Perineal and Abdominal Approaches in the Surgical Treatment of Rectal Prolapse: Our 10-year Clinical Experience

Abstract

Objective:Rectal prolapse is a rare condition characterized by protrusion of the rectum with all its layers from the anus. It is a disease that causes social and functional problems. In this study, it was aimed to investigate the abdominal and perineal approaches together with postoperative early and late results in our patients who underwent surgical treatment for rectal prolapse.Method:The records of 39 patients who were operated on with the diagnosis of rectal prolapse between 2010 and 2020 in the Department of General Surgery, Dicle University Faculty of Medicine were evaluated retrospectively. Demographic and physical examination findings of the patients, surgical methods applied, early and late postoperative complications, recurrence and mortality rates were recorded.Results:The most common complaints on admission to the hospital were gas control disorder, difficulty in defecating and getting wet with mucus. On physical examination, stage 1 rectal prolapse was found in 12.8% of the patients, and full-thickness prolapse was found in the other patients. The mean age of 39 patients included in the study was 36 (14-88) years. Of the patients included in the study, 14 (35.9%) were female and 25 (64.1%) were male. Surgery was performed with an abdominal and perineal approach in 53.8% of the patients, while laparoscopy was performed in 46.2%. The most frequently used abdominal surgical technique was Notaras (35.8%). The most common perineal approach technique was Altemeier (5.1%). Patients who underwent the perineal approach were older and had a shorter hospital stay, and it was often performed under regional anesthesia. Complications developed in the early postoperative period in 10.4% of the patients. The median hospital stay was 5 days (2-19) and the follow-up period was 13 months (9-19). Postoperative mortality did not occur in any of the patients. Hospital stay was significantly shorter in patients who underwent laparoscopic surgery. There was no statistical difference in terms of early postoperative complications and recurrence.Conclusion:Although more than a hundred surgical procedures have been described to date for the treatment of rectal prolapse, the ideal treatment method is still unclear. In terms of surgical treatment, the results of abdominal or perineal approaches to be applied are similar, considering the risk factors, patient findings and surgeon’s experience.

Keywords

• abdominal and perineal surgery
• notaras operation
• rectal prolapse