Perineal rectosigmoidectomy for rectal prolapse: Role of levatorplasty

S. W. Chun, A. J. Pikarsky, S. Y. You, P. Gervaz, J. Efron, E. Weiss, J. J. Nogueras, S. D. Wexner

Research output: Contribution to journalArticle

Abstract

Background: The management of full thickness rectal prolapse remains controversial. Although abdominal approaches have a lower recurrence rate than do perineal operations, they are associated with a higher morbidity. The aim of this study was to compare the outcomes of perineal rectosigmoidectomy with and without levatorplasty. Methods: Between 1989 and 1999, a total of 109 consecutive patients (10 men) underwent 120 perineal procedures. These patients were retrospectively evaluated in two groups on the basis of the type of surgery received: perineal rectosigmoidectomy (PRS) or perineal rectosigmoidectomy with levatorplasty (PRSL). Subsequent functional outcome and physiological parameters were assessed. Results: The patients had a mean age of 75.7 years (range, 23.0-94.8 years) and they were followed for an overall mean (in both groups combined) of 28.0 months (range, 0.4-126.4 months) after surgery. Mean duration of surgery was 78.1 min (SD=25.9) and 97.6 min (SD=32.3) in PRS and PRSL, respectively (p=0.002, unpaired t test). There was no significant difference between the two groups in terms of hospital stay, morbidity or mortality. Recurrence rates and mean time interval to recurrence were, respectively, 20.6% and 45.5 months in PRS compared to 7.7% and 13.3 months in PRSL (p=0.049, chi-square test; p=0.001, unpaired t test). Both groups had significant improvements in postoperative incontinence score (p<0.0001, Wilcoxon's matched-pairs signed-ranks test), however, there were no significant changes in anorectal manometric findings and pudendal nerve terminal motor latency assessment. Conclusions: Perineal rectosigmoidectomy with levatorplasty is associated with a lower recurrence rate and a longer time to recurrence than perineal rectosigmoidectomy alone. Levatorplasty should be offered to patients when a perineal approach for rectal prolapse is selected.

Original languageEnglish (US)
Pages (from-to)3-9
Number of pages7
JournalTechniques in Coloproctology
Volume8
Issue number1
DOIs
StatePublished - Mar 2004
Externally publishedYes

Keywords

  • Abdominal surgery
  • Incontinence
  • Levatorplasty
  • Perineal rectosigmoidectomy
  • Perineal surgery
  • Rectal prolapse

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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  • Cite this

    Chun, S. W., Pikarsky, A. J., You, S. Y., Gervaz, P., Efron, J., Weiss, E., Nogueras, J. J., & Wexner, S. D. (2004). Perineal rectosigmoidectomy for rectal prolapse: Role of levatorplasty. Techniques in Coloproctology, 8(1), 3-9. https://doi.org/10.1007/s10151-004-0042-z