title: Abdominal rectopexy for complete rectal prolapse: preliminary results of a new technique.
abstract: OBJECTIVE
  Although the technique for the surgical repair of rectal prolapse has advanced over the years, no ideal procedure has been found. We aim to test a new surgical procedure for abdominal rectopexy that uses the greater omentum to support the rectum below the rectopexy, to reconstruct the anorectal angle and dispense with the need for synthetic mesh, thus reducing the risk of infection.
  
  
  METHODS
  A series of ten patients, all young and medically fit, underwent repair surgery for rectal prolapse with the new rectopexy technique. Some patients had concomitant sigmoidectomy. Preoperative and postoperative assessment included a clinical examination, anal manometry and defecography.
  
  
  RESULTS
  Follow-up lasted a mean of 56.4 months. None of the patients had recurrent rectal prolapse or infection. Postoperative assessment at 24 months disclosed significant improvements in all the bowel and sphincter variables assessed. The 8 patients who had severe incontinence preoperatively had notably improved and 4 were fully continent, 3 moderately incontinent, and only 1 patient had persistently high levels of incontinence. In only 1 patient who initially had severe incontinence, continence completely regressed and severe constipation developed. Maximal basal pressure values increased significantly after surgery (p=0.0025), although they increased slightly less evidently in patients in whom marked incontinence persisted at postoperative follow-up. Maximal voluntary contraction pressure also increased significantly after surgery (p=0.0054), although the values changed less than those for basal pressure. During rest, squeeze and straining, and in all the patients who regained continence, even those who recovered it only partly, surgery substantially reduced the anorectal angle. The reduction during rest was statistically significant (p=0.0062).
  
  
  CONCLUSIONS
  The rectopexy technique we tested in patients with rectal prolapse avoids the need for synthetic mesh, and provides good results in terms of bowel and sphincter function, without infection or recurrence.
authors.affiliation: Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Giorgio
authors.forename: Daniele
authors.initials: D
authors.lastname: Biacchi
authors.forename: Simone
authors.initials: S
authors.lastname: Sibio
authors.forename: Fabio
authors.initials: F
authors.lastname: Accarpio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sinibaldi
authors.forename: Lea
authors.initials: L
authors.lastname: Petrella
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Cappiello
authors.forename: Paolo
authors.initials: P
authors.lastname: Sammartino
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D003248:Constipation / Q000209:etiology / Q000503:physiopathology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012005:Rectal Prolapse / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome