Institutional members access full text with Ovid®

Share this article on:

Is the Abdominal Repair of Rectal Prolapse Safer than Perineal Repair in the Highest Risk Patients? An NSQIP Analysis

Fang, Sandy H. M.D.1; Cromwell, John W. M.D.2; Wilkins, Kirsten B. M.D.1; Eisenstat, Theodore E. M.D.1; Notaro, Joseph R. M.D.1; Alva, Suraj M.D.1; Bustami, Rami Ph.D., M.B.A.3; Chinn, Bertram T. M.D.1

doi: 10.1097/DCR.0b013e31826ab5e6
Original Contributions: Benign Colorectal Disease

BACKGROUND: Although the perineal approach in the surgical management of rectal prolapse has a higher recurrence, it is the accepted approach for higher-risk patients because of its lower morbidity.

OBJECTIVE: The aim of this study was to determine outcomes of abdominal versus perineal approaches to rectal prolapse repair.

DESIGN SETTINGS: A retrospective study was performed comparing outcomes of patients undergoing different types of surgical approaches (open abdominal, laparoscopic, perineal) for rectal prolapse.

PATIENTS: The American College of Surgeons National Surgical Quality Improvement Participant User Data Files (2008–2009) were queried for patients undergoing adult, elective procedures for rectal prolapse.

MAIN OUTCOME MEASURES: Univariate analysis and multivariate logistic regression were performed to look at age, ASA classification, procedure type, and resultant mortality rate.

RESULTS: One thousand four hundred sixty-nine patients meeting our criteria were identified. Older patients (age>80) and higher-risk patients (ASA classifications 3and 4) were significantly associated with the selection of the perineal approach. The overall mortality rate was 0.5%. The mortality rate for all perineal procedures was 0.9% in comparison with 0.13% for all abdominal operations (p = 0.033). The mortality rate for the highest-risk groups (ASA 3 and 4) for perineal procedures was 1.3% in comparison with 0.35% in the abdominal procedure group; the relative risk for mortality was 4 times greater in the perineal procedure group than in the abdominal procedure group.

LIMITATIONS: The retrospective design and standardized outcomes measured use administrative-level data and prevent the assessment of procedure-specific outcomes.

CONCLUSIONS: Hospital mortality for the surgical repair of rectal prolapse is uncommon. The decision to choose the abdominal approach for the repair of rectal prolapse may not be as prohibitive as previously thought for higher-risk patients. Because of the broad range of functionality within each ASA classification, the operation offered should always be individualized, and patient selection is the most important factor.

1Division of Colon and Rectal Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson University Hospital, New Brunswick, New Jersey

2Division of Gastrointestinal Surgery, Minimally-Invasive and Bariatric Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa

3Division of Biostatistics, Atlantic Health System, Morristown, New Jersey

Funding/Support: Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242.

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Sandy H. Fang, M.D., Associated Colon and Rectal Surgeons, P.A., 3900 Park Ave, Suite 101, Edison, NJ 08820. E-mail:

© The ASCRS 2012