Risk factors for recurrent rectal prolapse after surgical treatment
DOI:
https://doi.org/10.32782/2415-8127.2023.68.2Keywords:
rectum, rectal prolapse, genital prolapse, recurrence, causesAbstract
Introduction. Modern works indicate various methods of surgical correction of external rectal prolapse, which include procedures aimed at obliteration of the Douglas space, pelvic floor reconstruction, resection of the sigmoid colon, anterior and posterior rectopexy using a prolene mesh. However, there is currently insufficient evidence to support one method over the other in terms of recurrence rates. Materials and methods. A total of 29 women (61.7%) and 12 men (29.3%) with an average age of 64.1 years were included in the study. Three patients had a history of procedures for rectal prolapse: posterior rectopexy (2) and Frykman-Goldberg procedure (1). Ten women underwent hysterectomy, and seven (17.1%) had associated genital prolapse. The operation was performed with spinal anesthesia in 32 patients (78.1%), with general anesthesia in 9 (21.9%). Levatorplasty was performed in seven patients (17.1%): in 4 – correction of the anorectal angle (Park's procedure) and in 3 – levatorplasty. Results and discussion. Recurrence of rectal prolapse occurred in 5 patients (12.2%). All relapses were diagnosed within 24 months. In patients without recurrence, the average age was 57.9 years. Among patients with relapse, all were elderly with an average of 66.2 years. Analyzing the influence of various factors on the development of rectal prolapse recurrence after surgical repair, we found that four of them were significant: age, history of hysterectomy, presence of constipation, and rectal prolapse greater than 5 cm. Conclusions. The recurrence rate after mucosectomy with Park's selective posterior puborectalis plication and anterior or posterior levatorplasty is 12.2%. Proved trigger factors for recurrence of rectal prolapse are age, history of hysterectomy, constipation, and rectal prolapse of more than 5 cm. Sex, ASA grade, associated genital prolapse in women, fecal incontinence, duration of RP, and choice of anesthesia method were not statistically significantly associated with recurrence of rectal prolapse.
References
Kwak HD, Chung JS, Ju JK. A comparative study between transanal and transabdominal approaches in treatment of complete rectal prolapse. Int J Colorectal Dis. 2023 Mar 24;38(1):78. doi: 10.1007/s00384-023-04371-3
Bender F, Tarasconi A, Catena F, Sartelli M, Coccolini F, Liese J, Padberg W, Reichert M, Hecker A. Current WSES-AAST guidelines on anorectal emergencies-Summary and comments. Chirurgie (Heidelb). 2023 Apr;94(4):333-341. doi: 10.1007/s00104-023-01826-9
Gallo G, Martellucci J, Pellino G, Ghiselli R, Infantino A, Pucciani F, Trompetto M. Consensus Statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of complete rectal prolapse. Tech Coloproctol. 2018 Dec;22(12):919-931. doi: 10.1007/s10151-018-1908-9
Keller DS, Smart N. Is rectal prolapse a hernia? Colorectal Dis. 2022 Apr;24(4):351-352. doi: 10.1111/codi.16132
Kumar N, Kumar D. Fecal incontinence and rectal prolapse. Indian J Gastroenterol. 2019 Dec;38(6):465-469. doi: 10.1007/s12664-020-01014-1
Fan K, Cao AM, Barto W, De Lacavalerie P. Perineal stapled prolapse resection for external rectal prolapse: a systematic review and meta-analysis. Colorectal Dis. 2020 Dec;22(12):1850-1861. doi: 10.1111/codi.15338
Wallace SL, Kim Y, Lai E, Mehta S, Gaigbe-Togbe B, Zhang CA, Von Bargen EC, Sokol ER. Postoperative complications and pelvic organ prolapse recurrence following combined pelvic organ prolapse and rectal prolapse surgery compared with pelvic organ prolapse only surgery. Am J Obstet Gynecol. 2022 Aug;227(2):317.e1-317.e12. doi: 10.1016/j.ajog.2022.05.050
Nygaard I, Barber MD, Burgio KL, et al; Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–1316.
González-Argenté FX, Jain A, Nogueras JJ, Davila GW, Weiss EG, Wexner SD. Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse. Dis Colon Rectum. 2001;44:920–926.
Tou S, Brown SR, Nelson RL. Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev. 2015;11:CD001758
Chivate SD, Chougule MV, Chivate RS, Thakrar PH. Transanal rectopexy for external rectal prolapse. Ann Coloproctol. 2022 Dec;38(6):415-422. doi: 10.3393/ac.2021.00262.0037
Tsunoda A, Takahashi T, Matsuda S, Kusanagi H. Predictive Factors for Recurrence of External Rectal Prolapse after Laparoscopic Ventral Rectopexy. J Anus Rectum Colon. 2021 Oct 28;5(4):376-385. doi: 10.23922/jarc.2021-024
Wallace SL, Enemchukwu EA, Mishra K, Neshatian L, Chen B, Rogo-Gupta L, Sokol ER, Gurland BH.Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J. 2021 Sep;32(9):2401-2411. doi: 10.1007/s00192-021-04778-y
Nacion AJD, Park YY, Kim HS, Yang SY, Kim NK. Surgical Treatment of Rectal Prolapse: A 10-Year Experience at a Single Institution. J Minim Invasive Surg. 2019 Dec 15;22(4):164-170. doi: 10.7602/jmis.2019.22.4.164
Catanzarite T, Klaristenfeld DD, Tomassi MJ, Zazueta-Damian G, Alperin M.Recurrence of Rectal Prolapse After Surgical Repair in Women With Pelvic Organ Prolapse. Dis Colon Rectum. 2018 Jul;61(7):861-867. doi: 10.1097/DCR.0000000000001023
