Complications after rectal prolapse surgery: does approach matter?

Background: Data comparing surgical outcomes following abdominal and transperineal approaches for rectal prolapse are limited.

Objective: We sought to identify differences in postoperative complications following abdominal vs transperineal approaches to rectal prolapse.

Design: We studied a retrospective cohort in the American College of Surgeon's National Surgical Quality Improvement Program from January 2005 through December 2008.

Patients: We identified all patients who underwent surgical treatment for rectal prolapse.

Intervention: We compared surgical outcomes of standard abdominal approaches compared with standard transperineal approaches to rectal prolapse.

Main Outcome Measures: The primary outcomes measured were the validated morbidity outcomes and 30-day mortality.

Results: During the study period, 1485 patients underwent rectal prolapse surgery (706 abdominal and 779 transperineal). Patients treated with abdominal approaches had significantly higher rates of infectious (9.8% vs 3.7%) and overall (12.9% vs 7.6%) complications in comparison with those treated with transperineal approaches. On multivariate analysis, risk factors for overall complications were ASA class 4 (OR 6.4) and abdominal surgery (OR 2.3), whereas an albumin level of ≥ 2.5 was protective (OR 0.05). Significant predictors of infectious complications were ASA class 4 (OR 7.5), BMI >25 (OR 1.8), and rectal prolapse surgery performed with an abdominal approach (OR 2.8).

Limitations: The retrospective design introduces potential selection bias.

Conclusions: Abdominal surgery for rectal prolapse is a predictor of both infectious and overall complications. Patients with significant comorbidities or a high BMI are at particularly high risk for complications and may be better suited for a transperineal rather than abdominal approach for the treatment of rectal prolapse.