Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse

Abstract

A randomized trial was performed to compare abdominal resection rectopexy and pelvic floor repair (n = 10) with perineal rectosigmoidectomy and pelvic floor repair (n = 10) in elderly female patients with full-thickness rectal prolapse and faecal incontinence. There were no recurrences of full-thickness prolapse following resection rectopexy but one after rectosigmoidectomy. Continence to liquid and solid stool was achieved in nine patients, with faecal soiling reported in only two, after resection rectopexy and in eight, with soiling in six, following rectosigmoidectomy. The median (range) frequency of defaecation was only 1 (1–3) per day following resection rectopexy compared with 3 (1–6) per day after rectosigmoidectomy. There was an increase in the mean(s.d.) maximum resting pressure after resection rectopexy (19·3(15·28) cmH2O) compared with a reduction following rectosigmoidectomy (– 3·4(13·75) cmH2O) (P = 0·003). Mean(s.d.) compliance was also greater after resection rectopexy than following rectosigmoidectomy (3·9(0·75) versus 2·2(0·78) ml/cmH2O, P<0·001). Abdominal resection rectopexy gives better functional and physiological results than perineal rectosigmoidectomy.