Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse.
BACKGROUND
We can divide surgery for rectal prolapse into two broad categories: abdominal and perineal. However, few studies compare the long-term outcomes and quality of life among operations for full-thickness rectal prolapse. The purpose of this study was to compare abdominal (AO) versus perineal (PO) procedures for the treatment of full-thickness rectal prolapse regarding recurrence rate, incontinence, constipation, and quality of life.


METHODS
Records of 177 operations from 1995 to 2001 were reviewed retrospectively. A telephone survey was attempted for all. Seventy-five (42%) responded to the Cleveland Clinic Incontinence Score (CCIS), KESS Constipation Score (KESS-CS), and SF-36 Quality of Life Score. Appropriate statistical analysis was performed.


RESULTS
For the 122 AO and 55 PO, there were no deaths. Mean follow-up was similar (PO 3.1 vs. AO 3.9 years; P = 0.306). As expected the PO patients were older (mean 69 vs. 55 years) and had higher ASA scores. Those undergoing PO had less procedural blood loss, operative time, hospital stay, and dietary restriction. The PO group also scored worse on the physical component of SF-36 (PO 33 vs. AO 39.6; P = 0.034). However, the rate of recurrent prolapse was significantly higher for the PO (PO 26.5% vs. AO 5.2%; P < 0.001). Complications, CCIS, KESS-CS, and SF-36 mental component were similar in both groups.


CONCLUSIONS
In full-thickness rectal prolapse, elderly, sick patients are selected for a perineal operation. The morbidity, functional outcomes, and quality of life are acceptable. However, the high recurrence rates make the perineal operation a second-best choice for younger, healthy patients.
Riansuwan
Woramin
W
Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A30, Cleveland, OH, 44195, USA. woramin@gmail.com
Hull
Tracy L
TL
Bast
Jane
J
Hammel
Jeff P
JP
Church
Jame M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D011788:Quality of Life; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome