Prospective study of the effect of rectopexy on colonic motility in patients with rectal prolapse.
BACKGROUND
Patients with rectal prolapse have abnormal hindgut motility. This study examined the effect of rectal prolapse surgery on colonic motility.


METHODS
Twelve patients undergoing sutured rectopexy were studied before and 6 months after surgery by colonic manometry, colonic transit study and clinical assessment of bowel function. The results were compared with those from seven control subjects.


RESULTS
Before surgery colonic pressure was greater in patients than controls (P < 0.050). Controls responded to a meal stimulus by increasing colonic pressure; this increase was absent in patients. After rectopexy, colonic pressure reduced towards control values and patients' colonic pressure response to a meal returned. High-amplitude propagated contractions (HAPCs) were seen in all controls but in only three patients before and two patients after surgery. Three patients had prolonged colonic transit before and eight after rectopexy.


CONCLUSIONS
Patients with rectal prolapse have abnormal colonic motility associated with reduced HAPC activity. Rectopexy reduces colonic pressure but fails to restore HAPCs, reduce constipation or improve colonic transit. These observations help explain the pathophysiology of constipation associated with rectal prolapse.
Brown
A J
AJ
Department of Coloproctology, Lister Surgical Unit, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK.
Nicol
L
L
Anderson
J H
JH
McKee
R F
RF
Finlay
I G
IG
D000328:Adult; D000368:Aged; D003106:Colon / Q000502:physiology*; D005260:Female; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011312:Pressure; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*