Long-term follow-up of simultaneous abdominoperineal repair of enterorectocele and internal mucosal prolapse.
BACKGROUND
Enterorectocele with recto-rectal intussusception and internal mucosal prolapse (ER-RI-MP) may require surgery for obstructed defecation, but symptoms tend to recur if only one lesion is corrected. This prospective study was designed to investigate the results of an abdominoperineal procedure aimed at treating all these lesions in one stage.


METHODS
Thirteen women with constipation (median age, 58 years) and ER-RI-MP underwent Douglas pouch suture, mesh obliteration of the pelvic inlet with or without rectopexy, and omentoplasty plus rectocele and prolapse obliteration. Constipation was scored on a scale from 0 to 20. Proctoscopy, enterocolpodefecography, manometry, anal-vaginal-perineal ultrasound, and psychological evaluation were performed before and after surgery.


RESULTS
Bleeding requiring transfusion, pelvic hygroma, and ureteric stricture requiring adhesiolysis occurred in three patients. Constipation score significantly decreased from a mean (+/- standard error of the mean) of 16 +/- 0.6 before to 7 +/- 0.9 after surgery (P < 0.0001). Seven patients were considered cured, five improved, and one remained unchanged at a median follow-up of 42 months. Anorectal physiology and imaging returned to normal in seven patients. Four patients had successful rehabilitation and psychotherapy for anismus, rectal hyposensation, and depression.


CONCLUSIONS
Simultaneous abdominoperineal ER-RI-MP repair integrated with conservative treatment of associated dysfunctions achieved a satisfactory long-term outcome. The results need to be confirmed in larger series.
Pescatori
Mario
M
Coloproctology Unit, Ars Medica and Villa Flaminia Hospitals, Rome, Italy. ucpclub@virgilio.it
D000328:Adult; D000368:Aged; D003248:Constipation / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012005:Rectal Prolapse / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D020047:Rectocele / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome