DOI: http://dx.doi.org/10.18203/2349-2902.isj20203488

Assessment of incidence of recurrence and constipation in patients of rectal prolapse undergoing rectal mobilization only with division of lateral stalks

Devendra Chowdhary, Jyoti S. Maran, Gaurav Singh Rajput

Abstract


Background: Rectal prolapse is a pelvic floor disorder that can occur in men and women of all ages. It results in pain, bleeding per rectum, seepage, diarrhoea or constipation and a disabled quality of life. With the advent of twentieth century, perineal operative procedures have become more common. Perineal procedures though have lower morbidities but have higher recurrence rate and high incidence of post-operative constipation. Novel abdominal approaches to rectal prolapse repair also became common during the first half of this century. Numerous types of surgical procedures have been attempted. Most techniques developed till now have some advantages and some short comings. CT Speakman and Pollen et al have shown in their studies   that division of lateral ligaments caused new onset constipation and they attributed this effect to denervation of rectum. As the issue of recurrence and post-operative constipation remained unsettled.

Methods: This was an observational study to assess the incidence of recurrence and post-operative constipation in patients of rectal prolapse. In well selected patients, we performed complete rectal mobilization with division   of lateral ligaments. We assessed the patients on the basis of Clevland clinical constipation scoring system.

Results: Out of 25 patients, 4 patients developed constipation, 2 had mild and 2 had moderate constipation and 2 patients had recurrence. Patients were kept under six monthly follow-up till a period of eighteen months.

Conclusions: Only rectal mobilization with division of lateral ligaments can be a good surgical option in patients of rectal prolapse not having severe constipation.


Keywords


Rectal prolapse, Rectal mobilization, Division of lateral pedicles

Full Text:

PDF

References


Varma MG. Overview of rectal procidentia (rectal prolapse). Dis Colon Rectum. 2017;60:1132-5.

Greene FL. Repair of rectal prolapse using a pubo-rectal sling procedure. Archives Surg. 1983;118(4):398-401.

Cannon JA. Evaluation, diagnosis, and medical management of rectal prolapse. Clinics Colon Rectal Surg. 2017;30(01):16-21.

Cannon JA. Evaluation, diagnosis, and medical management of rectal prolapse. Clinics Colon Rectal Surg. 2017;30(01):16-21.

Liu LW. Chronic constipation: current treatment options. Canadian J Gastroenterology Hepatology. 2011;25(B):22B-8B.

Yoon SG. Rectal prolapse: review according to the personal experience. J Korean Society Coloproctology. 2011;27(3):107.

Shin EJ. Surgical treatment of rectal prolapse. Journal Korean Society Coloproctol. 2011;27(1):5.

Hamel CT, Wexner SD. Rectal prolapse. In Surgical Treatment: Evidence-Based and Problem-Oriented. Zuckschwerdt. 2001;27(1):5-12.

Joubert K, Laryea JA. Abdominal approaches to rectal prolapse. Clinics Colon Rectal Surg. 2017;30(01):57-62.

RF. Pelvic floor anatomy and the surgery of pulsion enterocoele. Springer Science and AMP; Business Media; 2013.

Speakman CT, Madden MV, Nicholls RJ, Kamm MA. Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. British J Surg. 1991;78(12):1431-3.

Nelson R, Spitz J, Pearl RK, Abcarian H. What role does full rectal mobilization alone play in the treatment of rectal prolapse. Techniques Coloproctol. 2001;5(1):33.

Chen AF. Cleveland clinical constipation score: a constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39:681.

Cirocco WC. The Altemeier procedure for rectal prolapse: an operation for all ages. Diseases Colon AMP Rectum. 2010;53(12):1618-23.

Gama HA, Jacob CE, Jorge JM, Seid VE, Marques CF, Mantese JC, et al. Rectal procidentia treatment by perineal recto-sigmoidectomy combined with levatorani repair Hepato-gastroenterology. Int J Surg. 2006;53(68):213-7.

Mengensatzproduktion S, Stuckle D. The 51st Congress of the European Society for Surgical Research. May 25-28, 2016, Prague, Czech Republic: Abstracts. European Surg Res. 2016;57(1):1-41.

Mollen RM, Kuijpers JH, Hoek VF. Effects of rectal mobilisation and lateral ligaments division on colonic and anorectal function. Diseases Colon AMP Rectum. 2000;43(9):1283-7.

Nirnhuis,JE. De rectum prolaps. Erasmus University Rotterdam, 1983 Available at: http://hdl.handle.net/1765/37541. Accessed on 10 January 2019