Complications after rectal prolapse surgery: does approach matter?

Abstract

Data comparing surgical outcomes following abdominal and transperineal approaches for rectal prolapse are limited. We sought to identify differences in postoperative complications following abdominal vs transperineal approaches to rectal prolapse. We studied a retrospective cohort in the American College of Surgeon's National Surgical Quality Improvement Program from January 2005 through December 2008. We identified all patients who underwent surgical treatment for rectal prolapse. We compared surgical outcomes of standard abdominal approaches compared with standard transperineal approaches to rectal prolapse. The primary outcomes measured were the validated morbidity outcomes and 30-day mortality. 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). The retrospective design introduces potential selection bias. 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.