title: Surgical treatment of rectal prolapse: experience and late results with 51 patients.
abstract: The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another.
  
  
  OBJECTIVE
  Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002.
  
  
  METHODS
  Retrospective study.
  
  
  RESULTS
  Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation.
  
  
  CONCLUSIONS
  Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.
authors.affiliation: Department of Gastroenterology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil. sobrado@iconet.com.br
authors.forename: Carlos Walter
authors.initials: CW
authors.lastname: Sobrado
authors.forename: Desidério Roberto
authors.initials: DR
authors.lastname: Kiss
authors.forename: Sérgio C
authors.initials: SC
authors.lastname: Nahas
authors.forename: Sérgio E A
authors.initials: SE
authors.lastname: Araújo
authors.forename: Victor E
authors.initials: VE
authors.lastname: Seid
authors.forename: Guilherme
authors.initials: G
authors.lastname: Cotti
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid / Q000601:surgery; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012005:Rectal Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome