title: Incontinence in full-thickness rectal prolapse: low level of improvement after laparoscopic rectopexy.
abstract: OBJECTIVE
  The study aimed to quantify incontinence before and after laparoscopic rectopexy in patients suffering from rectal prolapse.
  
  
  METHODS
  Eighty-five patients underwent laparoscopic rectopexy to treat rectal prolapse between 2003 and 2009. Symptomatic and functional data were collected prospectively before and after surgery by self-administered questionnaires including the Cleveland Clinic Fecal Incontinence Score (CCIS) and constipation, gastrointestinal quality of life and urinary incontinence questionnaires. Incontinence was considered to be present when the CCIS remained at ≥ 5 after surgery.
  
  
  RESULTS
  After a mean follow-up period of 36 months after surgery, 83% of the patients reported good to excellent results. Continence was improved in 58 (68%), with a significant decrease in the continence score (-3.4 ± 5.8, P = 0.001). However, 50 (58.9%) patients remained incontinent: 47 (55%) reported urge incontinence and 27 (32%) had passive leakage. Incontinence for liquid stool, incontinence for solid stool and the need for protection was seen in 43 (51%), 35 (41%) and 43 (51%) patients. Manometry, defaecography and ultrasonography were not associated with any improvement. In contrast, the patients' average age (60.2 ± 15.8 vs 46.9 ± 15.5 years; P = 0.003), symptom duration before surgery (58.1 ± 70.1 vs 29.5 ± 33.3 months; P = 0.011), preoperative urinary incontinence score (10.7 ± 10.8 vs 4.2 ± 5.7; P = 0.0131) and faecal incontinence score (12.9 ± 4.9 vs 7.1 ± 6; P < 0.0001) were significantly higher in patients suffering from postoperative incontinence.
  
  
  CONCLUSIONS
  Despite some continence improvement in two-thirds of patients who underwent surgery for rectal prolapse, the level of improvement remained low in more than half of the patients.
authors.affiliation: CHU Rennes Service de Chirurgie hépatobiliaire et digestive, Rennes, France.
authors.forename: D
authors.initials: D
authors.lastname: Cunin
authors.forename: L
authors.initials: L
authors.lastname: Siproudhis
authors.forename: V
authors.initials: V
authors.lastname: Desfourneaux
authors.forename: P-Y
authors.initials: PY
authors.lastname: Bouteloup
authors.forename: B
authors.initials: B
authors.lastname: Meunier
authors.forename: A
authors.initials: A
authors.lastname: Ropert
authors.forename: I
authors.initials: I
authors.lastname: Berkelmans
authors.forename: J-F
authors.initials: JF
authors.lastname: Bretagne
authors.forename: K
authors.initials: K
authors.lastname: Boudjema
authors.forename: G
authors.initials: G
authors.lastname: Bouguen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D003248:Constipation / Q000209:etiology; D019841:Defecography; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011788:Quality of Life; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors