N. Sweis1, M. Giugliano2, E. Bianchi1, V. Chaudhry1, M.A. Abdulhai1, G. Gantt1, A. Perez-Tamayo1 2Vita-Salute University, Colorectal Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, MILAN, Italy 1University Of Illinois At Chicago, Colon And Rectal Surgery, Chicago, IL, USA
Introduction: Rectal prolapse, characterized by the full-thickness protrusion of the rectum beyond the anal sphincter, affects both genders but is predominantly seen in women, with a global prevalence of 0.25%-0.4%. This condition, ranging from asymptomatic to severely debilitating, often coexists with functional and anatomical bowel abnormalities, leading to chronic constipation and fecal incontinence in many patients. The aim of this review is to explore surgical interventions, particularly focusing on the perineal approaches (Delorme and Altemeier with and without levatorplasty) and a transanal stapled approach (PSPR), to improve patient outcomes and quality of life.
Methods: Following the PRISMA guidelines, we conducted a systematic literature search on PubMed and Scopus using terms: "Rectal prolapse," "Delorme procedure," "Altemeier procedure," "PSPR procedure," "surgical outcomes," “levatorplasty,” and "pelvic floor physical therapy." Studies evaluating the Delorme, Altemeier, and PSPR techniques in rectal prolapse patients were included. Data on peri-operative and post-operative outcomes, including recurrence rates, complication rates, and other metrics, were extracted.
Results: 69 studies involving 3,864 patients were included. Among these patients, 2,062 underwent Altemeier’s procedure alone, 434 had Altemeier’s with levatorplasty, 822 underwent Delorme’s procedure, and 546 had perineal stapled prolapse resection (PSPR). The average age of the patients was 75.6 years. The overall recurrence rate of rectal prolapse was 15.7%. Specifically, the median recurrence rates were 13% for Altemeier’s, 6.8% for Altemeier’s with plasty, 16% for Delorme’s, and 14% for PSPR. Complications were reported in 14.3% of patients. The median complication rates for Altemeier’s procedure, Altemeier’s with plasty, Delorme’s procedure, and PSPR were 11.3%, 10%, 13%, and 11.8%, respectively. The median length of resections was 17.9 cm for Altemeier’s procedure, 11.5 cm for Altemeier’s with levatorplasty, 8.2 cm for Delorme’s procedure, and 8.3 cm for PSPR. The median follow-up duration was 34 months.
Conclusion: Altemeier’s procedure, both alone and with levatorplasty, generally yields better outcomes for chronic rectal prolapse compared to Delorme’s and PSPR. However, the heterogeneity among studies calls for high-quality, long-term randomized controlled trials to confirm these findings.