Rectal prolapse, internal rectal intussusception and the ripstein rectopexy : a clinical, physiological and radiological study

Abstract

The aim of these studies was to increase the knowledge about rectal prolapse and internal rectal intussusception, with special reference to bowel function and treatment with the Ripstein rectopexy.

Results after the Ripstein rectopexy in 69 patients with rectal prolapse and in 43 patients with internal metal intussusception were evaluated. There was no operative mortality and early postoperative morbidity was 33%. The majority of complications were minor. Severe early complications were one faecal impaction and one ureteral stricture. Recurrencies and late complications were studied in 63 of the patients with rectal prolapse. Median length follow-up was 7.0 (range, 1.7-16.5) years. There was one recurrence. Forty-two of the patients with internal rectal intussusception were followed-up during median 5.4 (range, 1.1-16.5) years. Severe complications were two rectovaginal fistulae and one faecaloma in the sigmoid colon with perforation and lethal peritonitis. Pre- and postoperative functional evaluation was carried out in 76 patients. Anal continence improved postoperatively and the number of bowel movements per week decreased. Emptying difficulties did not change significantly in patients operated for rectal prolapse but increased in those operated for internal rectal intussusception.

Results of repeated defaecography studies in patients with internal rectal intussusception were analyzed. Among 38 patients with a second investigation after mean 5.6 (range, 1.1-19.5) years one had developed a rectal prolapse. The remaining patients were further followed-up: one developed a rectal prolapse, 7 underwent surgery for internal metal intussusception, 29 did not develop a rectal prolapse during a mean follow-up of 5.8 (range, LO- 14.6) years.

Anorectal manometry was carried out preoperatively and 7 days and 6 months postoperatively in 42 patients. Patients operated on for rectal prolapse had increased anal maximum resting pressure 6 months postoperatively but not after 7 days. Anal maximum squeeze pressure did not change significantly. No significant changes in anal maximum resting or squeeze pressures were seen in the patients with internal rectal intussusception. Anal continence improved.

Preoperative electrophysiological assessment (conventional needle EMG, FD-assessment and pudendal nerve latency) was compared with pre- and postoperative functional evaluation regarding anal continence in 43 patients. Electrophysiological examination could not predict the outcome of Ripstein rectopexy with respect to anal continence.

Whole gut transit studies were undertaken pre- and postoperatively in 30 patients. Retention of markers increased after the Ripstein rectopexy. The number of bowel movements per week decreased but constipation was mainly experienced as emptying difficulties. There was a correlation between preoperative retention of markers and postoperative emptying difficulties.

Conclusion: Rectal prolapse and internal rectal intussusception can be treated by the Ripstein rectopexy with low mortality and low frequency of serious complication. Tle functional putcome.is difficult to predict. Anal continence is often improved. Emptying difficulties often increase in patients with internal rectal intussusception. The risk of developing a rectal prolapse is small in patients with internal rectal intussusception.