Rectal procidentia treatment by perineal rectosigmoidectomy combined with levator ani repair

Perineal rectosigmoidectomy has gained acceptance as a valid alternative to treat rectal procidentia with the advantage of decreased surgical risk, shorter recovery time, and lower complication rates when compared to abdominal approaches, although controversies still exist about its recurrence rates and functional results. This study aimed to evaluate the results of perineal rectosigmoidectomy combined with repair of the levator ani muscles to treat rectal procidentia.

Forty-four patients who underwent perineal rectosigmoidectomy with levatorplasty for rectal procidentia between 1985 and 2000 were retrospectively analyzed.

There were 41 women and 3 men with mean age of 76 (57 to 96) years. Mean duration of symptoms was 29.2 (1 to 40) months. Mean length of prolapsed rectum was 8.3cm and the average size of the resected segment was 21.2cm. The complication rate was 9.1% and there was no mortality associated with this procedure. Mean hospital stay was 3.9 days. During a minimum period of follow-up of 24 months (24-120) with a mean of 49 months, the recurrence rate was 7.1% (two patients presented recurrence of procidentia and another prolapse of the rectal mucosa). Anal continence improved in 36 (85.7%) patients.

Perineal rectosigmoidectomy combined with levatorplasty is a safe procedure associated with a relatively low morbidity rate, satisfactory functional results, and an acceptably low recurrence rate.