Abstract
Constipation and incontinence are frequent complications of rectal prolapse. Surgery should not only aim to correct prolapse but also improve bowel and sphincter function. From 1986–1991 42 patients with procidentia were treated by rectopexy and sigmoid resection. The mean age was 61.1 years. Thirty-nine patients were available for follow-up examination. Mean follow-up was 54 months. Functional data were collected prospectively before the operation and at follow-up and included clinical parameters, a constipation score, an incontinence score, anal manometry [mean resting pressure (MRP), mean maximum pressure (MMP)], proctography [anorectal angle (ARA)] and colonic transit studies [mean transit time (MTT), rectosigmoid transit time (RSTT)]. The postoperative complication rate was 7.1% (n=3), mortality was 0%. No recurrence was seen. Constipation complaints improved from 43.6% to 25.6% (p<0.001) and incontinence from 66.6% to 23.1% (p<0.001). MRP increased from 36.5 mmHg to 46.0 mmHg and MMP from 90.5 mmHg to 103.0 mmHg (p<0.001). ARA changed from 102 to 98 degrees (p<0.001) and correlated with sphincter tone and continence. MTT decreased from 47.8 to 38.5 hours, segmental transit (RSTT) from 21.1 to 12.7 hours (p<0.001). Our results indicate that rectopexy with sigmoid resection is a safe and effective procedure for rectal prolapse and improves functional disorders of bowel and sphincter.
Résumé
Des désordres fonctionnels du sphincter anal et une irrégularité des selles sont souvent rencontrés chez les patients àyant un prolapsus du rectum. La majorité des patients se plaignent d'incontinence ou de comstipation ou des deux. Une large variété de procédés chirurgicaux ont été avancés pour traiter ce problème que ce soit par voie périnéale ou par voie abdominale. Une meilleure connaissance de l'étiologie des prolapsus et surtout les études radioscopiques démontrant l'invagination du côlon dans le rectum ont amené Frykman et Goldberg á proposer une intervention qui traite en même temps le prolapsus et l'excès de longueur du côlon sigmoïde, contribuant ainsi à prévenir la récidive du prolapsus du côlon. Puisque le côlon sigmoïde joue un rôle important dans la chronique, de tel patients relévent doublement de ce procédé.
Resumen
Alteraciones funcionales del esfinter anal y del movimentos intestinal y la defecación son hallazgos frecuentes en pacientes con prolapso rectal. La mayoría de estos pacientes sufre incontinencia y estreñimiento, o ambos. Se ha propuesto una gran variedad de procedimientos quirúrgicos para tratar este problema, tanto por abordaje perineal como por abordaje abdominal. El mayor conocimiento sobre la etiología de la procidencia (prolapso mayor) y, especialmente, los estudios floroscópìcos que demuestran la intususcepción del intestino grueso en el recto, llevó a Frykman y goldberg a proponer una operación que al tiempo que corrige el prolapso rectal reseca abundante colon sigmoide, con lo cual se evita un nuevo prolapso del intestino. Puesto que el sigmoide juega un papel de importancia en el estreñimiento crónico, tales pacientes deberiían recibir beneficio adicional con el procedimiento. El propósito de este estudio prospectivo fue evaluar si esta operación es efectiva y segura, y si podría realmente mejorar la función es del esfínter y del colon.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Broden, B., Snellman, B.: Procidentia of the rectum studied with cineradiography: a contribution to the discussion of causative mechanism. Dis. Colon Rectum 11:330, 1968
Devadhar, D.S.C.: A new concept of mechanism and treatment of rectal procidentia. Dis. Colon Rectum 8:76, 1965
Frykman, H.M., Goldberg, S.M.: The surgical treatment of procidentia. Surg. Gynecol. Obstet. 129:1225, 1969
Speakman, C.T.M., Madden, M.V., Nicholls, R.J., Kamm, M.A.: Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. Br. J. Surg. 78:1431, 1991
Chaussade, S., Roche, H., Khyari, A., Couturier, D., Guerre, J.: Mesure du temps du transit colique (TTC): description et validation d'une nouvelle technique. Gastrenterol. Clin. Biol. 10:385, 1986
Cummings, J.H., Jenkins, D.J.A., Wiggins, H.S.: Measurement of the mean transit time of dietary residue through the human gut. Gut 17:210, 1976
Metcalf, A.M., Phillips, S.F., Zinsmeister, A.R., MacCarthy, R.L., Beart, R.W., Wolff, B.G.: Simplified assessment of segmental colonic transit. Gastroenterology 92:40, 1987
Huber, F.T., Rüedi, T., Allgöwer, M.: Anal-und Rectumprolaps. In Chirurgische Gastroenterolgie (2nd ed.), J.R. Siewert, F. Harder, editors. Berlin, Springer-Verlag, 1990, pp. 1149–1162
Gordon, P.H., Hoexter, B.: Complications of the Ripstein procedure. Dis. Colon Rectum 21:277, 1978
Thompson, J.P.S., Ross, A.H.McL.: Management of infection after prosthetic abdominal rectopexy (Wells procedure). Br. J. Surg. 76:610, 1989
Parks, A.G., Swash, H., Ulrich, H.: Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18:656, 1977
Solla, J.A., Rothenberger, D.A., Goldberg, S.M.: Surgical technique in prolapse of the rectum. Langenbecks Arch. Chir. 374, 1989
Atkinson, K.G., Taylor, D.C.: Wells procedure for complete rectal prolapse: a ten-year experience. Dis. Colon Rectum 27:96, 1984
Boulos, P.B., Stryker, S.J., Nicholls, R.J.: The long term results of polyvinyl alcohol (Ivalon) sponge for rectal prolapse in young patients. Br. J. Surg. 71:213, 1984
Keighley, M.R., Fielding, J.W., Alexander-Williams, J.: Rectopexy for rectal prolapse in 100 consecutive patients. Br. J. Surg. 70:229, 1983
Morgan, C.N., Porter, N.H., Klugman, D.J.: Ivalon (polyvinyl alcohol) sponge in the repair of complete rectal prolapse. Br. J. Surg. 59:841, 1972
Penfold, J.C.B., Hawley, P.R.: Experiences of Ivalon-sponge implant for complete rectal prolapse at St. mark's Hospital, 1960–70. Br. J. Surg. 59:846, 1972
Duthie, G.S., Bartolo, D.C.C.: A comparison between Marlex and resection rectopexy. Neth. J. Surg. 41:136, 1989
Khubchandani, I.T., Bacon, H.E.: Complete prolapse of the rectum and its treatment. Arch. Surg. 90:337, 1965
Watts, J.D., Rothenberger, D.A., Buls, J.G., Goldberg, S.M., Nivatvongs, S.: The management of procidentia: 30 years experience. Dis. Colon Rectum 28:96, 1985
Mann, C.V., Hoffmann, C.: Complete rectal prolapse: the anatomical and functional results of treatment by extended abdominal rectopexy. Br. J. Surg. 75:34, 1988
Duthie, G.S., Bartolo, D.C.C.: Abdominal rectopexy for rectal prolapse: a comparison of techniques. Br. J. Surg. 79:107, 1992
Anderson, J.R., Wilson, B.G., Parks, T.G.: Complete rectal prolapse: results of Ivalon sponge rectopexy. Postgrad. Med. J. 60:411, 1984
Farouk, R., Duthie, G.S., MacGregor, A.B., Bartolo, D.C.C.: Recovery or continence following resection rectopexy for rectal prolapse: a physiologic assessment [abstract]. Am. Soc. Colon Rectum Surg. 36(4):19, 1993
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Huber, F.T., Stein, H. & Siewert, J.R. Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection. World J. Surg. 19, 138–143 (1995). https://doi.org/10.1007/BF00316999
Issue Date:
DOI: https://doi.org/10.1007/BF00316999