Comparative analysis of the results of surgical treatment of rectal prolapse

Akilov H.A.¹, Sadykov R.A.², Rustamov A.E.¹

Backgraund: Rectal prolapse (RP) to the full thickness, or procidentia, is a benign condition, which is defined as a circular protrusion of all layers of the rectal wall through the anal sphincter. The annual incidence is 2.5 cases per 100,000 people. The two most common operations on the perineum are Delorme’s operation, which is a mucosectomy and rectal plication, and perineal rectosigmoidectomy, also known as Altemeyer’s operation, which is a full-thickness excision of the rectum. So far, there is no substantial evidence of an advantage between perineal and abdominal access, or between resection or no resection in either access. In connection with the above, there is no doubt about the need to continue developing new technologies for surgical correction of the RP.

Aims: to improve the results of surgical treatment of the RP by developing a new method of surgical intervention using domestic implants and lasers.

Materials and methods: The research covered the period from 2013 to 2023, in total, the results of operations in 102 patients with RP stage 2–3 were analyzed. All patients were operated on the basis of the Republican Clinical Hospital No. 1. According to the performed interventions, all patients were divided into two groups. The main group included 49 patients operated according to the improved technique for 2018–2023. The comparison group consisted of 53 patients who were operated for 2013–2018 according to the traditional Wells rectopexy technique.

Results: Due to the use of laser technologies and composite material on top of a mesh prosthesis, the new method made it possible to achieve stable hemostasis in the area of surgery, as well as to prevent the development of a local adhesive process and scar deformation in the area of fixation of the intestine with a prosthesis. In general, the developed version of rectopexy made it possible to reduce the frequency of long-term postoperative complications requiring additional surgical measures or (and) significantly affecting the quality of life of patients from 34.0% to 10.2%, which ensured an improvement in the proportion of achieved good results of operations from 34.0% to 69.4% and a reduction in the frequency of unsatisfactory results from 24.5% to 8.2%.

Conclusions: The introduction into clinical practice of the developed method of surgical treatment of rectal prolapse through the use of a mesh implant coated with a composite material, as well as diode laser exposure to the presacral region, improved the quality of the course of the early postoperative period with a decrease in the frequency of immediate complications from 18.9 to 4.1% (χ² = 5.362; df = 1; p = 0.021), reduce the duration of the entire hospital stage from 12.6±2.0 to 10.8±1.3 days (t = 5.14; p<0.05).

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