Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study

Abstract

Purpose There are few reports on outcomes following surgical repair of recurrent rectal prolapse. The purpose of this study was to examine surgical outcomes for recurrent rectal prolapse. Methods We conducted a multicenter retrospective study of patients who underwent surgery for recurrent rectal prolapse. This study used data collected by the Korean Anorectal Physiology and Pelvic Floor Disorder Study Group. Results A total of 166 patients who underwent surgery for recurrent rectal prolapse were registered retrospectively between 2011 and 2016 in 8 referral hospitals. Among them, 153 patients were finally enrolled, excluding 13 patients who were not followed up postoperatively. Median follow-up duration was 40 months (range, 0.2–129.3 months). Methods of surgical repair for recurrent rectal prolapse included perineal approach (n = 96) and abdominal approach (n = 57). Postoperative complications occurred in 16 patients (10.5%). There was no significant difference in complication rate between perineal and abdominal approach groups. While patients who underwent the perineal approach were older and more fragile, patients who underwent the abdominal approach had longer operation time and admission days (P < 0.05). Overall, 29 patients (19.0%) showed re-recurrence after surgery. Among variables, none affected the re-recurrence. Conclusion For the recurrent rectal prolapse, the perineal approach is used for the old and fragile patients. The postoperative complications and re-recurrence rate between perineal and abdominal approach were not different significantly. No factor including surgical method affected re-recurrence for recurrent rectal prolapse.

Resultados funcionales en el tratamiento del prolapso rectal

“…El estudio PROSPER compara técnicas perineales entre sí y abdominales entre sí, no encontrando significancia, aunque en el número absoluto de la recurrencia se observó un aumento no esperado en técnicas abdominales alcanzando un 19% de esa muestra 2 . Existen estudios que muestran recurrencias menores, alcanzado 5,2 a 7,6%, según lo descrito en la revisión de Tou et al, no identificando diferencias entre las técnicas usadas 12,13 . En relación con el subgrupo de pacientes recidivados y operados en esta serie, 50% tuvo una precepción igual o peor, sin evidenciar diferencias significativas en EQ-5D, lo que es consistente con lo reportado en la literatura 2,12,14,15 .…”

“…Al revisar estudios, encontramos mejorías precoces desde los 3 meses, con reducciones del índice hasta 50% en su puntaje, pero con mayor intensidad en pacientes sometidos a rectopexia ventral, sin encontrarse además constipación ad-novo 9,16,17 . La explicación probable a la aparición de esta sintomatología podría ser la movilización de estructuras nerviosas autonómicas al momento de la disección del espacio presacro previo a instalación de malla protésica 9,13 . La calidad de vida fue evaluada con el cuestionario EQ-5D.…”