PHILADELPHIA — Treatment of rectal prolapse by abdominal repair led to a significantly lower rate of recurrence compared with perineal repair, in a review of 78 patients at a single center.
Although this finding is limited by the possibility of selection bias, the results “suggest that abdominal repair is preferable if a patient's risk profile permits this approach,” Scott R. Steele, M.D., said at the annual meeting of the American Society of Colon and Rectal Surgeons.
He and his associates reviewed the case records of 78 patients who underwent surgical repair for recurrent rectal prolapse at the University of Minnesota, Minneapolis, from June 1987 to March 2003. This group was drawn from 685 patients who, during this period, had an operative repair for full-thickness, external rectal prolapse.
In the group with a recurrent defect, 51 underwent a perineal procedure (average age 72), and 27 had an abdominal repair (average age 59). Patients in the two repair groups did not have a statistically significant difference in their average American Society of Anesthesiology risk class.
Seventy of the patients were women, and the average age for all patients in this subgroup was 66 years. The mean follow-up time was 9 months (range 1–82 months).
Among the 51 patients who underwent a perineal repair, 19 patients (37%) had a second recurrence. In contrast, among the 27 patients who had an abdominal repair, 4 (15%) had a second recurrence, reported Dr. Steele, a colon and rectal surgeon at the university.
Among the 23 patients in this group with a second recurrence (their third episode of prolapse overall), 6 had another perineal repair (3 of those had a subsequent recurrence), and 12 had an abdominal repair (1 of those had another recurrence).
Overall in this series, 57 patients had perineal repairs, with 22 (39%) having a recurrence. Among the 39 patients overall who had abdominal repairs, 5 had recurrences (13%). In this analysis of all prolapse repairs done for recurrent defects, the difference between the two methods was statistically significant, Dr. Steele said.
Adverse events were similar in the two repair groups. None of the patients died.