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. 2022 Feb 21;10(1):goac007.
doi: 10.1093/gastro/goac007. eCollection 2022 Feb.

External rectal prolapse: abdominal or perineal repair for men? A retrospective cohort study

Bang Hu  1   2 , Qi Zou  1   2 , Zhenyu Xian  1   2 , Dan Su  1   2 , Chao Liu  3 , Li Lu  1   2 , Minyi Luo  1   2 , Zixu Chen  4 , Keyu Cai  1   2 , Han Gao  1   2 , Hui Peng  1   2 , Wuteng Cao  5 , Donglin Ren  1   2
Affiliations

External rectal prolapse: abdominal or perineal repair for men? A retrospective cohort study

Bang Hu et al. Gastroenterol Rep (Oxf). .

Abstract

Background: External rectal prolapse is a relatively rare disease, in which male patients account for a minority. The selection of abdominal repair or perineal repair for male patients has rarely been investigated.

Methods: Fifty-one male patients receiving abdominal repair (laparoscopic ventral rectopexy) or perineal repair (Delorme or Altemeier procedures) at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between March 2013 and September 2019 were retrospectively analysed. We compared the recurrence, complication rate, post-operative defecation disorder, length of stay, and quality of life between the abdominal and perineal groups.

Results: Of the 51 patients, 45 had a complete follow-up, with a median of 48.5 months (range, 22.8-101.8 months). A total of 35 patients were under age 40 years. The complication rate associated with abdominal repair was less than that associated with perineal repair (0% vs 20.7%, P = 0.031) and the recurrence rate was also lower (9.5% vs 41.7%, P = 0.018). Multivariate analysis showed that perineal repair (odds ratio, 9.827; 95% confidence interval, 1.296-74.50; P = 0.027) might be a risk factor for recurrence. Moreover, only perineal repair significantly improved post-operative constipation status (preoperative vs post-operative, 72.4% vs 25.0%, P = 0.001). There was no reported mortality in either of the groups. No patient's sexual function was affected by the surgery.

Conclusions: Both surgical approaches were safe in men. Compared with perineal repair, the complication rate and recurrence rate for abdominal repair were lower. However, perineal repair was better able to correct constipation.

Keywords: Altemeier; Delorme; external rectal prolapse; laparoscopic ventral rectopexy; male.

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Figures

Figure 1.
Figure 1.
Measurement of external rectal prolapse (ERP) length on magnetic resonance imaging. ERP length was defined as the distance from the distal rectum margin to the anal margin when straining during defecation.
Figure 2.
Figure 2.
Age distribution of all patients with external rectal prolapse included in this study.
Figure 3.
Figure 3.
Alterations in preoperative and post-operative Wexner fecal incontinence scores and CCCS of patients with ERP who underwent abdominal or perineal repair. *P < 0.01; CCCS, Cleveland Clinic Constipation scores; ERP, external rectal prolapse.
Figure 4.
Figure 4.
Alterations in preoperative and post-operative EQ-5D-5 L scores of patients with ERP who underwent abdominal or perineal repair. ***P < 0.001; ERP, external rectal prolapse; EQ-5D-5 L, EuroQol 5-Dimension 5-Levels.
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