What is the most common complication of surgical correction for full thickness rectal prolapse?

Most Common Complication of Rectal Prolapse Surgery

Recurrence is the most common complication following surgical correction of full-thickness rectal prolapse, with rates varying significantly based on the surgical approach chosen.

Complication Rates by Surgical Approach

The choice of surgical technique dramatically impacts complication profiles:

Perineal Procedures (Altemeier's)

• Recurrence rates range from 5-21%, making this the most common complication for perineal approaches 1, 2
• Some studies report recurrence rates as high as 40% with perineal techniques 2
• The perineal approach (Altemeier procedure) is typically reserved for elderly patients or those with significant medical comorbidities 1

Abdominal Procedures (Rectopexy)

• Recurrence rates are significantly lower at 0-8% 1, 2, 3
• However, constipation becomes a major concern, affecting up to 50% of patients after posterior rectopexy 1
• Laparoscopic rectopexy shows fewer postoperative complications and shorter hospital stays compared to open approaches 1, 4

Ranking of Complications by Frequency

Based on the guideline evidence, complications occur in this order of frequency:

1. Recurrence: Most common overall, especially with perineal approaches (5-21%) 1, 2
2. Constipation: Particularly common after abdominal rectopexy (up to 50%), especially when lateral ligaments are divided 1, 5
3. Persistent/residual incontinence: Improves in most patients but persists in some 1, 6
4. Infection: Occurs at lower rates than recurrence 2
5. Bleeding: Less commonly reported as a major complication 1

Key Clinical Considerations

Factors Affecting Recurrence Risk

• Division of lateral ligaments during rectopexy reduces recurrence but increases constipation 1, 4
• Adding levatoroplasty to perineal procedures may reduce recurrence risk 1

Surgical Decision Algorithm

• For younger, healthier patients: Choose abdominal approach (lower recurrence 0-8%) 3, 7
• For elderly or high-risk patients: Accept higher recurrence risk (5-21%) with perineal approach for lower perioperative morbidity 1, 3
• For patients with pre-existing constipation: Consider adding sigmoid resection to reduce postoperative constipation 1, 7
• Avoid bowel resection in patients with pre-existing diarrhea or incontinence, as symptoms may worsen 1, 3

Answer to the Question

For the Altemeier procedure specifically mentioned in the question, recurrence (Option B) is the most common complication, with rates of 5-21% and potentially as high as 40% 1, 2. While constipation is extremely common after abdominal approaches (up to 50%), it is less prominent after perineal procedures like the Altemeier 1.