ABSTRACT
Purpose:
Treatment of rectal prolapse is extremely challenging; both perineal and abdominal approaches have shown significant limitations: considerable incidence of postoperative constipation after both laparotomic or laparoscopic rectopexies; long operative time and anastomotic leakage risk after resection-rectopexy; Delorme transrectal excision requires surgical skills and is associated with high anal stenosis and recurrence rate; finally, levatorplasty is often ineffective.
Methods:
We retrospectively reviewed our experience of the period 2004-2009: 89 constipated patients with rectal prolapse were treated using transperineal procedures in 28 cases and through transabdominal approaches in 61 cases. Furthermore, a literature review was performed using the National Library of Medicine’s Pubmed Database; articles reporting on treatment of rectocele both with transperineal procedures and abdominal rectopexy were examined.
Results:
Out of 89 constipated patients, 16 underwent Delorme procedure with a mortality rate of 1.4% morbidity of 5.2% and recurrence rate at 5 years of 9.2%; 12 patients underwent Altemeier procedure with similar results but lower recurrence rate (1% at 5 years). Sixty-one patients underwent abdominal rectopexy with mesh: 25 patients were treated according to Orr Loygue technique with similar results but lower recurrence rate (2.5% at 5 years) and 36 were operated on according to Wells technique with similar mortality and recurrence rate but postoperative defecation impairment in 20% of patients.
Conclusions:
In summary, predicting which patient will benefit from surgical intervention remains a challenge. An effective method of patient selection based on an accurate morpho-functional assessment and patient performance status examination would optimize the outcome. In our experience, basically, we use transanal/perineal procedures to treat rectocele, and rectal prolapse in elderly, high risk patients and abdominal operations to treat of rectal prolapse and enterocele in young patients.
