From the Guidelines
The most common complication after surgical correction of full thickness rectal prolapse is constipation (option D). This is based on the evidence from the study by Bharucha et al. 1, which states that after posterior rectopexy, 50% of patients complain of severe constipation. Additionally, perineal procedures have a similar incidence of constipation 1. The complications of surgical correction of full thickness rectal prolapse can be broken down into:
- Recurrence rates for transabdominal rectopexy, which are low (0–8%) 1
- Recurrence rates for perineal procedures, which range from 5–21% 1
- Constipation, which affects 50% of patients after posterior rectopexy and has a similar incidence in perineal procedures 1
- Infection and incontinence, which are potential complications but are not as commonly reported as constipation in the context of this specific surgical correction 1 Given the patient's symptoms of soiling, protruding mass, and incontinence, and the planned surgical correction, constipation is the most likely complication to occur post-surgery. It is essential to consider the patient's overall health and the potential risks and benefits of each surgical approach to minimize the risk of complications and optimize outcomes. The study by Bharucha et al. 1 provides valuable insights into the complications associated with surgical correction of full thickness rectal prolapse, highlighting the importance of careful patient selection and surgical technique to reduce the risk of constipation and other complications.
From the Research
Complications of Surgical Correction for Full Thickness Rectal Prolapse
- The most common complications of surgical correction for full thickness rectal prolapse include:
- Constipation: This is a significant complication, with studies showing that division of the lateral ligaments during rectopexy can lead to more postoperative constipation 2.
- Recurrence: The recurrence rate of full-thickness prolapse is a concern, with one study showing that mobilisation of the rectum only compared with rectopexy had a higher recurrence rate 2.
- Infection and other complications: While less common, other complications such as infection, bleeding, and port-site abscess can occur 3, 4.
- The choice of surgical technique can impact the risk of complications, with laparoscopic resection rectopexy showing benefits in terms of perioperative results and short-term outcome 5, 4.
- Long-term follow-up is necessary to fully assess the effectiveness of surgical correction and the risk of complications, with one study showing that laparoscopic resection rectopexy can lead to improvement or complete elimination of constipation and incontinence in a significant proportion of patients 4.
Factors Influencing Complications
- Previous perineal or open abdominal operations can increase the risk of recurrence after laparoscopic resection rectopexy 4.
- The technique used for fixation during rectopexy may not significantly impact the risk of complications, but division of the lateral ligaments can lead to more postoperative constipation 2.
- The use of bowel resection during rectopexy may be associated with lower rates of constipation 2, 6.