Anorectal function after abdominal rectopexy: Parameters of predictive value in identifying return of continence

Abstract

Abstract Posterior abdominal rectopexy was performed in 12 patients with a full-thickness rectal prolapse: 9 had faecal incontinence. The prolapse was successfully controlled in all cases and six of nine patients were rendered continent. Physiological studies in patients were compared with age- and sex-matched controls. Preoperative anal pressures were significantly lower than in controls at rest (R), during maximum pelvic floor contraction (Sq) and attempted defaecation (St) (R, P < 0·005; Sq, P < 0·005; St, P < 0·005). Anorectal angles were significantly more obtuse in patients than in controls (R, P < 0·05; St, P < 0·025). None of these parameters changed significantly after abdominal rectopexy. Median rectal emptying significantly decreased after operation (preoperative 83 per cent/min; postoperative, 58 per cent/min, P < 0·05). Median perineal descent during attempted defaecation also significantly decreased after operation (preoperative, 8·5 cm; postoperative, 7·1 cm; P < 0·025). Parameters which predicted return of continence included: delayed leakage during the saline infusion test (P < 0·025), a narrow anorectal angle during pelvic floor contraction (P < 0·025), minimal pelvic floor descent during contraction (P < 0·05), and a long anal canal at rest (P < 0·05) and during pelvic floor contraction (P < 0·025).