Treatment Of Complete Rectal Prolapse Research Articles

Outcomes of Laparoscopic Suture vs Mesh Rectopexy for Complete Rectal Prolapse.

Objective To compare outcomes of laparoscopic suture and laparoscopic mesh rectopexy for the treatment of complete rectal prolapse in adults. Materials and methods This study was conducted between December 2020 to December 2022, involving 75 patients (Group A: 34; Group B: 41). Inclusion criteria encompassed confirmed complete rectal prolapse. Preoperative measures included comprehensive assessments, mechanical bowel cleansing, prophylactic antibiotics, and rectal irrigation. Surgical techniques involved laparoscopic suture rectopexy for Group A and laparoscopic mesh rectopexy for Group B. Postoperative care and follow-up evaluations were conducted. Results Group A demonstrated advantages in terms of shorter operative times, quicker bowel activity resumption, and reduced hospital stays. Intraoperative bleeding was absent in Group A, while wound-related complications were higher in Group B. Recurrence rates were lower in Group A (2.9%) compared to Group B (9.8%). Both groups exhibited improvements in incontinence grades postoperatively. Constipation increased in both groups. Conclusion Both techniques are effective in treating complete rectal prolapse, each with its advantages and considerations. Group A showed potential benefits in terms of operative efficiency and fewer complications, albeit with a potential for increased recurrence. The study emphasizes the need for individualized patient care, considering factors such as operative characteristics, postoperative outcomes, and patient preferences.

A network meta-analysis of surgical treatments of complete rectal prolapse.

Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI). A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI. Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant. Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.

A comparative study between transanal and transabdominal approaches in treatment of complete rectal prolapse

There is a wide variety of surgical methods to treat rectal prolapse; however, to date, no clear agreement exists regarding the most effective surgical method. This study was designed to compare the results according to the surgical approach for complete rectal prolapse in women. This study was conducted from March 2016 to February 2021 on female patients with rectal prolapse who underwent surgery. First, all patients were classified into mucosal and complete layer groups to confirm the difference in results between the two groups, and only complete layer prolapse patients were divided into transanal and abdominal approaches to compare parameters and functional outcomes in each group. A total of 180 patients were included, with an average age of 71.7 years and 102 complete prolapses. The complete layer group was found to have more abdominal access, longer operating time, and higher recurrence rates compared to the mucosal layer group. (p<0.001) When targeting only the complete layer patients, there were 65 patients with the transanal and 37 with the abdominal (laparoscopic) approaches. The abdominal approach group had a longer operating time and hospital stay (p<0.001, respectively) and lower recurrence rate than the transanal group (transanal vs. abdominal, 38% vs. 10.8%, p=0.003), while the Wexner constipation and incontinence scores showed improved results in both groups. Although operating time and hospitalization period were shorter in the transanal group, laparoscopic abdominal surgery is a procedure that can reduce the recurrent rate for complete rectal prolapse.

A Network Meta-Analysis of Surgical Treatment of Complete Rectal Prolapse

A Network Meta-Analysis of Surgical Treatment of Complete Rectal Prolapse

Outcome of Open Abdominal Rectopexy for the Treatment of Complete Rectal Prolapse –Our Experience in 20 Cases

Introduction: Complete rectal prolapse (procidentia) is a very troublesome condition. In adults, the only curative treatment for complete rectal prolapse is surgery either bytrans abdominal or perineal approaches. Among the all surgical procedure, the option of abdominal rectopexy , which can be done either by open procedure or laparoscopically, has become the treatment of choice for complete rectal prolapse. Objective: The purpose of this study is to see the outcome of open abdominal rectopexy for the treatment of complete rectal prolapse by subjective assessment. Methodology: The study was conducted in the Department of Surgery, Women’s Medical College Hospital and different private hospital in Sylhet District, from July 2013 to May 2021.A total of 20 Patients who presented with complete rectal prolapsed fulfilling the inclusion criteria were selected as study population. Laparotomy was done by lower midline incision and spinal anaesthesia was chosen for all the cases. Assessment of operative time, postoperative pain, mean days of hospital stay, constipation score, in continence score and recurrence rate within six months of follow-up were observed and recorded. Result: A total of 20 patients were included in this study of which 65% were female and 35% were male. The mean age was 48.80 (SD 11.50) years, the mean BMI was 24.1 (SD 2.35) and the mean time of operation was 80(SD 10.75) minutes. The mean VAS was 5.0(SD 1.25) on the day of first postoperative and 3.8(SD 1.15) on the second postoperative day. The mean days to resume bowel activity was 3.12 (SD 1.0) days. Postoperative hospital stay mean was 5.2 (SD 1.14) days. The constipation scores during preoperative and postoperative period were 3.8(SD 2.12) and 2.6 (SD 1.75) respectively. The mean in continence score during preoperative and postoperative period were 7.1 (SD 3.25) and 2.0 (SD 2.25) respectively. No recurrence case was found within six months of follow up period in this study. Conclusion: Open abdominal rectopexy is a safe, simple and effective procedure for the treatment of complete rectal prolapse.

Evaluation of Delorme’s Procedure in the Treatment of Complete Rectal Prolapse- A Comparison with Abdominal Rectopexy (Well’s procedure)

Background: There are versatile operative techniques for treating complete rectal prolapse. Every procedure has some advantages and disadvantages. Delorme’s procedure and abdominal rectopexy (Well’s procedure) have gained more popularity. But to determine which approach is better, it is needed to evaluate the functional outcome of both procedures.&#x0D; Objective: To compare the outcome of Delorme’s procedure and abdominal rectopexy to treat complete rectal prolapse.&#x0D; Methodology: A randomized control trial was conducted in 25 patients with complete rectal prolapse in the department of Surgery, RMCH. They were divided into two groups by randomization. Fifteen patients included in Group-I underwent Delorme’s procedure, and ten patients included in group-II underwent abdominal rectopexy (Well’s procedure). The outcome of both procedures was compared postoperatively. Results: In group-1, we have found uneventful outcomes of 10 (66.66%) patients, and hemorrhage, minor incontinence, and retention of urine were found in 2(13.3%), 1(6.66), and 4(26.66%) patients, respectively. In group-2 patients, 5(50%) patients recovered uneventfully, whereas hemorrhage, surgical site infection, retention of urine, bladder dysfunction, and constipation were found in 2(20%), 1(10%), 1(10%), 1(10%) and 2(20%) patients respectively. The mean operation time in group-I was 92.86 min and in Group 2 was 124.00 min with a p-value of 0.001. The average post-operative hospital stay after Delorme’s procedure was &lt;4 days in 4 patients and 4-6 days in the rest 11 patients. But the hospital stay is a little lengthier in the case of abdominal rectopexy (Well’s procedure), where seven patients were discharged within 4-6 days, and three patients were discharged after the 5th day of operation. In group I, expenditure was &lt;7000 taka in 10 (66.66%) patients, whereas in group-2 , the cost was 10000-15000 in 7(70%) patients with a p-value of 0.001.&#x0D; Conclusion: We can conclude that Delorme’s procedure is comparatively safer and cost-effective than Well’s procedure, considering different vital parameters.&#x0D; TAJ 2021; 34: No-1: 40-46

Is it possible to reduce recurrences after Altemeier's procedure for complete rectal prolapse? Twenty-year experience in 130 consecutive patients.

In the attempt to understand the reasons for and to find a solution to the high recurrence rate after perineal surgery for complete rectal prolapse, we retrospectively analysed the long-term results of Altemeier's procedure alone, or associated with Trans-Obturator Colonic Suspension (TOCS) in a large series of patients with a median interval of 84 months (range 6-258). Medical records of 110 patients undergoing Altemeier with levatorplasty (group 1) and 20 patients submitted to the same procedure associated with TOCS (group 2) for newly diagnosed complete rectal prolapse were reviewed. All patients had been recruited after preoperative clinical examination, SF-36 quality of life, continence score and colonoscopy. Mortality was nil. The overall complication and the recurrence rates were 12.3%, and 15.0% (P= 0.769) and 24.6% and 5.0% (P=0.067) in group 1 and 2, respectively. Twelve patients of group 1 with a recurrence were submitted to a redo-Altemeier, 8 to a redo-Altemeier associated with TOCS, and 6 associated with an anterior coloplasty with a mesh. The only patient of group 2 with a recurrence was submitted to a Hartmann's operation. Preoperative vs postoperative mean (SD) continence score was 15.8 (3.1) and 15.6 (3.3) versus 4.1 (1.8) and 3.9 (1.9) in group 1 and 2, respectively (P < 0.001). All parameters of SF-36 improved after surgery (P<0.01) and no differences between the 2 groups were found CONCLUSIONS: Long-term results confirmed the safety and effectiveness of Altemeier's procedure for the treatment of complete rectal prolapse, with the limit of a non-negligible incidence of anastomotic complications and recurrences. The combination of Altemeier with TOCS showed a positive trend to a reduction of the recurrence rate, not worsening morbidity and outcomes.

Assessment of outcomes of combined minimally invasive perineal procedures for treatment of complete rectal prolapse in children: an approach to reduce recurrence rate

Background Rectal prolapse in children is common in developing countries with low health resources. Open and laparoscopic abdominal approaches are ideal for the treatment of rectal prolapse but they are not suitable for frail children and countries with poor medical resources. Perineal procedures are usually well tolerated and simple but have high recurrence rates. Objective Our objective is to assess the short-term outcomes of combined minimally invasive perineal procedures, including anal encirclement, submucosal alcohol injection, and Gant–Miwa procedure, in the management of full-thickness rectal prolapse in children. Through this combination, we looked forward toward magnifying the advantages of perineal procedures and allaying their complications, particularly recurrence rates. Patients and methods A total of 31 children with complete rectal prolapse were recruited during the period from May 2017 to June 2019. All the patients underwent three combined perineal procedures: mucosal plication (Gant’s technique), anal encirclement, and submucosal injection sclerotherapy. Results The study group included children with a median age of 6.55±2.14 years (range, 3.0–10.0 years). Mean operative time was 37.58±5.61 min (range, 30.0–45.0 min). The end results of our study were renovating anorectal physiology by correcting the rectal prolapse and improving continence (93.5%) and constipation (93.5%), with no mortality (0%) and low recurrence rates (3.2%). Conclusion Our approach (combined minimally invasive perineal procedures) is simple, effective, and less invasive, with minimal morbidity and a negligible recurrence rate, particularly for children with complete rectal prolapse.

Laparoscopic Suture versus Mesh Rectopexy for the Treatment of Persistent Complete Rectal Prolapse in Children: A Comparative Randomized Study.

Purpose To compare laparoscopic mesh rectopexy with laparoscopic suture rectopexy. Patients and Methods. The prospective study was conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between Feb 2010 and Jan 2015. Seventy-eight children with persistent complete rectal prolapse were subjected to laparoscopic rectopexy. Fourteen parents refused to participate. All patients received initial conservative treatment for more than one year. The remaining 64 patients were randomized divided into two equal groups. Group A; 32 patients underwent laparoscopic mesh rectopexy and group B, 32 underwent laparoscopic suture rectopexy. The operative time, recurrence rate, post-operative constipation, and effect on fecal incontinence, were reported and evaluated for each group. Results Sixty-four cases presented with persistent complete rectal prolapse were the material of this study. They were 40 males and 24 females. Mean age at operation was 8 (5–12) years. All cases were completed laparoscopically. Mean operative time in laparoscopic suture rectopexy was shorter than laparoscopic mesh rectopexy group. No early post-operative complications were encountered. No cases of recurrence with mesh rectopexy group while in suture rectopexy group it was 4 cases (14.2%). Post-operative constipation occurred in one case (3.57%) in suture rectopexy group and occurred in one case (3.3%) in mesh rectopexy group. Fecal incontinence improved in 26/28 cases (92.8%) in suture rectopexy while in mesh rectopexy it was improved in 30/30 cases (100%) of cases. Conclusion Both laparoscopic mesh and suture rectopexy are feasible and reliable methods for the treatment of complete rectal prolapse in children. However, no recurrence, low incidence of constipation and high improvement of incontinence at follow up more than 36 months with mesh rectopexy accordingly, we considered mesh rectopexy to be the procedure of choice in treatment of complete rectal prolapse.

Usefulness of laparoscopic posterior rectopexy for complete rectal prolapse: A cohort study.

Transabdominal rectopexy for complete rectal prolapse reportedly yields more definitive results than transperineal surgery. Recently, minimally invasive laparoscopic rectopexy has become a popular treatment option for patients with rectal prolapse. Herein, we describe our surgical procedure for correction of rectal prolapse. We further aimed to perform a comparative assessment between perioperative outcomes achieved with open and laparoscopic applications of this technique. In this cohort study, 65 patients underwent posterior rectopexy (laparoscopic, 50; open, 15) between April 2008 and December 2015. The basic procedure consisted of posterior rectopexy using mesh fixation (modified Wells' method). We assessed and compared perioperative outcomes (duration of surgery and hospitalization, complication rates, blood-loss, degree of fecal incontinence) of laparoscopic and open rectopexy. Furthermore, pre- and post-operative urinary incontinence was measured (using pad test, questionnaire) and compared to determine the effects of the procedure on pelvic organ function. A p-value <0.05 indicated statistical significance. The mean operative time of the laparoscopic and open procedures was 127 and 83.6 min, respectively. The amount of blood-loss was negligible and 77 (range, 18-200) g with the laparoscopic and open approaches, respectively. The mean duration of hospitalization was 4.2 and 7.2 days for the former and latter procedures, respectively (p < 0.05). Rectal prolapse and fecal incontinence (evaluated using Wexner's score) diminished in all patients. Urinary incontinence also decreased postoperatively. There were no recurrences of rectal prolapse. Laparoscopic rectopexy can be safely performed in older patients to achieve early postoperative ambulation and significantly shorten the hospital-stay. It may therefore be considered an effective treatment for complete rectal prolapse and urinary dysfunction.

Outcome of Laparoscopic Versus Open Abdominal Rectopexy for the Treatment of Complete Rectal Prolapse-Our experience in Bangabandhu Sheikh Mujib Medical University

Background: Complete rectal prolapse is a very distressing condition. In adults, the only potentially curative treatment for complete rectal prolapse is surgery either by transabdominal or perinea! approaches. Till date abdominal rectopexy is considered as the standard surgical treatment for complete rectal prolapse, which can be done laparoscopically or by open procedure.&#x0D; Objective: The purpose of the study was to observe the outcome of Laparoscopic rectopexy in the treatment of complete rectal prolapse by subjective assessment and to compare the result with that of conventional open abdominal rectopexy.&#x0D; Methodology: This randomized clinical trial was carried out in the Department of Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2012 to June 2014 for a period of twenty four (24) months. Patients who presented with complete rectal prolapse with age ranging from 25 to 70 years irrespective of gender were selected as study population. Patients were randomized by lottery method into two groups as group I who underwent laparoscopic rectopexy (LR) and group II who underwent open rectopexy (OR).&#x0D; Result: A total number of 50 patients were recruited in this study of which 25 patients were. in group I and 25 patients were in group II. The mean (s.d.) age was 49.40 (13.22) years and 46.48(13.27) years in group I and group II respectively (p&gt;0.05). The mean (s.d.) operative time was 115(19) minutes in group I and 75(12) minutes in group II (p&lt;0.05). In this study 1(4.0%) patient and 6 (24.0%) patients had abdominal wound infection in group I and in group II respectively (p&gt;0.05). Mean (s.d.) ambulation time was 1.96 (0.67) days in group I and 3.92(1.15) days in groups II (p&lt;0.05). Postoperative hospital stay mean (s.d.) was 3.08(1.18) days in group I and 8.16(3.57) days in group II (p&lt;0.05). Overall patients satisfaction were 92% and 76% in group I and group II respectively (p&gt;0.05).&#x0D; Conclusion: Laparoscopic rectopexy is a better option than conventional open abdominal rectopexy for the treatment of complete rectal prolapse.&#x0D; Journal of Surgical Sciences (2015) Vol. 19 (1) : 3-7

Delorme's Procedure for Full-Thickness Rectal Prolapse - Our experience in Bangabandhu Sheikh Mujib Medical University

Background: The study was undertaken to validate the efficacy of Delorme's procedure as the treatment modality of choice for full-thickness rectal prolapse.&#x0D; Materials and Methods: In this study, results of Delorme's procedure for full-thickness rectal prolapse were assessed retrospectively. 14 patients with full-thickness rectal prolapse who were operated on with Delorme's procedure between January 2010 and October 2013 in the department of Colorectal surgery, Bangabandhu Sheikh Mujib Medical University were included in the study.&#x0D; Results: There were 8 males with mean age of 32.62 years (range 15-70) and 6 females with mean age of 26 years (range 12-70 ).The mean operative time was 65±4.5 minutes (range 60-90); there was no mortality and blood loss was minimal. Mean hospital stay was 3.5 days (2-6 days). Outcomes of the procedure were satisfactory and no patient reported recurrence of the disease in the follow up period.Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases Delorme's procedure, especially in younger patients, is a relatively safe and effective treatment and should not be restricted to older frail patients. This procedure may not be suitable for recurrent cases.&#x0D; Conclusion: Delorme's operation is a safe and effective treatment for complete rectal prolapse in patients of all age groups.&#x0D; Journal of Surgical Sciences (2015) Vol. 19 (1) : 21-24

IPEG 2019 The 28th Annual Congress for Endosurgery in Children March 20-22, 2019, Santiago, Chile.

IPEG 2019 The 28th Annual Congress for Endosurgery in Children March 20-22, 2019, Santiago, Chile.

Evaluation of laparoscopic rectosigmoidopexy for the treatment of complete rectal prolapse in children

Aim: Rectal prolapse in children is a common condition in infancy and early childhood that usually responds to conservative measures. Surgery is reserved only for resistant cases that fail to respond to conservative measures. This study was designed to evaluate the efficacy of 3-point fixation concept (retrorectal dissection, rectopexy to presacral fascia of the sacral promontory and sigmoidopexy onto the anterior abdominal wall) in treatment of complete rectal prolapse in children using laparoscopy.

Outcome of Delorme's Procedure for Full-Thickness Rectal Prolapse: Our experience in Bangabandhu Sheikh Mujib Medical University, Dhaka

The study was undertaken to determine the efficacy and safety profile of Delorme's procedure as the treatment for full-thickness rectal prolapse. In this study, outcome of Delorme's procedure for full-thickness rectal prolapse were assessed retrospectively. All the patients who underwent this surgery (22 patients) from July, 2013 to June, 2015 were included in the study. There were 18 males and 4 females with mean age of 37.4 years (range 12-70). The mean operative time was 92.6 minutes (Range 60-180 minutes). There was no mortality and blood loss was minimal. Mean hospital stay was 3.5 days (2-6 days). Outcomes of the procedure were satisfactory and no patient reported recurrence of the disease within the follow up period. Delorme's operation is safe and effective treatment for complete rectal prolapse in patients of all age and sex.Faridpur Med. Coll. J. Jul 2015;10(2): 55-58

Mesh erosion after laparoscopic posterior rectopexy: A rare complication

Laparoscopic posterior mesh rectopexy (LPMR) is now an accepted surgical treatment for complete rectal prolapse. It is associated with complications such as partial mucosal prolapse, fecal impaction, constipation, and rarely recurrence. Erosion of the mesh into the rectum after LPMR is very rare. We report herein the case of 40-year-old man who presented with mesh erosion into the rectum and managed successfully by the laparoscopic excision of mesh. This is probably the first such case managed by the laparoscopic approach.

Comparative study between Delorme operation with or without postanal repair and levateroplasty in treatment of complete rectal prolapse

BackgroundRectal prolapse is a distressing and socially disabling condition. controversy exists regarding the preferred surgical technique for the treatment of complete rectal prolapse. ObjectiveWe compared Delorme operation alone or with postanal repair and levatroplasty in treating complete rectal prolapse. MethodsConsecutive patients treated for rectal prolapse at our colorectal unit were evaluated for inclusion. Participants were randomly allocated to receive Delorme operation only (GI), or Delorme operation with postanal repair and levatorplasty (GII). Main outcome measuresThe primary outcome measure was recurrence rate; secondary outcomes included improvement of constipation, incontinence, operative time, anal manometery and postoperative complications. ResultsEighty-two consecutive patients with rectal prolapse were randomized. There was a significant difference between the two groups with longer operative time in group II. Recurrence rate after one year was (14.28% in GI, and 2.43% in GII, respectively (P = 0.043). Constipation improved in group I & II but there was a significant difference in constipation scores postoperatively between the two groups. There was improvement in continence mechanism in both groups postoperatively but being higher in group II and this produce a significant statistical difference (0.004). Mean satisfaction score was significantly higher in group II than group I. Both groups succeed to produce a significant change in resting and squeeze pressure before & after the operation. ConclusionsDelorme operation seems to be an effective procedure for treating complete rectal prolapse especially if combined with postanal repair and levatorplasty. Clinical trial registrationNCT01656369.

Mesh-free Ventral Rectopexy for Women with Complete Rectal and Uterovaginal Prolapse

Background:Mesh rectopexy may be associated with infective complications, erosion into the vagina or rectum, and disintegration or dislodgement. A mesh-free rectopexy will avoid these complications. Objective of the study was to perform mesh-free ventral rectopexy and assess its safety and effectiveness.Materials and Methods:Nine women with complete rectal and uterovaginal prolapse were treated with total abdominal hysterectomy, closure of the vaginal vault, extirpation of the pouch of Douglas and suture of anterior rectal wall to the posterior vaginal wall (ventral suture rectopexy). The ventral suture rectopexy was achieved by three pairs of interrupted silk sutures, 2.5 cm above each other, and the first pair very close to the pelvic floor. This composite structure (anterior rectal wall and posterior vaginal wall), sits astride the perineal body. Intussusception and subsequent prolapse of the sutured rectum and vaginal wall is prevented. Vaginal vault prolapse was prevented by the suture of each round ligament of the uterus to the corresponding lateral vaginal fornix. No mesh was used.Results:Nine multiparous women aged between 52 and 70 years had the procedure. The mean operative time was 135 minutes (range 110-220). The follow-up period was between 29 months and 7 years. Full continence was restored in all patients within eight weeks of the operation. Bowel habit returned to once daily in four patients and once every other day in the remaining five patients, within thirteen weeks of surgery. One patient had intermittent mucus discharge per rectum for six months. This stopped without a specific treatment. There has been no known recurrence in these nine patients. One patient developed wound infection as a complication. There was no mortality. All the patients are now asymptomatic.Conclusion:Ventral suture rectopexy is a safe and effective treatment for complete rectal prolapse in a selected group of patients.

Rectal Prolapse: Review According to the Personal Experience

The aim of treatment of rectal prolapse is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. Faced with a multitude of options, the choice of an optimal treatment is difficult. It is best tailored to patient and surgeon. Numerous procedures have been described and are generally categorized into perineal or abdominal approaches. In general, an abdominal procedure has associated with lower recurrence and better functional outcome than perineal procedures. The widespread success of laparoscopic surgery has led to the development of laparoscopic procedures in the treatment of complete rectal prolapse. In Korea, there has been a trend toward offering perineal procedures because of the high incidence of rectal prolapse in young males and its being a lesser procedure. Delorme-Thiersch procedure has appeal as a lesser procedure for patients of any age or risk category, especially for elderly low-risk patients, patients with constipation or evacuation difficulties, young males, and patients with symptomatic hemorrhoids or mucosal prolapse. Laparoscopic suture rectopexy is recommended for either low-risk female patients or patients who are concerned with postoperative aggravation of their incontinence.

Complete Rectal Prolapse in Adults: Clinical and Functional Results of Delorme Procedure Combined with Postanal Repair

This study has been performed at the Department of General Surgery, Zagazig University Hospital and King Saud Hospital, Oniza, KSAduring the period from November 1998 to September 2008.Twentyadult patients (6 males and 14 females with a mean age of 55years) with complete rectal prolapse were eligible for the study, Where Delorme's procedure and postanal repairwere combined. All patients presented with complete rectal prolapse at least 5cm in length. The associated disorders included constipation (4 patients, 20%), variable degrees of incontinence (15 patients, 75%). Only one patient had no associated functional problems. The median follow up period was 65months. There was no mortality and immediate postoperative complications developed in 4 patients (20%). Recurrence of the prolapse occurred in two patient. Eleven patients (73.3%) (11/17) with faecal incontinence showed postoperative improvement and 4 patients failed to improve. The 4 patients presented with constipation were all improved postoperatively. We conclude that the combination of Delorme's procedure and postanal repair in the treatment of complete rectal prolapse in adults is a safe procedure that corrects the anatomical defects and improves the functional outcome. We recommend use of this method in the treatment of complete rectal prolapse especially in the elderly who are complaining of faecal incontinence.