The Surgical Treatment of Fecal Incontinence and Rectal Prolapse

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

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Simple fistula-in-ano: is it all simple? A systematic review

Techniques in Coloproctology ◽

10.1007/s10151-020-02385-5 ◽

2021 ◽

Author(s):

F. Litta ◽

A. Parello ◽

L. Ferri ◽

N. O. Torrecilla ◽

A. A. Marra ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Fecal Incontinence ◽

Anal Fistula ◽

Randomized Clinical Trials ◽

Weighted Average ◽

Anal Fistulas ◽

Postoperative Continence ◽

Average Success Rate

Abstract Background Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple anal fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple anal fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple anal fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple anal fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple anal fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.

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Evaluation and surgical treatment of rectal prolapse: an international survey

Colorectal Disease ◽

10.1111/j.1463-1318.2012.03135.x ◽

2012 ◽

Vol 15 (1) ◽

pp. 115-119 ◽

Cited By ~ 49

Author(s):

H. A. Formijne Jonkers ◽

W. A. Draaisma ◽

S. D. Wexner ◽

I. A. M. J. Broeders ◽

W. A. Bemelman ◽

...

Keyword(s):

Surgical Treatment ◽

Rectal Prolapse ◽

International Survey

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Rectal Prolapse: Perineal Procedures

10.2310/surg.2406 ◽

2019 ◽

Author(s):

Steven D. Wexner ◽

Susan M. Cera ◽

Victoria Valinluck Lao

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Key Words ◽

Rectal Wall ◽

Preoperative Evaluation ◽

Full Thickness ◽

Recent Advances

Rectal prolapse is a condition wherein a full thickness intussusception of the rectal wall protrudes out of the anus. The diagnosis is rare, ~ 0.5% of the population, and occurs most often in elderly females. The diagnosis is associated with constipation, fecal incontinence, or both. The repair of rectal prolapse can be divided into perineal and abdominal procedures. In this review, we will discuss preoperative evaluation, management and planning as well as describe key widely accepted perineal procedures, the Delorme and Altemeier, and report recent advances. Abdominal procedure and advances in that arena will be discussed in a separate review. This review contains 9 figures, 7 tables, and 32 references. Key words: Rectal prolapse, perineal procedure, resection, Altemeier, Delorme, Thiersch wire, perineal stapled resection, levatoroplasty

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Surgical Treatment of Complete Rectal Prolapse: Results of Abdominal and Perineal Approaches

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.1999.9.235 ◽

1999 ◽

Vol 9 (3) ◽

pp. 235-238 ◽

Cited By ~ 20

Author(s):

PAOLO BOCCASANTA ◽

RICCARDO ROSATI ◽

MARCO VENTURI ◽

UGO CIOFFI ◽

MATILDE DE SIMONE ◽

...

Keyword(s):

Surgical Treatment ◽

Rectal Prolapse ◽

Complete Rectal Prolapse

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Role of Pudendal Canal Syndrome in the Etiology of Fecal Incontinence in Rectal Prolapse

Digestion ◽

10.1159/000201488 ◽

1997 ◽

Vol 58 (5) ◽

pp. 489-493 ◽

Cited By ~ 12

Author(s):

Ahmed Shafik

Keyword(s):

Fecal Incontinence ◽

Rectal Prolapse ◽

Pudendal Canal Syndrome ◽

Pudendal Canal ◽

Canal Syndrome

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Ligaments of the Rectum: Anatomical and Surgical Considerations

The American Surgeon ◽

10.1177/000313481408000323 ◽

2014 ◽

Vol 80 (3) ◽

pp. 275-283 ◽

Cited By ~ 2

Author(s):

Ordessia Charran ◽

Mitchel Muhleman ◽

Sameer Shah ◽

R. Shane Tubbs ◽

Marios Loukas

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Rectal Prolapse ◽

Anatomical Features ◽

The Subject

The ligaments of the rectum have been the subject of controversy for decades. Not only have their contents and components been a source of contention, but also the very existence of these ligaments has been called into question. This article explores the anatomical features of these ligaments with implications for surgical treatment of rectal prolapse, rectal cancer, and resection of the rectum and mesorectum. A theory about the evolution of the lateral rectal ligaments and the mesorectum in humans and higher mammals is also presented.

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