Rectopexy to the promontory for the treatment of rectal prolapse

Abstract

From 1953 to 1982, 257 patients with complete rectal prolapse were operated upon. To the procedure described by Orr, we have added mobilization of the rectum prior to its suspension and eliminated the pouch of Douglas, and nylon strips have been used for suspension in most patients. There were 57 male and 200 female patients. Ages ranged from 11 to 90 years. Sixty-one patients had already undergone surgery for rectal prolapse with another procedure and prolapse had recurred. The postoperative course was uneventful in 96 per cent of patients. Two patients, aged 79 to 83 years, died of cardiac failure. Follow-up of 115 patients ranged from five to 23 years. Recurrent rectal prolapse was observed in 4.3 per cent of the patients in whom nylon strips were used to suspend the rectum. In 136 patients anal incontinence was associated with rectal prolapse. Normal continence was restored in 84.1 per cent of 107 patients with rectopexy alone and in 64.2 per cent of 14 patients who underwent rectopexy and anal sphincter repair. It is concluded that rectopexy to the promontory with nylon strips after mobilization of the rectum is a safe and efficient procedure for the treatment of rectal prolapse.

Laparoscopic ventral rectopexy in an elderly population with external rectal prolapse: clinical and anal manometric results

“…The operations were performed as a modified Orr-Loygue procedure with posterior mobilisation of the mesorectum and anchoring of the anal anterior wall of the rectum to the promontory of the sacral bone with a mesh [11]. Although the originally described procedure was performed with a laparotomy and antero-bilateral rectum anchoring, a modified laparoscopic method initially described in 1994 was used [12].…”

Genitalprolaps und Harninkontinenz bei Frauen mit operativ behandeltem Rektumprolaps

“…Die aktuellen Kenntnisse über die Beziehung zwischen Rektumund Genitalprolaps beschränken sich allerdings meist auf anekdotische Berichte [15] und Fallserien [1,16,17]. Ein Genitalprolaps lag bei 9-27% der Patienten mit RP vor [1,16,18], erforderte jedoch nur selten einen gleichzeitigen chirurgischen Eingriff. Eine frühere Fall-Kontroll-Studie zeigte, dass ein Genitalprolaps häufiger bei Patientinnen mit RP und/oder analer Inkontinenz auftrat als in einer Kontrollgruppe [19].…”

“…Ein RP wird sehr häufig bei älteren Frauen festgestellt, obwohl er auch junge und nicht-gebärende Frauen, Kinder und Männer betreffen kann [1]. Außer dem Prolaps selbst haben die Patienten häufig assoziierte Symptome einschließlich analer Inkontinenz, Obstipation, Schleimabsonderung und Stuhlschmieren [2].…”

Rectal prolapse in adults

“…Vergleichende Ergebnisse sind auch durch die Operation nach Orr-Loygue mit Fixation des Rektums nach präsakral durch lateral am Rektum angenähte Kunststoffstreifen zu erzielen [30].…”