Surgical correction is ineffective for improvement of dyssynergic defecation in patients with rectal prolapse.
OBJECTIVE
The patients with rectal prolapse suffer from not only a prolapse rectum but also associated dysfunction. However, most surgical techniques are successful regarding the prolapse, but either do not solve or even worsen defecation dysfunction. The purpose of this study was to investigate the functional and physiological results after surgical correction in patients with rectal prolapse.


METHODS
This study is a retrospective review of a single-institution experience. Patients with rectal prolapse who underwent anorectal manometry before and after Delorme's procedure were included. The primary outcomes measured were improvement of clinical symptoms and physiologic study.


RESULTS
Consecutive 19 patients with rectal prolapse (17 females, mean age of 68.1 ± 10.8 years) underwent anorectal manometry before and after Delorme's procedure. The two most prevalent symptoms before operation were rectal tenesmus (15/19, 78.9%) and excessive straining (13/19, 68.4%). The two most prevalent symptoms after operation were rectal tenesmus (14/19, 73.6%) and excessive straining (13/19, 68.4%). No significant differences in resting anal pressure, squeezing anal pressure, defecation index, and rectal sense were found postoperatively. However, vector asymmetry index before surgery was higher than that after surgery (35.0 vs. 32.0, P = 0.018). Ten patients (52.5%) had type I dyssynergic defecation before surgery. No improvement of dyssynergic pattern occurred after surgery.


CONCLUSIONS
In conclusion, dyssynergic defecation was not improved after reduction of rectal prolapse in patients with rectal prolapse. Further study about combination treatment with biofeedback therapy in these subgroups may be necessary.
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Seon-Young
SY
Park
Sung-Bum
SB
Cho
Chang-Hwan
CH
Park
Jae-Kyun
JK
Joo
Young-Eun
YE
Joo
Hyun-Soo
HS
Kim
Sung-Kyu
SK
Choi
Jong-Sun
JS
Rew
Defecation; Manometry; Rectal prolapse