Surgical correction is ineffective for improvement of dyssynergic defecation in patients with rectal prolapse

Abstract

Background/aims: The patients with rectal prolapse suffer from not only a prolapse rectum but also associated dysfunction. However, most surgical techniques are successful regarding the prolapse, but either do not solve or even worsen defecation dysfunction. The purpose of this study was to investigate the functional and physiological results after surgical correction in patients with rectal prolapse.

Methods: This study is a retrospective review of a single-institution experience. Patients with rectal prolapse who underwent anorectal manometry before and after Delorme's procedure were included. The primary outcomes measured were improvement of clinical symptoms and physiologic study.

Results: Consecutive 19 patients with rectal prolapse (17 females, mean age of 68.1 ± 10.8 years) underwent anorectal manometry before and after Delorme's procedure. The two most prevalent symptoms before operation were rectal tenesmus (15/19, 78.9%) and excessive straining (13/19, 68.4%). The two most prevalent symptoms after operation were rectal tenesmus (14/19, 73.6%) and excessive straining (13/19, 68.4%). No significant differences in resting anal pressure, squeezing anal pressure, defecation index, and rectal sense were found postoperatively. However, vector asymmetry index before surgery was higher than that after surgery (35.0 vs. 32.0, P = 0.018). Ten patients (52.5%) had type I dyssynergic defecation before surgery. No improvement of dyssynergic pattern occurred after surgery.

Conclusions: In conclusion, dyssynergic defecation was not improved after reduction of rectal prolapse in patients with rectal prolapse. Further study about combination treatment with biofeedback therapy in these subgroups may be necessary.

Keywords: Defecation; Manometry; Rectal prolapse.

Figure 1

Comparison of preoperative and postoperative symptoms using a 4-point scale. There was no significant improvement of clinical symptoms using 4-point scale between preoperative and postoperative period (Wilcoxon signed-rank test).

Figure 2

(A) Mannometric findings of a 70-year old woman show adequate propulsive force (rise in intrarectal pressure ≥ 40 mmHg) along with paradoxical increase in anal sphincter pressure; paradoxical increase. (B) Follow-up manometric features (after surgery) show still paradoxical increase in anal sphincter pressure.