The effectiveness of perineal rectosigmoidectomy for the treatment of rectal prolapse in elderly and high-risk patients

Abstract

We report herein on the follow-up of ten consecutive patients who underwent perineal rectosigmoidectomy, and discuss the indications, surgical technique, and outcomes of this procedure. The median age of the patients was 79 years, with a range of 26 to 85 years, and eight patients had complicating medical conditions. Of five patients who underwent this procedure for a recurrent prolapse after another type of perineal procedure, four had previously undergone the Thiersch operation combined with the Gant-Miwa technique. The mean length of the excised rectum and sigmoid colon was 22.1 cm. Pain was minimal or absent in all patients and oral intake was commenced after 2 days. There were no mortalities, but anastomotic leakage occurred in one patient. The mean follow-up period was 3.5 years. Only one patient developed recurrent rectal prolapse 24 months after the operation. Of seven patients who underwent concomitant levatoroplasty for incontinence, five became fully continent within 3 weeks after the operation, while the remaining two improved after 2 months. We propose that perineal rectosigmoidectomy is indicated for patients who have suffered an early recurrence of prolapse after another transperineal repair; elderly or high-risk patients with incontinence; male patients; and patients with an incarcerated or gangrenous prolapsed rectal segment.

Surgical Management of Rectal Prolapse

“…66 Some authors 15,60,85,92,95 have therefore suggested the addition of levatorplasty to perineal rectosigmoidectomy. The advantage of posterior levatorplasty is that it recreates the anorectal angle, which seems to improve anal continence.…”

Tiesiosios žarnos prolapsas: chirurginis perinealinis gydymas

“…This situation does not apply in cases of patients with rectal prolapse that does not have incontinence, there's no evidence of electromyographic pudendal nerve injury, so this theory is applicable only to patients with rectal prolapse and fecal incontinence. In addition, the relaxation of the lateral ligaments and the inertia of the pelvic floor muscles have been suggested as other causes for rectal prolapse [7]. The most common symptoms are bulging, bleeding, frequent defecation episodes, and rectal tenesmus.…”

“…To resolve this problem, options approach abdominal and perineal surgical treatment. Historically, perineal approaches are associated with higher recurrence rates [7,8]. This higher recurrence rate is compensated with lower perioperative morbidity, especially in patients with multiple comorbidities, old or too weak to withstand the abdominal surgical approach [16].…”

“…The reported mortality rates are from 0 to 5% and recurrence rates of 0-16%. Studies in which levatorplasty (levatorplasty) and other studies that were not performed are included in this data [7,8,14,[27][28][29][30][31][32][33]. The levatorplasty decreases the rate of recurrence when associated with perineal rectosigmoidectomy [3,4].…”

“…The levatorplasty decreases the rate of recurrence when associated with perineal rectosigmoidectomy [3,4]. Complications of rectosigmoidectomy perineal include anastomotic leak with pelvic sepsis and bleeding [7].…”