Surgical treatment of complete rectal prolapse

ABSTRACT

Shafik levatorplasty operation has been used to treat 24 consecutive patients with complete rectal prolapse. The mean age in this group was 50 years and the average length of the prolapse was 10 cms. There was no postoperative mortality. The follow up ranged from 5-18 months with a mean duration of 11.5 months and so far there has been two recurrences. One of these has been successfuly treated by a second Shafik levatorplasty operation. The second will repeat the procedure. All the incontinent patients became continent except one became incontinent to flatus only. These favourable results in term of recurrence and function [incontinence] would encourage surgeons to do it as a first choice operation in complete rectal prolapse if longer periods of follow up showed the same results. The surgical treatment of complete rectal prolapse remains controversial. Most procedures are a variation of a few basic modes of therapy and depend on the surgeon's concept of the anatomic defect. The options for treatment include narrowing of the anal orifice [Thiersch 1891], obliteration of the peritoneal pouch of Douglas [Moschcowita 1912], restoration of the pelvic floor [Mc Cann 1928] . Resection of the bowel by abdominal [Muir 1955], perineal [Miles 1933] or sacral [Thomas and jen kins 1965] approaches and lastly suspension or fixation of the rectum to the sacrum or to other structures [Hughes 1949, Graham 1942, Ripstein 1965]. Recently Shafik introduced a new concept of pathogenesis of rectal prolapse [Shafik 1981] and accordingly he suggested a new technique for treatment [Shafik 1987] with favourable results. This encourages us to evaluate the procedure in our unit in Kasr-el-Eini hospital and all the admitted patients treated with this technique