This is a retrospective study evaluating 179 patients with complete rectal prolapse operated on at the University of Minnesota affiliated hospitals from 1953 to 1983 with no mortality. One hundred and two of 138 patients who underwent abdominal proctopexy and sigmoid resection were followed from six months to 30 years with a recurrence rate of 1.9 percent. Twenty-two of the 33 patients who underwent perineal rectosigmoidectomy were followed from six months to three years with no recurrence. Nine patients who underwent abdominal proctopexy and subtotal colectomy because of colonic inertia associated with procidentia were followed from one to six years with no recurrence. Patient interviews revealed that 72 to 80 percent considered their results as excellent or good. Incontinence or persistent constipation caused the remaining patients to consider their results fair or poor, despite anatomic correction of the prolapse. Abdominal proctopexy and sigmoid resection was more likely to result in improvement of continence than was perineal rectosigmoidectomy.
Hemorrhoidal disease affects more than one million Americans per year. We reviewed the treatment pattern for patients who presented with symptomatic hemorrhoids to our large university-affiliated group practice over a 66-month period. Over 21,000 patients presented to the practice with bleeding, thrombosis, or prolapse. Only 9.3 percent of patients required operative therapy. Conservative therapy was given to 45.2 percent of patients, while rubber band ligation was performed on 44.8 percent of patients. We retrospectively reviewed the complications and length of stay for a subset of patients undergoing operative therapy during the 66-month study period. Postoperative urinary complications (retention or infection) were seen in 20.1 percent of patients. Delayed hemorrhage was seen in 2.4 percent of patients. In-hospital length of stay was 2.5 days, which is approximately two days less than the length of stay found in a similar review of our practice in 1978. We conclude that over 90 percent of symptomatic hemorrhoids can be treated conservatively or with rubber band ligation, and, as surgery is reserved for only the most severe cases, complication rates may not decrease. However, we expect that in-hospital length of stay will continue to decrease over the ensuing years.
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