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Perineal rectosigmoidectomy in the elderly

O B Johansen1, S D Wexner, N Daniel

  • 1Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309.

Diseases of the Colon and Rectum
|August 1, 1993
PubMed
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Perineal rectosigmoidectomy safely treats elderly patients with rectal prolapse. The procedure significantly improved continence in 90% of patients, even those with severe nerve damage.

Area of Science:

  • Colorectal Surgery
  • Geriatric Medicine
  • Gastroenterology

Background:

  • Full-thickness rectal prolapse affects the elderly, often leading to incontinence.
  • Surgical intervention is necessary for severe cases, but safety and efficacy in the elderly are key concerns.

Purpose of the Study:

  • To evaluate the safety and efficacy of perineal rectosigmoidectomy and coloanal anastomosis for full-thickness rectal prolapse in elderly patients.
  • To assess the impact of the procedure on fecal incontinence and the predictive value of pudendal nerve terminal motor latency (PNTML).

Main Methods:

  • A consecutive series of 20 elderly patients (mean age 82) with full-thickness rectal prolapse underwent perineal rectosigmoidectomy and coloanal anastomosis.
  • Patients were assessed using a detailed functional scale for incontinence and underwent physiologic testing, including PNTML.

Related Experiment Videos

  • Outcomes including continence scores, complications, recurrences, and PNTML results were analyzed.

    • Main Results:

    • The mean preoperative continence score (14.5) significantly improved to a mean postoperative score of 8.4.
    • 90% of patients experienced improved postoperative continence.
    • One postoperative death and one pelvic hematoma complication occurred. No recurrences were noted at a mean follow-up of 26 months.
    • Severe pudendal neuropathy was present in 60% of tested patients, but did not accurately predict poor postoperative continence outcomes.

    Conclusions:

    • Perineal rectosigmoidectomy is a safe and effective surgical option for elderly patients with full-thickness rectal prolapse.
    • The procedure leads to significant improvements in fecal incontinence, even in the presence of severe pudendal neuropathy.
    • PNTML is not a reliable predictor of functional outcomes after this surgery in this patient population.