ABDOMINAL RECTOPEXY FOR RECTAL PROLAPSE - A COMPARISON OF TECHNIQUES

To compare the methods of abdominal rectopexy and to elucidate the mechanism by which rectopexy restores continence in patients with rectal prolapse, the role of sphincter recovery, rectal morphological changes and improved rectal sensation were assessed in 68 patients (eight men, 60 women) of median age 63 (range 18-83) years undergoing resection rectopexy (n = 29), anterior and posterior Marlex(R) rectopexy (n = 20), posterior Ivalon(R) rectopexy (n = 9) or suture rectopexy (n = 10). Preoperative and postoperative manometry, radiology and electrosensitivity measurements were made. Age and duration of follow-up were similar in all groups and the prolapse was controlled in all patients. Significantly improved continence was seen in all but the Ivalon group. There was no evidence of increasing postoperative constipation. Sphincter length and voluntary contraction were unaltered, but improved resting tone was seen in the resection and suture groups. This was not seen in the prosthetic groups. Improved continence correlated with recovery of resting pressure. Upper anal sensation was improved in all groups. Radiological changes did not correlate with improved continence. We conclude that continence is improved by all rectopexy procedures but seems better without prosthetic material. Sphincter recovery seems to be the most important factor.