Comparison of three perineal procedures for the treatment of rectal prolapse.
BACKGROUND
The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to compare the short-term outcome of three perineal procedures in patients with rectal prolapse.


METHODS
Between April 1989 and April 1995, all consecutive patients who had Delorme's procedure, perineal rectosigmoidectomy, or perineal rectosigmoidectomy with levatoroplasty for full-thickness rectal prolapse were clinically and physiologically assessed before and after surgery. A standard incontinence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence), was used to compare the results of each procedure. Additionally, morbidity and mortality and clinical and functional outcome were evaluated and compared.


RESULTS
The study group of 61 patients who had perineal procedures for rectal prolapse included 55 women and 6 men, with a mean age of 75 years (range, 48 years to 101 years); 16 patients died of comorbid conditions between 3 months and 42 months after surgery. 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. However, preoperative and postoperative anal manometry did not reveal statistically significant changes within or between the groups.


CONCLUSIONS
Perineal rectosigmodectomy with levatoroplasty has the best short-term outcome for the treatment of rectal prolapse.
Agachan
F
F
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309-1743, USA.
Reissman
P
P
Pfeifer
J
J
Weiss
E G
EG
Nogueras
J J
JJ
Wexner
S D
SD
D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003106:Colon / Q000601:surgery; D012809:Colon, Sigmoid / Q000601:surgery; D003108:Colonic Diseases / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D003672:Defecation / Q000502:physiology; D005069:Evaluation Studies as Topic; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D011312:Pressure; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome