Surgically treated rectal prolapse: experience at a teaching hospital.

OBJECTIVE: To analyze our results regarding the surgical treatment of complete rectal prolapse performed at the Aga Khan University Hospital, from January 1988 to December 2003. METHODS: Files were retrieved from our medical records and data was reviewed for all adult patients admitted and operated upon for complete rectal prolapse during our study period. Long-term follow-ups were obtained through these files and also by contacting patients through telephone and letters. Data was recorded in a standardized two-page proforma and analysis was carried out between different variables using SPSS 10.0. RESULTS: A total number of twenty surgeries (n = 20) were performed. All patients had the presenting complaint of something coming out of anus, 70% (n = 14) patients complained of some bleeding per rectum, 30% (n = 6) had anal pain and 20% (n = 4) had faecal incontinence. Chronic constipation was found in 50% (n = 10) patients, obstructive uropathy in 30% (n = 6), weight loss, chronic cough and mental illness, each in 10 % (n = 2) of patients. Primary procedure was carried out in 70% patients. Mean operative time was 178 minutes; mean length of stay was 7 days with a mean follow-up of 25 months. Early complications were noted in 5% (n = 1) patients, and late complications in 30% (n = 6). Based on this data, comparative analysis was carried out between different variables. CONCLUSIONS: Surgery is the only treatment for rectal prolapse in adults. Several procedures are done suggesting that there is no standard treatment for this ailment. The number of male patients was higher, chronic constipation was the most common risk factor, abdominal rectopexy was the favored procedure, perineal procedures were associated with shorter operative time, hospital stay, and were done more often in females and elderly. Revision surgery was associated with longer operative time and hospital stay.