Comparison of abdominal and perineal procedures for complete rectal prolapse: an analysis of 104 patients

Abstract

PurposeSelecting the best surgical approach for treating complete rectal prolapse involves comparing the operative and functional outcomes of the procedures. The aims of this study were to evaluate and compare the operative and functional outcomes of abdominal and perineal surgical procedures for patients with complete rectal prolapse.MethodsA retrospective study of patients with complete rectal prolapse who had operations at a tertiary referral hospital and a university hospital between March 1990 and May 2011 was conducted. Patients were classified according to the type of operation: abdominal procedure (AP) (n = 64) or perineal procedure (PP) (n = 40). The operative outcomes and functional results were assessed.ResultsThe AP group had the younger and more men than the PP group. The AP group had longer operation times than the PP group (165 minutes vs. 70 minutes; P = 0.001) and longer hospital stays (10 days vs. 7 days; P = 0.001), but a lower overall recurrence rate (6.3% vs. 15.0%; P = 0.14). The overall rate of the major complication was similar in the both groups (10.9% vs. 6.8%; P = 0.47). The patients in the AP group complained more frequently of constipation than of incontinence, conversely, in the PP group of incontinence than of constipation.ConclusionThe two approaches for treating complete rectal prolapse did not differ with regard to postoperative morbidity, but the overall recurrence tended to occur frequently among patients in the PP group. Functional results after each surgical approach need to be considered for the selection of procedure.

Constipation Risk in Patients Undergoing Abdominal Surgery

“…Problems regarding bowel elimination are quite common in patients who underwent abdominal surgery. It was reported that this ratio was 25% to 40% in hospitalized patients who underwent surgery ( 3 , 4 ). Bowel frequency is influenced by several factors, including intake of dietary factors, emotional status, immobility, previous bowel elimination history, and psychological morbidity after abdominal surgery ( 5 , 6 ).…”

What is the recommended procedure for recurrent rectal prolapse? A retrospective cohort study in a single Japanese institution

“…In the report by Russell et al [ 12 ], which evaluated morbidity and 30-day mortality in 1485 patients who underwent RP surgery in the American College of Surgeon’s National Surgical Quality Improvement Program between January 2005 and December 2008, the complication rates for the trans-abdominal and trans-perineal approaches were 12.9 and 7.6%, respectively. In addition, Lee et al [ 13 ] reported that, in Asian patients, immediate major complications occurred more frequently using the trans-abdominal approach, including open rectopexy, than using the trans-perineal approach (25% vs. 15%), although a significant difference was not observed. On the contrary, Kaiwa et al [ 14 ] reported that lap-rectopexy is as safe for patients aged > 70 years as it is specifically designed for younger patients.…”

Laparoscopic-Assisted Altemeier’s Procedure for Recurrent Strangulated Rectal Prolapse: A Case Report

“…These 2 approaches have been shown to be similar in postoperative morbidity, but the perineal approach has a higher recurrence rate. Functional results depend on the type of technique used [2]. …”

“…Surgery may be carried out through an abdominal or perineal approach and may involve excision, fixation, or plication of the prolapse. Recurrence rates are higher with a perineal approach, and abdominal procedures are more commonly performed in fit individuals [2]. …”