduced associated symptoms. Redo perineal procedures are feasible, similar if not identical to primary resections, and are often easier to perform because the hernia sac is often easily identified. The same principles of perineal primary repair should be used in a redo perineal procedure.

Erratum to: Primary vs. delayed perineal proctectomy-there is no free lunch.

Erratum to: Primary vs. delayed perineal proctectomy-there is no free lunch.

Bio-Thiersch as an Adjunct to Perineal Proctectomy Reduces Rates of Recurrent Rectal Prolapse.

The rates of recurrent prolapse after perineal proctectomy vary widely in the literature, with incidences ranging between 0% and 50%. The Thiersch procedure, first described in 1891 for the treatment of rectal prolapse, involves encircling the anus with a foreign material with the goal of confining the prolapsing rectum above the anus. The Bio-Thiersch procedure uses biological mesh for anal encirclement and can be used as an adjunct to perineal proctectomy for rectal prolapse to reduce recurrence. The aim of this study was to evaluate the Bio-Thiersch procedure as an adjunct to perineal proctectomy and its impact on recurrence compared with perineal proctectomy alone. A retrospective review of consecutive patients undergoing perineal proctectomy with and without Bio-Thiersch was performed. Procedures took place in the Division of Colon and Rectal Surgery at a tertiary academic teaching hospital. Patients who had undergone perineal proctectomy and those who received perineal proctectomy with Bio-Thiersch were evaluated and compared. All of the patients with rectal prolapse received perineal proctectomy with levatorplasty, and a proportion of those patients had a Bio-Thiersch placed as an adjunct. The incidence of recurrent rectal prolapse after perineal proctectomy alone or perineal proctectomy with Bio-Thiersch was documented. Sixty-two patients underwent perineal proctectomy (8 had a previous prolapse procedure), and 25 patients underwent perineal proctectomy with Bio-Thiersch (12 had a previous prolapse procedure). Patients who received perineal proctectomy with Bio-Thiersch had a lower rate of recurrent rectal prolapse (p < 0.05) despite a higher proportion of them having had a previous prolapse procedure (p < 0.01). Perineal proctectomy with Bio-Thiersch had a lower recurrence over time versus perineal proctectomy alone (p < 0.05). This study was limited by nature of being a retrospective review. Bio-Thiersch as an adjunct to perineal proctectomy may reduce the risk for recurrent rectal prolapse and can be particularly effective in patients with a history of previous failed prolapse procedures.

PWE-381 Life after prosper: a review of the management of rectal prolapse

<h3>Introduction</h3> A questionnaire completed by members of the ACPGBI in 2000 was a precursor to the PROSPER trial. It showed a significant variation in favoured practice for the surgical treatment of rectal prolapse. We repeated the same questionnaire in 2014 to assess how practice has changed. <h3>Method</h3> A 10 question online survey was circulated to all members of the ACPGBI with identical questions to those used in the original in 2000. <h3>Results</h3> Similar numbers of surgeons responded (122 vs. 153). Median operations per surgeon per year is unchanged 6 (0–30) vs. 6 (0–25) and a similar proportion of surgeons have a favoured approach for fit patients (67.2% vs. 64%). More surgeons favour an abdominal approach in 2014 (55.0% vs. 40.1% (p = 0.01)). The most popular abdominal approach in 2014 is a ventral rectopexy (44.1% vs. 5.9% (p &lt; 0.01)) while those favouring a posterior rectopexy has decreased dramatically 45% vs. 92.6% (p &lt; 0.01). Only 5.4% still favour resection rectopexy compared to 39.7% previously (p &lt; 0.01). The use of perineal procedures is unchanged with 59.8% and 21.5% currently choosing Delorme’s and perineal proctectomy respectively compared to 63.4% and 14.9% in 2000. 38.5% prefer perineal approaches in elderly or unfit patients, compared with 39.2% previously and 59.8% had no age preference (61.3%). The use of laparoscopic repair has increased dramatically with 78.7% of surgeons currently choosing this approach compared to 19% previously (p &lt; 0.01). <h3>Conclusion</h3> The surgical approach to management of rectal prolapse is still varied, although more surgeons now favour a laparoscopic abdominal approach. The perineal approach continues to be a favoured option particularly in elderly and unfit patients. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Senapati A, Gray RG, Middleton LJ <i>et al</i>. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. <i>Colorectal Dis</i>. 2013 Jul;15(7):858–68

Clinical outcomes of perineal proctectomy among patients of advanced age.

Rectal prolapse occurs primarily in older patients who often have significant comorbidities. With the aging population, increasing numbers of elderly patients are presenting with rectal prolapse. The perineal approach is preferred for these patients because it involves less perioperative risk than an abdominal procedure, but the outcomes of this procedure in elderly patients are unknown. The aim of this study was to examine whether clinical outcomes after perineal proctectomy are similar among elderly patients versus patients of younger age. This study was a retrospective review. This study was conducted in mixed academic and private practice; the operations were performed at 16 hospitals. Patients who had perineal proctectomy for rectal prolapse from 1994 to 2012 were grouped according to age: <70 (group A), 70 to 79 (group B), 80 to 89 (group C), and ≥90 years (group D). Perineal proctectomy with or without concurrent levatorplasty was performed. The primary outcomes measured were postoperative complications, recurrence, and survival after perineal proctectomy. Four hundred patients underwent 518 perineal proctectomies: group A, N = 113; group B, N = 113; group C, N = 208; and group D, N = 84. The immediate and late complication rates were 5.6% and 3.5% and did not vary by age. Recurrence was 22.6% and was significantly different between groups, with the lowest recurrence in group D, 14.3% (p = 0.007). Reoperation after recurrence was less likely in group D. The main type of reoperation was perineal proctectomy (41.5%), but, for group D, recurrence was usually managed nonoperatively (58.3%). Median survival after operation was more than 4 years in the advanced age group. Retrospective data, which did not allow analysis of patients with rectal prolapse who did not undergo surgery, were used in this study. When selected appropriately, patients 90 years of age or older have outcomes similar to younger patients; therefore, age alone should not be a contraindication to surgery. In addition, elderly patients have a median survival of more than 4 years after surgery, so the operative risk can be worth the benefit accrued.

Altemeier operation for gangrenous rectal prolapse.

A stranguled rectal prolapse is a rare cause of intestinal occlusion. It requires emergency surgery. A patient who underwent emergency perineal proctectomy, the Altemeier operation, combined with diverting loop sigmoid colostomy is described. The postoperative course was uneventful, with an excellent final result after colostomy closure. The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual scenario of bowel incarceration.

Transanal endoscopic microsurgery: a new technique for completion proctectomy

Following subtotal colectomy, the retained rectal stump is a potential source of morbidity. Although restorative ileal pouch-anal anastomosis is the gold standard for ulcerative colitis, up to 14% of patients will opt for a permanent ileostomy and undergo completion proctectomy, traditionally by an abdomino-perineal approach, which itself carries significant morbidity. We describe a new technique of perineal proctectomy using transanal endoscopic microsurgery (TEMS) equipment. To our knowledge, this technique has not previously been described in the literature. Twelve patients, mean (SD) age 66 (±13) years, underwent TEMS proctectomy, performed by a single surgeon between January 2007 and October 2011. Excision began with an intersphincteric dissection following which the TEMS (WOLF) proctoscope was inserted and close rectal dissection was performed, entering the peritoneal cavity (if the top of the stump was intraperitoneal). Following perineal extraction of the specimen, the external sphincter and skin were closed with an absorbable suture. Nine patients had inflammatory bowel disease, two had neoplasia and one had intractable radiation proctitis. The mean (SD) rectal stump length was 17.8 (±6.1) cm and the peritoneal cavity was entered in nine patients, with no small-bowel injury. The median postoperative hospital stay was 5.5 days. In four patients there was delayed healing of the perineal wound. There was no perioperative mortality. TEMS perineal proctectomy is a novel, but safe, technique that may avoid the need for a traditional abdominoperineal approach in selected patients.

Persistent vaginal discharge following proctocolectomy—if there is no fistula, what is it?

Dear Editor: Distressing vaginal discharge following conventional proctocolectomy has been reported in up to 50 % of patients. The primary evaluation of such patients includes assessing for the presence of an enterovaginal fistula. We report a case of a patient who presented with distressing vaginal discharge lasting for 2 years after a conventional proctocolectomy. The discharge was found to be a result of the pelvic floor muscle shift and compression of the vagina, with a formation of a fluid reservoir in the upper third of the vagina. A 39-year-old woman with ulcerative colitis (UC) underwent an urgent total colectomy, rectal preservation, and end ileostomy for toxic colitis. The postoperative period was uneventful. Histopathological examination confirmed the diagnosis. Due to persistent rectal mucous discharge and her reluctance to have a completion proctectomy with ileal pouch and anal anastomosis, a perineal proctectomy was performed. The operation and the postoperative period were uneventful. Following the second operation, the patient complained of new onset vaginal discharge. She described recurrent episodes of sudden drainage of copious amount of fluid from the vagina, which was often brown or bloody and had an unpleasant odor. The patient underwent a gynecologic assessment which included repeated vaginal examinations and cultures, without findings. The comprehensive evaluation included transvaginal ultrasonography, computed tomography (CT), gastrografin enema, and magnetic resonance imaging (MRI) for the assessment of an enterovaginal fistula. All of the studies failed to identify a fistula, but the ultrasound, CT, and MRI demonstrated an accumulation of fluid in the upper vagina. An examination under anesthesia was performed, which also failed to diagnose a fistula. Two years after the second procedure, the patient was referred to a vulvovaginal clinic. Detailed history revealed that since analresection, the patient also had dyspareunia and a “phantom” anal pressure sensation. Upon palpation of the levator ani muscle, a ventral migration was noted. Insertion of a speculum was disrupted by a circular narrowing of the upper vagina. Passing the narrowing resulted in the drainage of large amount of fluid. The vagina appeared normal without inflammation, and microscopic evaluation of the discharge was negative. Review of the MRI films confirmed a pelvic floor muscle shift and the compression of the vagina, with the formation of a reservoir offluidintheupper third of the vagina. The patient was referred to pelvic floor physiotherapy, and following pelvic floor muscle relaxation and voluntary emptying of her vaginal contents, she became symptom free.

Rectal Prolapse in the Elderly: Trends in Surgical Management and Outcomes from the American College of Surgeons National Surgical Quality Improvement Program Database

Full thickness rectal prolapse (FTRP) is managed with an abdominal or perineal operation. Traditionally, the approach has been determined by patient age and comorbidities. Our aim was to determine operative trends and outcomes for repair of FTRP in elderly patients using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. We queried the ACS NSQIP database from 2006 to 2009 for patients with FTRP who were 70 years of age or older. Patients were grouped according to type of surgical repair: laparoscopic (LR), open (OR), or perineal (PR) technique. We reviewed demographics, operative trends of surgical technique, and short-term outcomes for each group. A total of 816 patients were analyzed; 596 (73%) PR, 130 (16%) OR, and 90 (11%) LR patients. Patients who received OR and LR had lower mean American Society of Anesthesiologists (ASA) scores than PR patients (2.6, 2.5, and 2.7, respectively, p < 0.001). The percentage of LR and OR procedures decreased as age increased by decade; the inverse was seen for PR (p < 0.001). The distribution of operative techniques has not changed from year to year. Length of stay was significantly shorter for LR (3.77 days) and PR (3.44 days) patients vs OR patients (6.23 days) (p = 0.01). Complication rates were 2.22%, 8.72%, and 12.31% for LR, PR, and OR, respectively (p = 0.021). Open surgery was the only factor associated with an increased complication rate, with an odds ratio of 6.29 (95% CI 1.38 to 28.6, p < 0.02). Despite the appeal of perineal proctectomy in the elderly and debilitated patient, the approach to FTRP is slowly evolving in the era of laparoscopic surgery. Laparoscopic repair of FTRP in the elderly is associated with improved short-term outcomes when compared with OR and PR.

Modified perineal stapled rectal resection with contour transtar for full‐thickness rectal prolapse

We report a modified technique of perineal proctectomy using a new reloadable curved cutter stapler, the Contour Transtar (Ethicon Endo-Surgery), to treat full-thickness external rectal prolapse. Between May and July 2008 three female patients were treated. All had a full-thickness external rectal prolapse up to 10 cm in length. The prolapse was initially divided by a linear cutter in anterior and posterior flaps, and resection of the prolapse was performed with a Contour Transtar stapler. There was no mortality or early or late morbidity. Follow-up was 2-4 months. All patients had a bowel movement within 3 days of the operation, oral feeding started immediately and the hospital stay was 5 days in all cases. All patients reported an improvement of constipation and continence. Our procedure may be indicated for full-thickness prolapse with a rectal protrusion up to 10 cm, as it allows a simple resection without any mobilization or dissection of the rectum. The technique is safe, easier and faster to perform than conventional perineal rectosigmoidectomy.

Evisceración vaginal. Abordaje abdominal y reparación con malla sintética

Spontaneous vaginal evisceration is a rare phenomenon in daily clinical practice. Since McGregor reported the first case at the beginning of the past century, more than 70 cases have been reported to date. Spontaneous vaginal evisceration usually occurs in patients with postmenopausal hypoestrogenism associated with previous gynecologic surgery. This entity has recently been described in non-gynecological conditions after perineal proctectomy. We present a new case of spontaneous vaginal evisceration in a postmenopausal woman with previous gynecological surgery. Surgical mesh repair was performed through conventional laparotomy.

Recurrence and Quality of Life Following Perineal Proctectomy for Rectal Prolapse

BackgroundSurgical outcome and quality of life (QOL) following perineal proctectomy for rectal prolapse remain poorly documented. MethodsFrom 1994 to 2004, patients with full-thickness rectal prolapse were treated exclusively with perineal proctectomy independent of age or comorbidities. Subjective patient assessments and recurrences were determined retrospectively from hospital and clinic records. Consenting patients completed the gastrointestinal quality of life index (GIQLI). ResultsPerineal proctectomy was performed in 103 consecutive patients with a median age of 75 years (range 30–94). Most patients underwent concurrent levatorplasty (anterior 85.8%, posterior 67.9%). Durable results were obtained in all patients; the recurrence rate was 8.5% over a mean follow-up of 36 months. Preoperatively, 75.5% of patients reported fecal incontinence, and 32.1% had obstructed defecation. Incontinence significantly improved post-proctectomy (41.5%, p < 0.001), as did constipation (10.4%, p < 0.001). GIQLI respondents reported satisfaction following proctectomy with 63% scoring within one standard deviation of healthy controls. Patients with recurrent prolapse reported a lower QOL. Risk factors for recurrence included duration of prolapse, need for posterior levatorplasty, and prior anorectal surgery. ConclusionsPerineal proctectomy provides significant relief from fecal incontinence and obstructive symptoms caused by rectal prolapse, with an acceptable recurrence rate and low morbidity.

Should we consent for bowel evisceration as a potential complication of hysterectomy?

Transvaginal evisceration of bowel has been described following vaginal, abdominal and laparoscopic hysterectomy, enterocele repair and perineal proctectomy. This complication may happen anytime af...

Preoperative Anal Manometry Predicts Continence After Perineal Proctectomy for Rectal Prolapse

This study examines whether preoperative anal manometry and pudendal nerve terminal motor latency predict functional outcome after perineal proctectomy for rectal prolapse. All adult patients treated by perineal proctectomy for rectal prolapse from 1995 to 2004 were identified (N = 106). Forty-five patients underwent anal manometry and pudendal nerve terminal motor latency testing before proctectomy and they form the basis for this study. Perineal proctectomy with levatoroplasty (anterior 88.9 percent; posterior 75.6 percent) was performed in all patients, with a mean resection length of 10.4 cm. Four patients (8.9 percent) developed recurrent prolapse during a 44-month mean follow-up. Preoperative resting and maximal squeeze pressures were 34.2 +/- 18.3 and 60.4 +/- 30.5 mmHg, respectively. Pudendal nerve terminal motor latency testing was prolonged or undetectable in 55.6 percent of patients. Grade 2 or 3 fecal incontinence was reported by 77.8 percent of patients before surgery, and one-third had obstructed defecation. The overall prevalence of incontinence (77.8 vs. 35.6 percent, P < 0.0001) and constipation (33.3 vs. 6.7 percent, P = 0.003) decreased significantly after proctectomy. Patients with preoperative squeeze pressures >60 mmHg (n = 19) had improved postoperative fecal continence relative to those with lower pressures (incontinence rate, 10 vs. 54 percent; P = 0.004), despite having similar degrees of preoperative incontinence. Abnormalities of pudendal nerve function and mean resting pressures were not predictive of postoperative incontinence. Perineal proctectomy provides relief from rectal prolapse, with good intermediate term results. Preoperative anal manometry can predict fecal continence rates after proctectomy, because patients with maximal squeeze pressures >60 mmHg have significantly improved outcomes.

Perineal dissection of synchronous abdominoperineal resection of the rectum: an anatomical description.

Abdominoperineal resection (APR) has remained the gold standard for management of distal rectal adenocarcinoma since the original description by W. Ernest Miles in 1908. 1 The classic Miles procedure involved a 1-team approach: after the initial abdominal mobilization of the rectosigmoid colon, the patient was placed in the left lateral position for the perineal proctectomy. Lloyd-Davies 2 described the currently popular synchronous, combined approach in 1939 after Devine 3 introduced adjustable stirrups to place the patient in the lithotomy position. Several modifications of the Lloyd-Davies APR procedure have been described through the years, but the basic principles espoused by Miles remain unchanged.

Surgical Therapy for Colitis Cystica Profunda and Solitary Rectal Ulcer Syndrome.

The initial treatment for patients with colitis cystica profunda is aimed at re-education of bowel habits to avoid straining. Patients are instructed to spend the minimum time on the commode. A high-fiber diet with bulk laxatives is recommended. If fiber does not work, polyethylene glycol solutions and surface-active stool softeners such as docusate sodium are tried. Conservative therapy resolves most symptoms. Biofeedback is offered to patients who fail dietary therapy. For patients with associated rectal prolapse, an operation designed to correct the intussusception is considered. For full-thickness prolapse (procidentia) a mucosal resection (Delorme) or perineal proctectomy (Altemeier) is recommended. Surgical treatment of internal (occult) prolapse is problematic. If attempted, a resection and suture rectopexy has the most support. In the absence of procidentia, transanal excision may be used in selected patients. If other measures fail, a mucosal sleeve resection with coloanal pull-through or a diverting colostomy may be considered.

The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse--a clinical and manometric study.

When treating a complete rectal prolapse, the most important objective is elimination of the prolapse. In addition, restoration of sufficient anorectal continence is extremely important for the patients. We examined the value of posterior levator repair with respect to stabilization of the pelvic floor and to improvement in anorectal incontinence. In patients with disabling anorectal incontinence, a posterior levatorplasty can be concomitantly performed during operative removal of the prolapse. To facilitate evaluation of the operative results, we implemented a scoring system to judge the patients' subjective symptoms of incontinence; in addition, we performed manometric measurements of resting and squeezing pressures of the anal sphincter to objectify the anorectal incontinence. From 1991 to 1997, 84 patients (mean age 65+/-10 years, 38-91 years; 79 women, 5 men) with complete rectal prolapse and severe incontinence were operatively treated; corresponding follow-ups were done. The following procedures were performed: Frykmann-Goldberg, 28 patients; Wells, 18 patients; Ripstein, 22 patients; and perineal proctectomy, 16 patients. Incontinence for liquid and solid stools was present in all of these patients. Posterior levatorplasty was implemented in 38 patients, and in this group we found significantly better postoperative results, both clinically and in the manometric measurements. Continence was improved by 84% in the group with levatorplasty, but improvement was only 67% in the other group (P<0.05). The incontinence score decreased significantly in the group with levatorplasty (preoperative 16.4+/-3.1, postoperative 9.3+/-4.5, P<0.05, vs the other group with preoperative 15.6+/-4.2, postoperative 11.5+/-5.1). Manometric observations in the group with levatorplasty demonstrated 55% improvement in resting pressure (preoperative 29+/-17 cm H2O, postoperative 45+/-21 cm H2O, P<0.05) and 40% improvement in squeezing pressure (preoperative 61+/-25 cm H2O, postoperative 85+/-31 cm H2O, P<0.05). In the group without levatorplasty, resting and squeezing pressure improved only by 20% (resting pressure: preoperative 32+/-16 cm H2O, postoperative 38+/-18 cm H2O; squeezing pressure: preoperative 64+/-29 cm H2O, postoperative 75+/-26 cm H2O). Posterior levatorplasty is an easy and efficient operative procedure which facilitates an improvement in anorectal continence. There are no apparent disadvantages. For this reason, levatorplasty can be part of operative procedures implemented in the treatment of a complete rectal prolapse accompanied by disabling anorectal incontinence.