J Korean Soc Coloproctol.  2001 Oct;17(5):220-226.

Perineal Rectosigmoidectomy with Levatoroplasty for Rectal Prolapse Early functional outcome

• Yoon SG
• Lee JH
• Yoon JS
• Kim KU
• Kim HS
• Lee JK
• Kim KY

Abstract

PURPOSE
This study was designed to analyze the short-term clinical and functional outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse.
METHODS
The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner's constipation score (0-30), Wexner's incontinence score (0-20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3-6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7).
RESULTS
During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated.
CONCLUSIONS
Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea-predominant irritable bowel syndrome.

Keyword

Rectal prolapse; Rectosigmoidectomy; Levatoroplasty; Constipation; Fecal incontinence

MeSH Terms

Ambulatory Care Facilities
Anal Canal
Constipation
Defecation
Fecal Incontinence
Follow-Up Studies
Humans
Interviews as Topic
Irritable Bowel Syndrome
Length of Stay
Manometry
Mortality
Physiology
Prolapse
Prospective Studies
Pudendal Nerve
Surveys and Questionnaires
Rectal Prolapse*
Recurrence
Soil
Urinary Tract Infections
Soil