Results of perineal procedures for the treatment of rectal prolapse

Abstract

The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to evaluate the short-term outcome of perineal procedures in patients with rectal prolapse. Between April 1989 and April 1995, all consecutive patients at the Cleveland Clinic Florida who underwent Delorme's procedure or perineal rectosigmoidectomy with or without levatoroplasty for full-thickness rectal prolapse were evaluated. Clinical and physiological assessments were performed before and after surgery. A standard continence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence) was used to assess the results of each procedure. Additionally, morbidity and mortality, and clinical and functional outcomes were evaluated. Sixty-one patients underwent perineal procedures for rectal prolapse; 16 patients died from comorbid conditions after undergoing postoperative physiologic assessment. These 55 females and 6 males, with a mean age of 75 (range, 48-101) years were studied. Patients were followed up for 27.2 (6-72) months, and mean prolapse duration was 4.2 (0.2-30) years. Although mean preoperative incontinence score was 15.9 (8-20), it was 6.3 (range, 0-12) in postoperative course. Mean resection length of rectosigmoid was 23.3 (3-71) cm, and in these patients, two (3.3%) coloanal anastomotic leaks and four (6.5%) anastomotic strictures were observed. There was one postoperative death. There were statistically significant differences among the groups relative to short-term recurrence rates, postoperative incontinence scores, mean resection length, coloanal anastomotic stricture, and leak (P< 0.001). However, pre- and postoperative anal manometry did not reveal statistically significant changes (P > 0.05) in each group or among the groups. Perineal procedures were found to be safe and effective in eradicating rectal prolapse and improving fecal incontinence in the elderly.