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Does the Length of the Prolapsed Rectum Impact Outcome of Surgical Repair? Diseases of the colon and rectum Nugent, E., Spivak, A., Gurland, B., Shawki, S., Hull, T., Zutshi, M. 2021

Abstract

BACKGROUND: There are many surgical options for the treatment of rectal prolapse with varying recurrence rates reported. The association between rectal prolapse length and recurrence risk has not been explored previously.OBJECTIVE: To determine if length of prolapse predicts a risk of recurrence.DESIGN: Consecutive patients from a prospectively collected IRB approved data registry were evaluated.SETTING: Department of colorectal surgery at the Cleveland Clinic, Ohio.PATIENTS: All patients from 2010 - 2018 who underwent surgical intervention for rectal prolapse.INTERVENTION: Perineal repair including Delorme procedure and Altemeier. Abdominal repair including ventral rectopexy, resection rectopexy and posterior rectopexy.MAIN OUTCOME MEASURES: Prolapse length, recurrence, type of surgery and primary or secondary procedure.RESULTS: In total 280 patients had prolapse surgery over 8 years, mean age 59 years (SD 18) and 92.4% were female. Seventy percent had a prolapse length documented as <5 cm and 30% had prolapse length documented as >5 cm. The mean prolapse length was 4.8 cm (SD 2.9). The overall rate of recurrent prolapse was 18%. There were 51 patients who had a recurrent prolapse after their first prolapse surgery. Factors significant for recurrence on univariate analysis were a perineal approach (p=0.03), previous Delorme procedure (p<0.001) and prolapse length > 5 cm (p=0.04). On multivariate analysis there was significantly increased recurrence with length of prolapse >5 cm (OR 2.2, 95% CI 1.09-4.4, p=0.02) and having a previous Delorme procedure (OR 4, 95% CI 1.6-10.1, p=0.004). For each 1 cm increase in prolapse the odds of recurrence increased by a factor of 2.2.LIMITATIONS: Retrospective study of a heterogenous patient cohort.CONCLUSION: The greater the length of prolapsed rectum the greater the risk of recurrence. The length of prolapse should be considered when planning the most appropriate surgical repair to modify the recurrence risk. See Video Abstract at http://links.lww.com/DCR/B463.

View details for DOI 10.1097/DCR.0000000000001856

View details for PubMedID 33463998