Most Common Complication of Rectal Prolapse Surgery
Recurrence is the most common complication following corrective surgery for rectal prolapse, with rates varying significantly based on surgical approach—perineal procedures show recurrence rates of 5-21% (up to 40% in some series), while abdominal approaches demonstrate substantially lower rates of 0-8%. 1, 2
Complication Hierarchy by Frequency
Primary Complication: Recurrence
- Perineal approaches (such as perineal rectosigmoidectomy) carry the highest recurrence burden at 5-21%, with some studies reporting rates as high as 40% 1
- Abdominal approaches (rectopexy with or without resection) demonstrate significantly lower recurrence rates of 0-8% 1, 2
- One large series of perineal rectosigmoidectomy showed 10% recurrence rate over 3-90 months of follow-up 3
Secondary Complications: Functional Disorders
Incontinence is the second most clinically significant complication, though it represents both a pre-existing condition that may persist and a potential surgical outcome:
- Fecal incontinence affects many patients preoperatively and may improve or persist postoperatively 3
- In one series, 67 patients had preoperative incontinence; only 26 of 56 (46%) who underwent perineal rectosigmoidectomy alone improved or regained continence 3
- Abdominal approaches show superior outcomes for resolving associated fecal incontinence 2
Constipation represents another important functional complication:
- Develops postoperatively especially when lateral ligaments are divided during rectopexy 1
- Division of lateral ligaments is associated with less recurrent prolapse but more post-operative constipation 4
- Adding sigmoid resection to rectopexy reduces post-operative constipation rates in patients with pre-existing constipation 5
Tertiary Complications: Perioperative Issues
Infection occurs at lower rates than recurrence 1:
- Urinary tract infections are reported in various series 6
- Wound infections occur but remain relatively uncommon 6
Bleeding is reported at 2-5% across techniques 6
Clinical Context
The question asks specifically about complications of "correcting surgery," and the evidence clearly establishes a hierarchy: recurrence >> incontinence (as a persistent/worsening problem) > infection > bleeding. Fecal impaction is not prominently featured in the surgical complication literature for rectal prolapse repair and appears to be a distractor option.
The choice of surgical approach directly impacts complication profiles, with perineal procedures trading higher recurrence for lower perioperative morbidity, while abdominal approaches offer superior recurrence rates at the cost of slightly higher operative complexity 2, 7.