Our Clinical Experience with Surgical Management of Rectal Prolapse: A Retrospective Analysis of Cases Treated with Abdominal and Perineal Approaches
DOI:
https://doi.org/10.58600/eurjther2803Keywords:
altemeier, notaras, rectal prolapseAbstract
Objective: Rectal prolapse is the condition where the rectum, the final part of the large intestine, descends and protrudes through the anus, involving all its layers. It is known to be more common in women. Rectal prolapse can occur due to increased intra-abdominal pressure caused by obesity, pregnancy, chronic constipation, or perineal injury. It can also be observed in children with congenital defects in the pelvic connective tissues or perianal sphincter muscles.
Methods: The data of a total of 35 patients, both male and female, who underwent surgery for rectal prolapse between 2013 and 2021 at the General Surgery Clinic of Gaziantep University Medical Faculty, were retrospectively analyzed. These patients were classified as Stage 3 (true rectal prolapse) according to the grading system for rectal prolapse by Altemeier et al.
Results: A total of 35 patients underwent surgery. The mean age of the patients was 51.37 ± 12.86 years. Of the operated patients, 19 (54%) were female and 16 (46%) were male. The mean body mass index of our patients was 26.1 kg/m². The incontinence complaints of the patients at the time of admission were evaluated according to the Boutsis-Ellis criteria. Considering these criteria, postoperatively, Stage 1 incontinence persisted in 5 patients (15%), and Stage 2 incontinence persisted in one patient. Recurrent rectal prolapse was observed in one patient (2.8%) three years after undergoing the Altemeier procedure. The average hospital stay for the patients was 3.8 days. No mortality or morbidity related to these surgeries was observed in any of our patients. None of the 16 male patients who underwent surgery developed complications such as impotence in the short or long term.
Conclusion: In patients planned for surgical treatment due to rectal prolapse, the choice of surgical method should be made considering the surgeon’s experience as well as the patient’s overall condition. Perineal approaches may be attempted in frail elderly patients and young male patients. More extensive, multicenter studies are needed to evaluate the long-term outcomes of these methods.
References
Rectal Prolaps. Current problems in surgery. Vol XXIII number 6, 1986, year book of medical publishers Inc.
Boccasanta P, Venturi M, Barbieri S, Roviaro G. (2006) Impact of new technologies on the clinical and functional outcome of Altemeier’s Procedure: A randomized, controlled trial. Dis Colon Rectum. 49(5):652-660. https://doi.org/10.1007/s10350-006-0505-6
Goldstein SD, Maxwell PJ. (2011) Rectal prolapse. Clin Colon Rectal Surg. 24(1)39-45. https://doi.org/10.1055/s-0031-1272822
Yuzbasioglu MF, Bulbuloglu E, Ozkaya M, Oksuz H. (2008) A different approach to incarcerated and complicated rectal prolapse. Med Sci Monit. 14:60-63.
Akcan A, Sözüer E, Akyıldız H, et al. (2007) Comparison of surgical outcome of rectopexy with and without sigmoid resection for fullthickness rectal prolapse. Ulusal Cerrahi Dergisi. 23(2):54-57.
Michalopoulos A, Papadopoulos VN, Panidis S, et al. (2011) Surgical management of rectal prolapse. Tech Coloproctol. 15(1): 25–28. https://doi.org/10.1007/s10151-011-0747-8
Duthie GS, Bartolo DC. (1992) Abdominal rectopexy for rectal prolaps, A comparision of techniques. Br J Surg 79:107-113. https://doi.org/10.1002/bjs.1800790205
Riansuwan W, Hull TL, Bast J, Hammel JP, Church JM. (2010) Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. World J Surg. 34(5):1116–1122. https://doi.org/10.1007/s00268-010-0429-0
Altemeier WA, Culbertson WR, Schowegerdt C, Hunt S. (1971) Nineteen years experience with the one stage perineal repair of rectal prolapse. Ann Surg. 173(6):993-1006.
Boutsis C, Ellis H. (1974) The Ivalon sponge wrap operation for rectal prolapse. Dis Colon Rectum. 17(1):21-37. https://doi.org/10.1007/BF02587532
Kairaluoma MV, Kellokumpu IH. (2005) Epidemiologic aspects of complete rectal prolapse. Scand J Surg. 94:207-210. https://doi.org/10.1177/145749690509400306
Madiba TE, Baig MK, Wexner SD. (2005) Surgical Management of Rectal Prolapse. Arch Surg. 140(1): 63-73. https://doi.org/10.1001/archsurg.140.1.63
Mellegren A, Doll A, Johanscon C. (1994) Enterocele is correctable using the Ripstein rectopexy. Dis Colon Rectum. 34:800-804. https://doi.org/10.1007/BF02050145
Lisa KJ, Lin YJ, Orkun BA. (1997) The best operation for rectal prolaps. Surg Clin N Am. 77:49-70. https://doi.org/10.1016/S0039-6109(05)70532-6
Karahasanoğlu T, Hamzaoğlu İ, Baca B, et al. (2007) Laparoscopic Surgery in the Treatment of Rectal Prolapse. Kolon rektum hastalıkları dergisi. 17:186-190.
Çalıskan C, Korkut AM, Fırat Ö, Akgün E, Osmanoğlu H. (2008) Rectal prolapse experience: 68 cases in 27 years. Ege Journal of Medicine. 47(1): 29-34.
Mckee RF, Lauder JC, Poon FW, Aitchison MA, Finlay IG. (1992) A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obst. 174: 145-148.
Conze J, Junge K, Klinge U, Weiss C, Polivoda M, et al. (2005) Intraabdominal adhesion formation of polypropylene mesh Influence of coverage of omentum and polyglactin. Surg Endosc. 19(6):798-803. https://doi.org/10.1007/s00464-004-2192-5
Kayaoglu HA, Ozkan N, Hazinedaroglu SM, Ersoy OF, Erkek AB, Koseoglu RD. (2005) Comparison of adhesive properties of five different prosthetic materials used in hernioplasty. J Invest Surg. 18(2):89-95. https://doi.org/10.1080/08941930590926357
Hawley P. (1975) Procidentia of the rectum . Ivalon sponge repair. Dis col rect. 18:461-463. https://doi.org/10.1007/BF02587210
Akgün YA, Demirel AH, Kapan M, Öktem Ö, Öngören AU, Tezel S. (2004) Rektal prolapsusun tedavisinde rektopeksinin yeri. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 37(1): 37-41.
Steele SR, Goetz LH, Minami S, Madoff RD, Mellgren AF, Parker SC. (2006) Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum. 49(4):440–445. https://doi.org/10.1007/s10350-005-0315-2
Yakut M, Kaymakcioglu N, Simsek A, Tan A, Sen D. (1998) Surgical treatment of rectal prolapse. A retrospective analysis of 94 cases. Int Surg. 83(1):53-55.
Gordon PH. In: Gordon PH, Nivatvongs S, eds. Principles and Practice of Surgery for the Colon, Rectum, and Anus, 2nd ed. St. Louis, MO: Quality Medical Publishing Inc, 1999:575– 717.
Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD. (1999) Complete rectal prolapse: evolution of management and results. Dis Colon Rectum. 42(4): 460-469. https://doi.org/10.1007/BF02234167
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