RESULTS OF THE SURGICAL-MANAGEMENT OF RECTAL PROLAPSE IN ADULTS - 21 YEARS EXPERIENCE

Between 1971 and 1992, 89 patients (57 women, 32 men; mean age: 61 years) underwent surgical treatment for total rectal prolapse. 68.5% were constipated, and 12.3% had a solitary rectal ulcer, 46% were incontinent (3 grades 2, 11 grades 3, 27 grades 4). Twelve patients (21%) had been previously but unsuccessfully operated. Manometry showed low resting pressures in the upper part of the anal canal, particularly in incontinent patients. Voluntary contraction was lower in incontinent patients. The resting anorectal angle was obtuse (113 degrees). Orr-Loygue operation (n = 53), modified rectopexy (n = 22), rectopexy to the left inguinal ligament (n = 6), Delorme operation (n = 4), and posterior rectopexy (n = 4) were performed. There was no operative mortality. Intraoperative and postoperative morbidity rates were 3.4% (n = 3) and 29%. Rectal prolapse recurred in 3 cases (3.4%). Solitary rectal ulcer healed in all patients. Only 8 patients were incontinent after operation, but control was better in 6 cases; in other both patients, preoperative electromyography showed grade III denervation. Bowel habit was postoperatively better (68.5% of patients were constipated before operation, 51.7% after operation). Resting pressures increased in preoperatively incontinent patients in the upper part of the anal canal; resting external sphincter pressures always increased. There was no change in the resting anorectal angle (112 degrees).