Evaluation of Open Abdominal Ventral Rectopexy for Management of Complete Rectal Prolapse in Adult Male Patients

Abstract Background: Circumferential full-thickness protrusion of the rectal wall through the anus is not an uncommon surgical problem that is known as complete rectal prolapse. Many factors were accused for the pathogenesis of this clinical problem, such as straight rectum, weak fascial attachments of the rectum against the sacrum, a long redundant sigmoid colon, deep Douglas pouch, and a weak anus. Neurological illnesses, connective tissue disorders, and high parity were also found to be causes for rectal prolapse. In addition, rectal prolapse occurs more at the extremes of age. The multi-factorial etiologies of this disease resulted in a difficulty in planning for the proper treatment which is required to restore both anatomical and functional outcomes. Aim of Study: To evaluate open abdominal Ventral Rec-topexy (VR) for management of rectal prolapse in adult male patients regarding recurrence and post-operative complications. Patients and Methods: This is a retrospective study that included all adult male patients who underwent open VR for complete rectal prolapse in Colorectal Surgery Unit, Alexandria Main University Hospital during the period from January 2014 to December 2017. Data was retrieved through patients' files regarding pre-operative, operative and post-operative data, including pre-operative and post-operative Wexner score. Post-operative early and late complications were also reported. Post-operative urinary dysfunction (using International Prostate Symptom Score), sexual activity (using International Index for Erectile Function) and patients' satisfaction (using a scale from 1-5) were determined by communication with the patients through their contact numbers. Results: Thirty five patients were included in the study with a mean age of 36.3±12.9 years. Four patients (11.4%) had recurrence after a mean of 7.8±3.4 months. Out of 14 patients who reported pre-operative constipation, 10 patients reported improvement, while two patients reported newly developed constipation. Post-operatively, there was significant improvement of continence status. Patients showed satisfactory results regarding post-operative urinary dysfunction and sexual activity. Thirty patients (85.7%) were satisfied by the results of the operation.
Conclusions: Ventral rectopexy for management of com-plete rectal prolapse in male patients seems to be safe and effective, with low recurrence rate and high patients' satisfac-tion regarding improved fecal incontinence, urinary dysfunction and maintained sexual activity. Prospective randomized control trials may be necessary to substantiate our results.