Repair of rectal prolapse: experience with the Ripstein sling.

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Outcomes Research

Background:

• Rectal prolapse is a condition requiring surgical intervention.
• Previous surgical methods for rectal prolapse had high recurrence or complication rates.
• A potential association between rectal prolapse and solitary rectal ulcer syndrome (SRUS) has been suggested.

Purpose of the Study:

• To assess the outcomes of surgical treatments for rectal prolapse.
• To evaluate the effectiveness and safety of the Ripstein sling procedure.
• To investigate the relationship between rectal prolapse and solitary rectal ulcer syndrome.

Main Methods:

• Retrospective review of 48 patients with rectal prolapse treated between 1955 and 1977.
• Comparison of the Ripstein sling procedure (used since 1970) with prior methods: perineal (Altemeer), sigmoidectomy, and Thiersch procedures.
• Assessment of recurrence rates, complication rates, and patient satisfaction.

Main Results:

• The Ripstein sling procedure demonstrated low recurrence (2/21 patients) and low morbidity (2/21 patients with overly tight slings).
• Previous surgical procedures were associated with high recurrence or complication rates.
• Twenty out of 21 questioned patients found the Ripstein procedure results satisfactory.
• Symptoms of SRUS and rectal prolapse are similar, possibly representing different responses to the same stimulus, with SRUS largely unaffected by prolapse repair.

Conclusions:

• The Ripstein sling procedure is an effective and safe surgical option for rectal prolapse repair.
• The Ripstein procedure offers significant advantages over older surgical techniques due to its low recurrence and morbidity.
• Solitary rectal ulcer syndrome appears distinct from rectal prolapse, despite symptom overlap, and is not significantly improved by prolapse repair.