Management of recurrent rectal prolapse: surgical approach influences outcome

Recurrent rectal prolapse is an unresolved problem and the optimal treatment is debated. This study was designed to review patterns of care and outcomes in a large cohort of patients after surgery for recurrent prolapse. From 685 patients who underwent operative repair for full-thickness external re...

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Vydané v:Diseases of the colon & rectum Ročník 49; číslo 4; s. 440
Hlavní autori: Steele, Scott R, Goetz, Laura H, Minami, Shigeki, Madoff, Robert D, Mellgren, Anders F, Parker, Susan C
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 01.04.2006
Predmet:
Abdomen - surgery
Adult
Aged
Aged, 80 and over
Cohort Studies
Digestive System Surgical Procedures - methods
Female
Humans
Male
Middle Aged
Perineum - surgery
Rectal Prolapse - surgery
Recurrence
Retrospective Studies
Treatment Outcome
ISSN:0012-3706
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Shrnutí:Recurrent rectal prolapse is an unresolved problem and the optimal treatment is debated. This study was designed to review patterns of care and outcomes in a large cohort of patients after surgery for recurrent prolapse. From 685 patients who underwent operative repair for full-thickness external rectal prolapse, we identified 78 patients (70 females; mean age, 66.9 years) who underwent surgery for recurrence. We reviewed the subsequent management and outcomes for these 78 patients. Mean interval to their first recurrence was 33 (range, 1-168) months. There were significantly more re-recurrences after reoperation using a perineal procedure (19/51) compared with an abdominal procedure (4/27) for their recurrent rectal prolapse (P = 0.03) at a mean follow-up of nine (range, 1-82) months. Patients undergoing abdominal repair of recurrence were significantly younger than those who underwent perineal repair (mean age, 58.5 vs. 71.5 years; P < 0.01); however, there was nosignificant difference between the two groups with regard to the American Society of Anesthesiologists classification (P = 0.89). Eighteen patients had surgery for a second recurrence, with perineal repairs associated with higher failure rates (50 vs. 8 percent; P = 0.07). Finally, when combining all repairs, the abdominal approach continued to have significantly lower recurrence rates (39 vs. 13 percent; P < 0.01). The re-recurrence rate after surgery for recurrent rectal prolapse is high, even at a relatively short follow-up interval. Our data suggest that abdominal repair of recurrent rectal prolapse should be undertaken if the patient's risk profile permits this approach.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0012-3706
DOI:10.1007/s10350-005-0315-2