Author(s): Balakrishna Nanjundappa Setty1, Sushrutha C. Suresh2, Sathish Obalanarasimhaiah3, Aravinda Nirmala Kotresh4, Savitha Krishnagouda Karlwad5, Venugopal Hunasanahalli Giriyappa6, Vinay Boppasamudra Nanjegowda7, Nagesh Nayakarahalli Swamygowda8
Rectal prolapse is defined as protrusion of rectal wall through the anal canal. It is further classified into 3 different categories based on the extent of rectal prolapse called partial thickness (mucosal) rectal prolapse when only the mucosa is prolapsed through the anal verge, complete rectal prolapse (procidentia) involves full thickness of rectal wall prolapsing out of the anal verge and internal rectal prolapse (rectal intussusception) involves intussusception of the rectum into the anal canal without protrusion beyond the anal verge. Rectal prolapse can be partial to begin with and may or may not progress to complete rectal prolapse.
The aim of our study is to analyse and compare two surgical techniques laparoscopic suture rectopexy and Altemeier’s procedure available for the management of rectal prolapse along with the outcomes of both in a single centre.
MATERIALS AND METHODS
The study was conducted in Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute, Karnataka. It’s a retrospective observational study conducted between August 2012 and May 2016. The presenting feature, intraoperative events, postoperative course, complications and follow up were noted with regard to faecal incontinence, constipation and recurrent prolapse.
A total of 35 patients were included in this study. The male-to-female ratio was 1.7:1. The presenting feature being intermittent rectal prolapse in 31 (88%), irreducible rectal prolapse in 2 (5.7%) and 2 (5.7%) patients were operated for recurrent rectal prolapse. The presenting symptom in the patients were constipation in 14 (40%), incontinence in 5 (14.28%) and solitary rectal ulcer syndrome in 3 (8.6%). 20 patients (57.14%) underwent laparoscopic suture rectopexy with conversion to open in two patients. 15 (42.8%) patients underwent Altemeier’s procedure. The average total duration of hospital stay for patients with suture rectopexy was 3.05263 days and for Altemeier’s procedure was 5.73333 days with a statistically significant difference (p value <0.001). Morbidity in the suture rectopexy group was seen in 3 patients and in Altemeier’s group in 7 patients. No recurrence was seen in our follow up of 1 to 2 years.
Successful treatment of rectal prolapse is accomplished by restoration of both the anatomy and physiology of the rectum. Although, no significant differences were seen in randomised studies, the treatment should be individualised to attain satisfactory results in terms of postop bowel movements and to prevent recurrences. In our study, we observed that the patients undergoing laparoscopic suture rectopexy had higher incidence of constipation postoperatively and patients undergoing Altemeier’s had higher incidence of incontinence postoperatively.