Lomas-Cooperman technique for rectal prolapse in the elderly patient.
BACKGROUND
A variety of surgical procedures is used to correct complete rectal prolapse (RP). We analysed the immediate and long-term results of the Lomas-Cooperman technique in the management of symptomatic RP in elderly patients with severe concomitant diseases.


METHODS
Across a 13-year period, all patients with RP having undergone surgery with this procedure were retrospectively evaluated. The technique consisted in placing a triply folded piece of polypropylene mesh encircling the anal canal through a perineal approach.


RESULTS
A total of 22 patients (20 female) with a mean age of 84 years (range, 72-93 years) with severe concomitant pathologies were assessed. Four patients were classified as ASA II and 18 as ASA III. Mean Karnofsky score was 50%, ranging between 40% and 60%. All patients were operated on under regional anaesthesia without incidents. Mean operative time was 35 min(range, 20-60 min) and mean hospital stay was 4.5 days (range, 2-17 days). The most common immediate postoperative complication was urinary tract infection, found in 18% of the cases. Mean follow-up was 32 months (range, 4-84 months). During follow-up, 4 cases (18%) of mesh exteriorisation were detected, requiring mesh trimming at the outpatient clinic. Rectal prolapse recurred in 2 patients; one of them was managed with a new cerclage reaching a satisfactory outcome. Thus, by intention-to-treat basis, the recurrence rate was 4.5%. Constipation was resolved in three out of 4 patients, but in 18% of the cases late faecal impact was recorded. Mean preoperative incontinence score improved from 5.1+/-0.62 to 3.4+/-1.61 (p<0.0001) after surgery.


CONCLUSIONS
Anal cerclage with the Lomas-Cooperman technique constitutes a simple and reproducible surgical technique with an acceptable morbidity and recurrence rate in high-risk elderly patients with RP.
Mansilla
J E
JE
Department of Colorectal Surgery, Hospital San Borja Arriaran, Faculty of Medicine, University of Chile, Santiago.
Bannura
G C
GC
Contreras
J P
JP
Barrera
A E
AE
Melo
C L
CL
Soto
D C
DC
D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006801:Humans; D008297:Male; D011126:Polypropylenes; D019919:Prosthesis Implantation / Q000379:methods*; D012005:Rectal Prolapse / Q000517:prevention & control / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D013526:Surgical Mesh; D016896:Treatment Outcome
D011126:Polypropylenes