What is the most common complication of surgical correction for full-thickness rectal prolapse, characterized by symptoms including soiling, protruding mass, and fecal incontinence (inability to control bowel movements)?

From the Guidelines

The most common complication following 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 patient's presentation with a two-year history of full thickness rectal prolapse accompanied by soiling, protruding mass, and incontinence requires surgical intervention, and the risk of constipation should be considered and discussed with the patient. Some key points to consider in this case include:

• The surgical approach chosen can influence the risk of complications, with abdominal procedures generally having lower recurrence rates, but potentially higher rates of constipation
• The patient's age, tissue quality, and presence of connective tissue disorders can also influence the risk of complications
• Proper patient selection for each surgical approach and meticulous surgical technique are essential to minimize the risk of complications, including constipation
• The study by Bharucha et al. 1 provides the most recent and highest quality evidence on this topic, and should be considered when making treatment decisions. Key complications to consider in this case include:
• Constipation: 50% of patients complain of severe constipation after posterior rectopexy 1
• Recurrence: varies depending on the surgical approach chosen, with abdominal procedures generally having lower recurrence rates (0-8%) compared to perineal approaches (5-21%) 1
• Incontinence: can occur postoperatively, but is not the most common complication
• Infection: can occur postoperatively, but is not the most common complication.

From the Research

Complications of Surgical Correction for Full Thickness Rectal Prolapse

The most common complications of the corrective procedure post-surgery for full thickness rectal prolapse include:

• Constipation: This is a significant issue, as division of the lateral ligaments during rectopexy is associated with more postoperative constipation 2.
• Recurrence: The recurrence rate for full-thickness rectal prolapse can be significant, with rates varying depending on the surgical approach and patient factors 2, 3, 4.
• Infection and other complications: While not as commonly discussed in the context of long-term outcomes, infection and other complications can occur post-surgery 3, 5.
• Incontinence: Some patients may experience improvements in incontinence post-surgery, while others may experience de novo or worsened incontinence 6, 5.

Factors Influencing Complications

Several factors can influence the risk of complications post-surgery, including:

• Surgical approach: The choice of surgical approach, such as abdominal vs. perineal, can impact the risk of complications 2, 4.
• Patient factors: Age, comorbidities, and previous surgical history can all impact the risk of complications post-surgery 3, 4.
• Technical factors: The technique used during surgery, such as division of the lateral ligaments, can impact the risk of complications 2.