Introduction Rectal prolapse is a disabling condition which is under-reported and affects the quality of life of our ageing population. Despite this there is ‘no accepted standard procedure’1a given patient should receive. The perceived risk of surgery has meant that elderly patients often undergo a perineal operation with an abdominal operation being reserved for younger patients or those with recurrence. Randomised controlled trials have found it challenging to recruit patients making comparison between outcomes difficult for abdominal and perineal operations.
Method The Surrey and South West London Pelvic floor group was founded in 2014 and includes the following hospitals – Ashford and St Peters Hospital, Croydon University Hospital, East Surrey Hospital, Epsom and St Heliers Hospital, Frimley Park Hospital, Kingston Hospital, Royal Berkshire Hospital, St Georges Hospital and Wexham Park Hospital.
All patients who underwent surgery for full thickness rectal prolapse between April 2011 and March 2013 were included. Data was collected retrospectively from the notes using a standardised proforma.
Results 244 patients underwent surgery for full thickness rectal prolapse in the study period. Seven patients were excluded due to incomplete data leaving 237 patients. All but four patients were female. Median age at time of operation was 78.4 years with an average ASA of 2.1. The recorded overall recurrence for all surgery was 17.7%. Median length of stay (LOS) was 2 days.
Conclusion In this retrospective multicentre study abdominal operations for full thickness rectal prolapse had a significantly lower rate of recurrence than the perineal approach. This was despite there being a higher proportion of patients in the abdominal group who had had previous surgery for rectal prolapse. Although patients in the abdominal group were younger and fitter there was no difference in length of stay and complication rates.
The rates of recurrence for perineal operations were similar1but the recurrence rate after abdominal operations was higher than previousy reported in the literature.1This may be a reflection of the individual learning curves for laparoscopic rectal prolapse surgery during the study period (2011–2013).
Disclosure of interest None Declared.
Senapati A, Gray RG, Middleton LJ, et al.; PROSPER Collaborative Group. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68