Management of rectal prolapse in octogenarians: lesson learned in 13 years' experience from a high-volume center

Abstract

When treating rectal prolapse, traditionally perineal procedures are recommended for elderly patients, while abdominal approaches are usually preferred in healthier and younger ones. We hypothesize that octogenarian patients can be safely treated with abdominal approaches. Our study aimed to evaluate the safety of abdominal procedures in the treatment of rectal prolapsed and to evaluate the recurrence rate. We conducted a retrospective IRB approved review of all patients ≥ 80 years old who underwent rectal prolapse surgery from 2010 to 2023 in our tertiary referral center. Patients were grouped according to the approach used to treat the prolapse (perineal or abdominal). Of the 164 patients included, abdominal approaches were performed in 58 (35.4%) and perineal in 106 (64.6%). Comparing the two approaches, no differences were observed in the female sex (96.6% vs 93.4%. p = 0.5), mean BMI (22.7 vs 23.8 kg/m², p = 0.14), mean ASA class (2.9 vs 2.72, p = 0.4), comorbidities and history of prior rectal prolapse surgery. No differences were found in the use of general anesthesia (100% vs 93.4% p = 0.052) hospitalization course, 30-day morbidity, and mortality rates. Rectal prolapse recurrence was significantly more common following perineal procedures (8.6% vs 18.9%, p = 0.001), with a mean follow-up period of 6.8 months. When treating rectal prolapse in octogenarians, abdominal approaches are safe and have a lower recurrence rate. We recommend for abdominal approaches whenever possible and limiting perineal approaches exclusively to patients with non-permissible risk for general anesthesia or abdominal surgery.

Keywords: Altemeier; Octogenarians; Rectal prolapse; Recurrent rectal prolapse; Ventral mesh rectopexy.