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Rectal prolapse, or procidentia, is a relatively uncommon clinical entity characterized by protrusion of full-thickness rectal wall through the anal orifice. Although prolapse has been recorded as early as the ancient Egyptians (Ebers papyrus, c. 1500 BC), the exact incidence of prolapse is not known(1). Despite its infrequency, a plethora of surgical options exist to treat rectal prolapse. These include perineal approaches (Altemeier and Delorme procedures) and abdominal approaches (rectopexy with or without resection). Laparoscopic techniques can be applied in appropriate cases. Despite this extensive surgical armamentarium, postoperative recurrence of rectal prolapse is reported in 10-;20% of cases(2). This article reviews our experience over a 10-year period and outlines the current understanding of the causes of prolapse, the evaluation of the patient with prolapse, and the more commonly used surgical alternatives.
PATIENTS AND METHODS
After institutional IRB approval, a retrospective analysis of patients who underwent surgical repair of rectal prolapse at a single tertiary care institution (Ochsner Clinic Foundation, New Orleans, LA) between May 1, 1995, and January 1, 2005, was performed. All surgical interventions were performed by staff surgeons in the Department of Colon and Rectal Surgery.
A comprehensive review of clinic and hospital records was performed, with abstraction of data pertaining to patient age, gender, symptoms at time of clinical presentation, type of surgical procedure performed, postoperative length of hospitalization, morbidity and mortality, and recurrence of prolapse during the follow-up period. The time to recurrence, when applicable, was calculated between the date of the initial operation and the date of clinical presentation with signs and symptoms of recurrent prolapse.
Mean length of stay was compared using an unpaired t-test with p < 0.05 considered significant.
RESULTS
Over a 10-year period, 75 patients underwent surgical repair of primary rectal prolapse. Sixty-eight patients (91 %) were female, and seven (9%) were male. The average patient age was 60.8 ± 19.9 years. The most frequent complaint at the time of clinical presentation was the sensation of a protruding rectal mass (n = 74, 98.7%). Additional symptoms and clinical findings included painful defecation (n = 27, 36%), fecal incontinence (n = 29, 38.7%), rectal bleeding (n = 19, 25.3%), constipation (n = 19, 25.3%), and rectal ulcer (n = 6, 8%).
The surgical...