Low Anterior Resection with Fixation of the Lateral Rectal Ligaments by EEA Stapler in Rectal Prolapse

Kim, Byung Chun; Cho, Ji Woong; Kim, Hong Ki

Abstract

Rectal prolapse means an abnormal descent of all layers of the rectum, with or without protrusion through the anus, and is classified into incomplete and complete rectal prolapse. Complete rectal prolapse is further divided into the first, second and third degree based on the severity. The choice of the operation for rectal prolapse is controversial. PURPOSE: The aim of this study was to evaluate the safety and effectiveness of the low anterior resection and stapled colorectal end-to-end anastomosis with fixation of the lateral rectal ligaments in rectal prolapse with redundant sigmoid colon.
METHODS
We describe our experience from January 1989 through December 1998. During this period, eight cases of complete rectal prolapse were managed at the Chunchon Sacred Heart Hospital, Hallym University. They were all men. The average age of the patients was 37 years (range, 19 to 73) and the average at onset before surgery was 19 years (range, 6 months to 33 years). At rectal examination the patients were placed in either a left supine or squatting position and were asked to strain. The duration of the follow-up assessment was ranged from one to seven years after operation. All those patients were investigated by personal interview and physical examination.
RESULTS
The most common complaint was protruding anal mass and anal bleeding. Four patients were heavy alcohol abusers. Two patients had mental retardation. Among them four patients had undergone prior anorectal procedure; two men had been treated due to hemorrhoids. The average body weight was 55 kg. The average length of the postoperative hospital stay was 16.8 days (range, 9 to 39 days). Preoperatively, there were 5 cases who had decreased anal sphincter tone. In all cases EEA stapler was used for anastomosis. The rectum was completely mobilized posteriorly and sutured to the sacrum. There was no recurrence and incontinence in all patients. The lengths of removed bowel were 15 to 20 cm (average 16.2 cm). There was no postoperative mortality, but postoperative adhesive ileus was developed in two patients, which were managed by conservative treatment.
CONCLUSIONS
In rectal prolpase, the low anterior resection of redundant sigmoid colon and stapled colorectal end-to-end anastomosis with fixation of the lateral rectal ligaments is one of the most efficient treatment.