title: No surgery for full-thickness rectal prolapse: what happens with continence?
abstract: BACKGROUND
  Surgery is the only validated means of treating overt rectal prolapses, but both patients and physicians may decline or postpone the surgical approach. However, little is known on the functional outcome of nonoperated rectal prolapse. The aim of the present study was to highlight the natural history of overt rectal prolapse in patients for whom surgery was avoided or delayed.
  
  
  METHODS
  A total of 206 patients complaining of full-thickness rectal prolapse were referred to a single institution that provided anorectal physiology for functional anorectal disorders. Standardized questionnaires, anorectal manometry, endosonography, and evacuation proctography constituted a prospective database. Fecal incontinence was evaluated with the Cleveland Clinic score (CCIS), and constipation was evaluated with the Knowles Eccersley Scott Symptom score (KESS).
  
  
  RESULTS
  Forty-two nonoperated patients (mean age: 61 ± 16 years) were compared to those of operated patients paired according to age and gender: the mean follow-up was 44 ± 26 months. The two groups had a similar past-history, follow-up, stool frequency, and main complaints, but lower quantified symptomatic scores and a better quality of life were reported in the nonsurgical group. At the end of follow-up, the nonsurgical group did not show any variation in CCI and KESS scores. By contrast, these two scores significantly improved in the rectopexy group. Sixteen nonoperated patients experienced a degradation of their continence status with an average increase of 5 ± 4.3 points of the CCIS. The patients with a CCIS <7 at referral were likely to deteriorate as compared to those having a higher score. Patients with a symptom history longer than 4 years never improved and in two-thirds continence deteriorated throughout the follow-up.
  
  
  CONCLUSIONS
  In the absence of the surgical option, patients with a 4-year duration of rectal prolapse and those with mild incontinence had no chance of improvement. These findings may be taken into account when surgery of rectal prolapse is not chosen.
authors: CHU Rennes Service de Chirurgie Hépatobiliaire et Digestive, 35033, Rennes, France. dianecunin@hotmail.fr
authors: Diane
authors: D
authors: Cunin
authors: Laurent
authors: L
authors: Siproudhis
authors: Véronique
authors: V
authors: Desfourneaux
authors: Isabelle
authors: I
authors: Berkelmans
authors: Bernard
authors: B
authors: Meunier
authors: Jean-François
authors: JF
authors: Bretagne
authors: Guillaume
authors: G
authors: Bouguen
mesh_terms: D003248:Constipation / Q000503:physiopathology; D019841:Defecography; D019160:Endosonography; D005242:Fecal Incontinence / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012005:Rectal Prolapse / Q000503:physiopathology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016312:Treatment Refusal