Outcome of Fecal Incontinence in Patients with Rectal Prolapse Undergoing the Altemeier Procedure with or without Posterior Levatorplasty

Abstract

Objective To compare the fecal incontinence status of patients submitted to theAltemeier procedure with or without posterior levatorplasty. Materials and Methods Medical records of the patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered. In some cases, the operation was performed with posterior levatorplasty. Rectal prolapse due to collagen or connective tissue disorders, anal/sacral anomalies, immunodeficiency, history of rectal surgery, and pelvic radiotherapy were the exclusion criteria of the present study. In addition to the demographics (including age, gender, and body mass index), the fecal incontinence status of each case was determined through the Wexner scale preoperatively and 12 months after the surgery. The incontinence scores were then compared against the baseline values of the two groups of patients: those with and those without posterior levatorplasty. The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, US), software, version 21. Results In total, 53 patients (17 men and 36 women) with a mean age of 55.23 ± 18.24 years were analyzed. The comparison of the pre- and postoperative scores on the Wexner scale between the two groups revealed no statistically significant difference (p >0.05). Conclusion Posterior levatorplasty during the Altemeier procedure did not result in significant improvement of the fecal incontinence outcome of the patients.

Role of Levatorplasty in Management of Rectal Prolapse in Patients with Wide Pelvic Hiatus

“…Regarding Wexner scores, the comparison of the pre-and postoperative scores on the Wexner scale between the two groups revealed no statistically signi cant difference (p > 0.05) (24). However, in our study, there was a decrease in Wexner scores over time (pre-operative and post-operative) with a statistically signi cant difference (p < 0.001).…”

“…In our study, postoperative recurrence in the Levatorplasty group was 1 (3.3%), which was lower than that in the Without Levatorplasty group, where it was 6 (20%), with a statistically signi cant difference (P value 0.044). In another study by Bananzadeh et al (2021), medical records of patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered.…”

“…In some cases, the operation was performed with posterior levatorplasty. In total, 53 patients (17 men and 36 women) with a mean age of 55.23 ± 18.24 years were analyzed (24).…”