Recurrence and quality of life following perineal proctectomy for rectal prolapse.
BACKGROUND
Surgical outcome and quality of life (QOL) following perineal proctectomy for rectal prolapse remain poorly documented.


METHODS
From 1994 to 2004, patients with full-thickness rectal prolapse were treated exclusively with perineal proctectomy independent of age or comorbidities. Subjective patient assessments and recurrences were determined retrospectively from hospital and clinic records. Consenting patients completed the gastrointestinal quality of life index (GIQLI).


RESULTS
Perineal proctectomy was performed in 103 consecutive patients with a median age of 75 years (range 30-94). Most patients underwent concurrent levatorplasty (anterior 85.8%, posterior 67.9%). Durable results were obtained in all patients; the recurrence rate was 8.5% over a mean follow-up of 36 months. Preoperatively, 75.5% of patients reported fecal incontinence, and 32.1% had obstructed defecation. Incontinence significantly improved post-proctectomy (41.5%, p < 0.001), as did constipation (10.4%, p < 0.001). GIQLI respondents reported satisfaction following proctectomy with 63% scoring within one standard deviation of healthy controls. Patients with recurrent prolapse reported a lower QOL. Risk factors for recurrence included duration of prolapse, need for posterior levatorplasty, and prior anorectal surgery.


CONCLUSIONS
Perineal proctectomy provides significant relief from fecal incontinence and obstructive symptoms caused by rectal prolapse, with an acceptable recurrence rate and low morbidity.
Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Sean C
SC
Glasgow
Elisa H
EH
Birnbaum
Ira J
IJ
Kodner
James W
JW
Fleshman
David W
DW
Dietz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011788:Quality of Life; D012005:Rectal Prolapse / Q000523:psychology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology