Long-term clinical outcome of surgery for solitary rectal ulcer syndrome.
BACKGROUND
When severe symptoms of solitary rectal ulcer syndrome persist despite medical management, surgery may be necessary.


METHODS
A retrospective review was carried out of 81 patients undergoing surgery for solitary rectal ulcer syndrome in the 10-year period from 1984 to 1993 to determine the long-term outcome at a minimum follow-up of 12 months. Of the 81 patients, 15 were excluded from further analysis (11 were followed up for less than 12 months, two died and two were lost to follow-up). Sixty-six patients were studied (median age 38 (range 15-77) years; 53 female). Of these, 49 underwent rectopexy, nine Delorme's operation, two anterior resection and four creation of a stoma as the initial operation.


RESULTS
At a median follow-up of 90 (range 12-177) months, the rectopexy had failed in 22 of 49 patients; 19 of these patients underwent further surgery, including rectal resection with coloanal anastomosis (four with three failures), colostomy (11) and other procedures (four). Ultimately, 14 required a stoma. Constipation was the indication for a stoma in nine of the 11 patients who had colostomy as the first procedure after failure of rectopexy. Nine patients had Delorme's operation as the first procedure. At median follow-up of 38 (range 19-107) months, there were four failures. Two of these ultimately required a stoma. Of the seven patients who underwent anterior resection as the initial or subsequent procedure, a stoma was finally necessary in four. Anterior resection used as a salvage procedure was not successful. The overall stoma rate was 30 per cent (20 patients). Of 11 symptoms assessed before operation only incontinence and incomplete evacuation were related to a poor outcome following surgery.


CONCLUSIONS
Antiprolapse operations result in a satisfactory long-term outcome in about 55-60 per cent of patients having surgery for solitary rectal ulcer syndrome. Results of anterior resection are disappointing.
Sitzler
P J
PJ
Department of Surgery, St Mark's Hospital, Harrow, UK.
Kamm
M A
MA
Nicholls
R J
RJ
McKee
R F
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012002:Rectal Diseases / Q000601:surgery*; D012005:Rectal Prolapse / Q000209:etiology / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D054047:Surgical Stomas; D013577:Syndrome; D016896:Treatment Outcome; D014456:Ulcer / Q000601:surgery*