PURPOSE:This study examines whether preoperative anal manometry and pudendal nerve terminal motor latency predict functional outcome after perineal proctectomy for rectal prolapse.METHODS:All adult patients treated by...PURPOSE:This study examines whether preoperative anal manometry and pudendal nerve terminal motor latency predict functional outcome after perineal proctectomy for rectal prolapse.METHODS:All adult patients treated by perineal proctectomy for rectal prolapse from 1995 to 2004 were identified(N = 106) .Forty-five patients underwent anal manometry and pudendal nerve terminal motor latency testing before proctectomy and they form the basis for this study.RESULTS:Perineal proctectomy with levatoroplasty(anterior 88.9 percent;posterior 75.6 percent) was performed in all patients,with a mean resection length of 10.4 cm.Four patients(8.9 percent) developed recurrent prolapse during a 44-month mean follow-up.Preoperative resting and maximal squeeze pressures were 34.2 ± 18.3 and 60.4 ± 30.5 mmHg,respectively.Pudendal nerve terminal motor latency testing was prolonged or undetectable in 55.6 percent of patients.Grade 2 or 3 fecal incontinence was reported by 77.8 percent of patients before surgery,and one-third had obstructed defecation.The overall prevalence of incontinence(77.8 vs.35.6 percent,P< 0.0001) and constipation(33.3 vs.6.7 percent,P = 0.003) decreased significantly after proctectomy.Patients with preoperative squeeze pressures >60 mmHg(n = 19) had improved postoperative fecal continence relative to those with lower pressures(incontinence rate,10 vs.54 percent;P = 0.004) ,despite having similar degrees of preoperative incontinence.Abnormalities of pudendal nerve function and mean resting pressures were not predictive of postoperative incontinence.CONCLUSIONS:Perineal proctectomy provides relief from rectal prolapse,with good intermediate term results.Preoperative anal manometry can predict fecal continence rates after proctectomy,because patients with maximal squeeze pressures >60 mmHg have significantly improved outcomes.展开更多
文摘PURPOSE:This study examines whether preoperative anal manometry and pudendal nerve terminal motor latency predict functional outcome after perineal proctectomy for rectal prolapse.METHODS:All adult patients treated by perineal proctectomy for rectal prolapse from 1995 to 2004 were identified(N = 106) .Forty-five patients underwent anal manometry and pudendal nerve terminal motor latency testing before proctectomy and they form the basis for this study.RESULTS:Perineal proctectomy with levatoroplasty(anterior 88.9 percent;posterior 75.6 percent) was performed in all patients,with a mean resection length of 10.4 cm.Four patients(8.9 percent) developed recurrent prolapse during a 44-month mean follow-up.Preoperative resting and maximal squeeze pressures were 34.2 ± 18.3 and 60.4 ± 30.5 mmHg,respectively.Pudendal nerve terminal motor latency testing was prolonged or undetectable in 55.6 percent of patients.Grade 2 or 3 fecal incontinence was reported by 77.8 percent of patients before surgery,and one-third had obstructed defecation.The overall prevalence of incontinence(77.8 vs.35.6 percent,P< 0.0001) and constipation(33.3 vs.6.7 percent,P = 0.003) decreased significantly after proctectomy.Patients with preoperative squeeze pressures >60 mmHg(n = 19) had improved postoperative fecal continence relative to those with lower pressures(incontinence rate,10 vs.54 percent;P = 0.004) ,despite having similar degrees of preoperative incontinence.Abnormalities of pudendal nerve function and mean resting pressures were not predictive of postoperative incontinence.CONCLUSIONS:Perineal proctectomy provides relief from rectal prolapse,with good intermediate term results.Preoperative anal manometry can predict fecal continence rates after proctectomy,because patients with maximal squeeze pressures >60 mmHg have significantly improved outcomes.
