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Perineal proctectomy for rectal prolapse in elderly and debilitated patients
1Department of Surgery, Alfred Hospital, Caulfield, Victoria, Australia.
Insights
Perineal proctectomy effectively manages complete rectal prolapse in elderly, high-risk patients. This low-risk surgery offers successful outcomes with minimal complications, even if recurrence requires repeat procedures.
Area of Science:
- Colorectal Surgery
- Geriatric Surgery
Background:
- Complete rectal prolapse poses significant challenges, particularly in elderly and debilitated patients.
- Traditional surgical approaches may carry high risks for this vulnerable population.
Purpose of the Study:
- To evaluate the indications, surgical technique, and outcomes of perineal proctectomy for complete rectal prolapse.
- To assess the safety and efficacy of this procedure in high-risk, elderly patients.
Main Methods:
- Retrospective analysis of hospital records and postal questionnaires.
- Study included 16 consecutive elderly patients (mean age 81) with complete rectal prolapse undergoing perineal proctectomy.
- Follow-up ranged from 3 to 37 months (mean 16 months).
Main Results:
- No postoperative mortality observed in 18 procedures.
- Successful prolapse control in 15 out of 16 patients.
- Continence improved in 7 patients; low morbidity with minor complications like hemorrhage and stricture.
Conclusions:
- Perineal proctectomy is a safe and effective low-risk option for managing complete rectal prolapse in elderly and debilitated individuals.
- The procedure demonstrates good long-term success rates and can be safely repeated if prolapse recurs.
Abstract:
This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff. There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow-up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re-operated for recurrent symptomatic prolapses at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse. Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.