Major Complications After Rectal Prolapse Surgery
Incontinence is the major complication after surgery for rectal prolapse. 1
Understanding Post-Surgical Complications in Rectal Prolapse
Rectal prolapse surgery aims to correct the anatomical defect while minimizing functional complications. The three main complications after rectal prolapse surgery are:
- Incontinence - Most significant complication
- Constipation
- Infection
Incontinence as the Primary Complication
According to the Clinical Gastroenterology and Hepatology guidelines, incontinence is a significant adverse event following rectal prolapse surgery, particularly with procedures like STARR (Stapled Transanal Rectal Resection) 1. The guidelines specifically note that 15% of STARR patients experienced adverse events including incontinence, which was occasionally severe enough to require further surgery.
Surgical Approaches and Associated Complications
Different surgical approaches carry different risks of complications:
Abdominal Approach
- Recurrence rate: Low (0-8%)
- Constipation: High risk (50% of patients after posterior rectopexy)
- Incontinence: May worsen with bowel resection in patients with pre-existing diarrhea 1
Perineal Approach
- Recurrence rate: Higher (5-21%)
- Incontinence: Significant risk
- Perioperative morbidity: Lower than abdominal approach 1
Risk Factors for Post-Surgical Incontinence
Several factors contribute to post-surgical incontinence:
- Pre-existing sphincter weakness
- Extensive rectal mobilization during surgery
- Division of lateral ligaments
- Alteration of rectal compliance after surgery
- Advanced age of patient
Surgical Technique Considerations
The choice of surgical technique significantly impacts functional outcomes:
- Ventral rectopexy may have a beneficial effect on obstructed defecation with lower rates of post-operative constipation 2
- Resection rectopexy shows improvement in incontinence in 67.3% of patients, but still leaves approximately 23% with persistent incontinence 3, 4
- Laparoscopic approaches have shown benefits regarding perioperative results but still carry risks of functional complications 3
Prevention and Management
To minimize the risk of post-operative incontinence:
- Careful patient selection for the appropriate surgical approach
- Preservation of lateral ligaments when possible
- Avoid bowel resection in patients with pre-existing diarrhea or incontinence
- Consider laparoscopic ventral rectopexy which appears to have lower rates of severe post-operative functional complications 2
Conclusion
While all three complications (incontinence, constipation, and infection) can occur after rectal prolapse surgery, incontinence represents the most significant functional complication with the greatest impact on quality of life. The surgical approach should be carefully selected based on the patient's pre-existing bowel function, age, and comorbidities to minimize this risk.