Association study of polymorphisms between the Radixin gene and rheumatoid arthritis in a Korean population.

Radixin (RDX) is part of the ezrin-radixin-moesin (ERM) protein family. It functions as a membrane-cytoskeletal linker in actin-rich cell surface structures and is thought to be essential for cortical cytoskeleton organization, cell motility, adhesion, and proliferation. An increase in phosphorylated ERM in fibroblast-like synoviocytes contributes to rheumatoid arthritis (RA) synovial hyperplasia. We examined the genetic association between the RDX gene and RA in a Korean population. To identify the relationship between RDX gene polymorphisms and RA, we genotyped 2 single nucleotide polymorphisms (SNPs; rs11213326 and rs12575162) of RDX using a direct sequencing method in 296 RA patients and 493 control subjects. In this study, the 2 SNPs showed no association with RA disease susceptibility. However, further analysis based on clinical information of the RA patient group showed that the SNPs were associated with the erythrocyte sedimentation rate (ESR) in RA patients. These data suggest an association between RDX polymorphisms and the clinical features of RA patients, particularly the ESR.

Endorectal advancement flap in perianal Crohn's disease.

The aim of this study was to evaluate the outcome of patients undergoing endorectal advancement flap repair for perianal Crohn's disease relative to the primary site of intestinal Crohn's disease. From January 1991 to December 1995, 31 consecutive endorectal advancement flap repairs were performed in 26 patients. The results relative to surgical outcomes, length of hospitalization, and recurrence were analyzed. The mean patient age was 40.2 years (range, 16-70). Type of fistulas included: rectovaginal: 20 (64.5%), fistula in ano: 8 (25.8%), rectourethral: 1 (3.2%) and others: 2 (6.5%). The mean length of follow-up was 17.3 (range 3-60) months. The mean length of hospitalization was 3.7 (range 2-5) days. A temporary diverting stoma was created in 6 patients with a 66.7% (4/6) surgical success rate. Twenty-one of the 26 patients had previous procedures consisting of 12 (38.7%) bowel resections, 6 (19.4%) seton placements, 4 (12.9%) drainages, and 6 (19.4%) diverting ileostomies. Eleven patients had multiple procedures. Ultimately, fistulas were eradicated in 22 (71%) cases, including 15 (75%) of the 20 with rectovaginal fistulas and 7 (63.6%) of the 11 with other fistulas. There was no mortality; morbidity included a flap retraction in 1 patient, who required antibiotics for 5 days and bleeding in 1 patient, who required reoperation. Success was noted in 2 of 8 (25%) patients with small bowel Crohn's disease as compared to 20 of 23 (87%) patients without small bowel Crohn's disease (P < 0.05). Endorectal advancement flap is an effective surgical modality for the treatment of fistulas due to perianal Crohn's disease but is less apt to succeed in patients with concomitant small bowel Crohn's disease.

Results of perineal procedures for the treatment of rectal prolapse.

The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to evaluate the short-term outcome of perineal procedures in patients with rectal prolapse. Between April 1989 and April 1995, all consecutive patients at the Cleveland Clinic Florida who underwent Delorme's procedure or perineal rectosigmoidectomy with or without levatoroplasty for full-thickness rectal prolapse were evaluated. Clinical and physiological assessments were performed before and after surgery. A standard continence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence) was used to assess the results of each procedure. Additionally, morbidity and mortality, and clinical and functional outcomes were evaluated. Sixty-one patients underwent perineal procedures for rectal prolapse; 16 patients died from comorbid conditions after undergoing postoperative physiologic assessment. These 55 females and 6 males, with a mean age of 75 (range, 48-101) years were studied. Patients were followed up for 27.2 (6-72) months, and mean prolapse duration was 4.2 (0.2-30) years. Although mean preoperative incontinence score was 15.9 (8-20), it was 6.3 (range, 0-12) in postoperative course. Mean resection length of rectosigmoid was 23.3 (3-71) cm, and in these patients, two (3.3%) coloanal anastomotic leaks and four (6.5%) anastomotic strictures were observed. There was one postoperative death. There were statistically significant differences among the groups relative to short-term recurrence rates, postoperative incontinence scores, mean resection length, coloanal anastomotic stricture, and leak (P< 0.001). However, pre- and postoperative anal manometry did not reveal statistically significant changes (P > 0.05) in each group or among the groups. Perineal procedures were found to be safe and effective in eradicating rectal prolapse and improving fecal incontinence in the elderly.

Laparoscopic surgery for lower gastrointestinal fistulas.

BACKGROUND: Increased experience and improved instrumentation have lead to a reduction in morbidity and a commensurate increase in the spectrum of laparoscopic indications. The purpose of this study was to assess the feasibility of laparoscopic surgery in patients with gastrointestinal fistulas. METHODS: Between March 1993 and March 1995, patients with gastrointestinal fistulas who were laparoscopically treated were analyzed for age, gender, diagnosis, type of procedure, operative time, conversion rate, length of postoperative hospitalization, time until oral intake and return of bowel function, morbidity, and mortality. RESULTS: Ten patients (five females; five males) with a mean age of 49.7 (range 20-86) years were preoperatively diagnosed as having the following fistulas: colocutaneous fistula due to diverticulitis (one), enterocolic fistula (two)-due to Crohn's ileocolitis (one) and due to diverticulitis (one)-pouchvaginal fistula after restorative proctocolectomy for familial adenomatous polyposis (two), colofallopian fistula due to diverticulitis (one), rectourethral fistula due to Crohn's disease (one), high transsphincteric fistula due to perianal Crohn's disease (one), enteroenteric fistula due to Crohn's disease (one), and colovesical fistula due to diverticulitis (one). Procedures performed consisted of sigmoidectomy with coloproctostomy (four), ileocolic resection (two), small-bowel resection with ileostomy (one), and diverting loop ileostomy (three). A complex jejunal enterotomy was noted in one (10%) patient. The mean operative time was 195 (range 75-360) min and mean postoperative hospital stay was 6.1 (range 3-12) days. Two additional cases were converted to open procedures for extensive disease (one) and adhesions (one). The patients started oral intake after a mean of 2.2 (range 1-5) days and bowel function returned after a mean of 3.4 (range 2-7) days. One patient required laparotomy on postoperative day 7 for a malrotated loop ileostomy. CONCLUSIONS: Laparoscopic colorectal surgery is feasible in patients with simple lower gastrointestinal fistulas. The morbidity rate of 10% and length of hospitalization of 6 days are similar to results after laparoscopic procedures for "simpler" colorectal pathology. However, the 30% conversion rate is higher, attesting to the challenging nature of these conditions.

Is laparoscopic resection of colorectal polyps beneficial?

BACKGROUND: We set out to compare the results of laparoscopic and open resections of colorectal polyps. METHODS: Forty-five consecutive patients who underwent operation by a single surgeon for endoscopically irretrievable colonic polyps between April 1992 and March 1996 were classified into the following two groups: group I, laparoscopic procedures for colonic polyps (n = 23); and group II, open procedures for colonic polyps (n = 22). RESULTS: No significant differences were seen between the groups relative to age [71.7 +/- 10.7 versus 70.6 +/- 13.7 years], gender [male:female = 10:13 versus 13:9], history of previous abdominal operation (eight of 23 [34.8%] versus 10 of 22 [45.5%]), type of pathology (villous: seven of 23 [30.4%] versus four of 22 [18.1%], tubulovillous: nine of 23 [39.1%] versus six of 22 [27.2%], tubular: three of 23 [13.0%] versus seven of 22 [31.8%]), size of polyps (2.6 +/- 1.7 cm versus 2.7 +/- 1.5 cm), or type of procedures (right hemicolectomy: 15 of 23 [65.2%] versus 11 of 22 [50%], sigmoid colectomy: five of 23 [21.7%] versus six of 22 [27.3%], left hemicolectomy: two of 23 [8.7%] versus two of 22 [9.1%]). There was no mortality and no difference in the incidence of postoperative complications (four of 23 [17.4%] versus seven of 22 [31.8%]), blood loss (167 cc versus 243 cc), number of retrieved lymph nodes (7.1 +/- 5 versus 6.6 +/- 4), incidence of carcinoma in polyps (two of 23 [13.0%] versus four of 22 [18.2%]), or medical cost ($22,840 versus $18,420), respectively, between the two groups. There were statistically significant differences in length of ileus (3.5 +/- 1.0 days versus 5.5 +/- 1.8 days), postoperative pain (2.3 +/- 1.4 versus 3.7 +/- 1.9 on postoperative day 1 [patient pain rating scale 1-10]), length of hospital stay (6. 5 +/- 2.0 days versus 9.4 +/- 2.7 days), and return to normal activity (5.2 +/- 4.2 weeks versus 9.3 +/- 12.1 weeks) in group I compared to group II, respectively. However, patients in group II had a longer mean specimen length (18.5 +/- 6.4 cm versus 29.1 +/- 22.7 cm) and a shorter mean operative time (177.6 +/- 52.7 min versus 143 +/- 51.4 min) than patients in group I. CONCLUSIONS: Laparoscopic colectomy for colonic polyps has definite advantages over traditional open surgery, including less postoperative pain, earlier return of bowel function, and earlier return to normal activity. Conversely, its disadvantages include longer operative time and a shorter specimen.

Initial North American experience with botulinum toxin type A for treatment of anismus.

PURPOSE: Botulinum toxin type A (BTX-A), produced by Clostridium botulinum, is a potent neurotoxin. The purpose of this study was to evaluate the efficacy of BTX-A for treatment of anismus. MATERIALS AND METHODS: All patients treated with BTX-A for anismus were evaluated. Eligibility criteria included a history of chronic assisted evacuation (laxatives, enemas, or suppositories), demonstration of anismus by cinedefecogram and electromyography, and failure of a minimum of three sessions of supervised biofeedback therapy (BF). Contingent on body mass, 6 to 15 units of BTX-A was injected bilaterally under electromyography guidance into the external sphincter or the puborectalis muscle. Treatment was repeated as necessary for a maximum of three sessions during a three-month period. Success was considered as discontinuation of evacuatory assistance and was evaluated between one and three months and again at up to one year. RESULTS: Between July 1994 and May 1995, four patients ranging from 29 to 82 years in age (2 females, 2 males) had anismus that failed to respond to between 3 and 15 biofeedback sessions. All patients improved between one and three months after BTX-A injection, and two had sustained improvement for a range of three months to one year. There was no morbidity or mortality associated with BTX-A injection. CONCLUSIONS: BTX-A is extremely successful for temporary treatment of anismus that is refractory to BF management. However, because the mechanism of action is short, longer term results are only 50 percent successful. Hopefully, modifications in the strain of BTX-A and dose administered will allow longer periods of success or a repeat trial of BF. Nonetheless, this preliminary report is very encouraging in offering a method of managing this recalcitrant condition.

Intraoperative laparoscopic complications. Are we getting better?

PURPOSE: The aim of this study was to assess various intraoperative and postoperative complications associated with laparoscopic colorectal surgery. Specifically, the impact of surgical experience and procedure type on complications was analyzed. METHODS: All patients who underwent laparoscopic surgery were analyzed by age, sex, surgical indications, procedure performed, procedure length, intraoperative and postoperative complications, incidence and causes for conversion, duration of postoperative ileus, and length of hospital stay. Patients were classified for type of procedure and chronologically into four consecutive groups. Procedures were also categorized into four different groups: GI, total abdominal colectomies; GII, segmental resections; GIII, diverting procedures; GIV, others (abdominoperineal resection, Hartmann's creation or closure, anterior resection, and rectopexy). RESULTS: Between August 1991 and October 1995, 167 patients of a mean age of 49.6 (15-88) years underwent laparoscopic colorectal procedures. All procedures were electively performed. Common indications for surgery included inflammatory disease in 70 (42 percent), neoplasia in 56 (33 percent), functional bowel disorders in 30 (18 percent), and other forms of colorectal disorders in 11 (7 percent) patients. The most significant variable affecting intraoperative laparoscopic complication rate was surgical experience measured as the time interval during which surgery was performed (P = 0.02). Total complication rate decreased from 29 percent during the first period to 11 percent by the second period (P < 0.04) and 7 percent during the third period (P < 0.005). Thus, the learning curve appeared to have required more than 50 cases to achieve. Moreover, even after performance of 94 (1991-1993) procedures in GI and GIV, these procedures were associated with higher complication rates than were those procedures in GII and GIII (P = 0.04). CONCLUSION: Surgical experience and case selection are the most critical variables by which the surgeon can decrease the intraoperative laparoscopic complication rate.

Association of serum lipids and glucose with the risk of colorectal adenomatous polyp in men: a case-control study in Korea.

Previous studies on life style for colorectal cancer risk suggest that serum lipids and glucose might be related to adenomatous polyps as well as to colorectal carcinogenesis. This case-control study was conducted to investigate the associations between serum lipids, blood glucose, and other factors and the risk of colorectal adenomatous polyp. Male cases with colorectal adenomatous polyp, histologically confirmed by colonoscopy (n=134), and the same number of male controls matched by age for men were selected in hospitals in Seoul, Korea between January 1997 and October 1998. Serum lipids and glucose levels were tested after the subjects had fasted for at least 12 hr. Conditional logistic regression showed that there was a significant trend of increasing adenomatous polyp risk with the rise in serum cholesterol level (Ptrend=0.07). Increasing trend for the risk with triglyceride was also seen (Ptrend=0.01). HDL-cholesterol and LDL-cholesterol had increasing trends for the risk, which were not significant. In particular, it was noted that higher fasting blood glucose level reduced the adenomatous polyp risk for men (Ptrend=0.001). This study concluded that both serum cholesterol and triglyceride were positively related to the increased risk for colorectal adenomatous polyp in Korea. Findings on an inverse relationship between serum glucose and the risk should be pursued in further studies.

Laparoscopic colorectal surgery. Do we get faster?

BACKGROUND: A variety of parameters can affect the outcome of laparoscopic colorectal surgery. All consecutive laparoscopic colorectal procedures (LCP) were analyzed in an attempt to define an operative time curve for different categories of procedures. Additionally, impacts of case number and procedure type on length of procedure were assessed. METHODS: Our computerized data system was reviewed for all patients who underwent LCP in a 4-year period. Parameters reviewed included age, sex, surgical indications, procedures performed, length of procedure, intraoperative and postoperative complications, incidence and causes for conversion, duration of postoperative ileus, and hospital stay. RESULTS: Between August 1991 and December 1995, 175 patients with a mean age of 48.4 (range 15-88) years underwent LCP. Patients were divided chronologically into five consecutive groups. Procedures were classified as either basic or complex. Complex procedures were those in which there was either a fixed tumor, an abscess or fistula, or extensive intraabdominal adhesions from prior surgery. Complex procedures performed each year ranged from 37% to 66%. As well, the percentage of patients with adhesions increased from 17% in 1991 to 29% in 1995. Despite increased difficulty, the intraoperative complication rate fell significantly from 29% in 1991 to 8% in 1995 (p < 0.005). Additionally, the operative length decreased from a mean of 201 min in 1991 to a mean of 141 min in 1995 (p < 0.05). CONCLUSION: The rapid improvement in these parameters may reflect both ascents in the learning curve and change in type of procedure. Adhesions, due to prior surgery or inflammation making dissection tedious, is the most important technical factor which effects operation time (p < 0.001). However, despite increased complexity, operating time decreased, reflecting improved skills. Thus, the experienced laparoscopic surgeon can increase the spectrum of applications with expectations of shorter operations and lower complication rates.

Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained?

AIM: This study was designed to analyze the functional and clinical outcomes of straight coloanal anastomosis compared with colonic J-pouch performed after low anterior resection. MATERIALS AND METHODS: Between September 1989 and June 1996, all patients who underwent low anterior resection with anastomosis less than 4 cm from the dentate line were classified into two groups based on the restoration of intestinal continuity: "straight" coloanal anastomosis (n = 39) or colonic J-pouch (n = 44). Both groups were assessed according to the level of anastomosis, anastomotic complications (stricture, leak, pelvic abscess), age, and gender. For comparison of functional outcome, daily bowel movements, tenesmus, urgency, incontinence score (range, 0-20), and anorectal manometric findings were evaluated preoperatively and at six months, and one and two years after surgery. RESULTS: There were no significant differences between the groups relative to age: (coloanal anastomosis, 66.3 +/- 10.1 (range, 46-86), vs. colonic J-pouch, 64.9 +/- 13.2 (range, 39-88) years); gender (females): (coloanal anastomosis, 46.2 percent vs. colonic J-pouch; 38.6 percent); diagnosis: (rectal carcinoma: coloanal anastomosis, 84.6 percent, vs. colonic J-pouch, 77.3 percent); preoperative incontinence score (coloanal anastomosis, 1.5 +/- 4.6, vs. colonic J-pouch, 1.1 +/- 4); bowel movements: (coloanal anastomosis, 2.1 +/- 2.3, vs. colonic J-pouch, 2.1 +/- 1.9/day); level of anastomosis: (coloanal anastomosis, 1.8 +/- 1.3, vs. colonic J-pouch, 1.5 +/- 1.3 cm from the dentate line); history of perioperative radiation therapy: (coloanal anastomosis, 15.4 percent, vs. colonic J-pouch, 20.5 percent); or manometric findings. There was also no significant difference in postoperative mortality: (coloanal anastomosis, 5.1 percent, vs. colonic J-pouch, 2.3 percent); or anastomotic complications: (coloanal anastomosis, 7/39 (17.9 percent), vs. colonic J-pouch, 2/44 (4.5 percent) P = 0.08); strictures: (10.3 vs. 0 percent); leaks: (5.1 vs. 2.3 percent); bleeding: (2.6 vs. 0 percent); rectovaginal fistula: (0 vs. 2.3 percent). Also, in the colonic J-pouch group, two patients developed pouchitis, and one patient experienced difficult evacuation one year after surgery. There was a statistically significant better function judged by less frequent bowel movements (4 +/- 2 vs. 2.4 +/- 1.3/day; P < 0.005) and urgency (36.7 vs. 7.7 percent; P < 0.05), incontinence score (2.2 +/- 3.7 vs. 0.8 +/- 1.6; P < 0.05) up to one year after surgery. At two years, the coloanal anastomosis group did not show statistical improvement in functional results compared with one year postoperatively. Rectal compliance in manometric findings was significantly increased in the coloanal anastomosis group at one year after surgery (12.4 +/- 12.6 vs. 4.2 +/- 1.5 ml/mmHg; P < 0.05). However, these differences were less profound after two years. CONCLUSION: The functional superiority of the colonic J-pouch was greatest at one year after surgery. By two years, adaptation of the "straight" coloanal anastomosis yielded similar functional results. However, the almost fourfold reduction in anastomotic complications in the colonic J-pouch group reveals a second potential advantage of this technique.

Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy.

BACKGROUND: The aim of this study was to evaluate disability after laparoscopic colectomy in patients with benign colorectal disease. METHODS: Patients who underwent laparoscopic colectomy for benign colorectal diseases were matched with patients who underwent laparotomy for the same diseases by the same surgeons during the same time period. A standardized questionnaire used to assess disability included days until return to partial activity, full activity, and work. RESULTS: Seventy-one patients who underwent laparotomy were compared with 71 patients who underwent laparoscopy. Pathology included 26 patients with adenoma, 23 with Crohn's disease, 13 with diverticulitis, and 9 with reversal of Hartmann's procedure in each group. Procedures were partial colectomy with ileocolostomy, colocolostomy, or colorectostomy. There were no significant differences (p > 0.05) in age (55.8 vs. 59.7 years) or in the incidence of perioperative complications (25% vs. 29%) between the laparoscopy and laparotomy groups, respectively. The operative time was longer in the laparoscopic group than in the laparotomy group: 165 versus 122 min (p < 0.001). However, length of hospitalization, return to partial and full activity, and time off of work were significantly shorter in the laparoscopy than in the laparotomy group: 6.3 versus 9.0 days, 2.1 versus 4.4 weeks, 4.2 versus 10.5 weeks and 3.8 versus 7.5 weeks, respectively (p < 0.01 for all). CONCLUSIONS: Laparoscopic colectomy for benign colorectal diseases was associated with significantly less disability than was laparotomy in terms of length of hospitalization as well as return to baseline partial and full activity and employment.

Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited.

Cathartic colon is a historic term for the anatomic alteration of the colon secondary to chronic stimulant laxative use. Because some have questioned whether this is a real entity, we investigated changes occurring on barium enema in patients ingesting stimulant laxatives. Our study consisted of two parts. In part 1, a retrospective review of consecutive barium enemas performed on two groups of patients with chronic constipation (group 1, stimulant laxative use [n=29]; group 2, no stimulant laxative use [n=26]) was presented to a radiologist who was blinded to the patient group. A data sheet containing classic descriptions of cathartic colon was completed for each study. Chronic stimulant laxative use was defined as stimulant laxative ingestion more than three times per week for 1 year or longer. To confirm the findings of the retrospective study, 18 consecutive patients who were chronic stimulant laxative users underwent barium enema examination, and data sheets for cathartic colon were completed by another radiologist (part 2). Colonic redundancy (group 1, 34.5%; group 2, 19.2%) and dilatation (group 1, 44.8%; group 2, 23.1%) were frequent radiographic findings in both patient groups and were not significantly different in the two groups. Loss of haustral folds, however, was a common finding in group 1 (27.6%) but was not seen in group 2 (p < 0.005). Loss of haustral markings occurred in 15 (40.5%) of the total stimulant laxative users in the two parts of the study and was seen in the left colon of 6 (40%) patients, in the right colon of 2 (13.3%) patients, in the transverse colon of 5 (33.3%) patients, and in the entire colon of 2 (13.3%) patients. Loss of haustra was seen in patients chronically ingesting bisacodyl, phenolpthalein, senna, and casanthranol. We conclude that long-term stimulant laxative use results in anatomic changes in the colon characterized by loss of haustral folds, a finding that suggests neuronal injury or damage to colonic longitudinal musculature caused by these agents.

Laparoscopic colectomy is superior to laparotomy for reduction of disability in patients with colorectal adenoma.

BACKGROUND: This study was to evaluate disability after laparoscopic colectomy in patients with colorectal adenomas as compared to disability after laparotomy. METHODS: Patients who underwent laparoscopic colectomy for colorectal adenoma were compared to patients who underwent laparotomy for the same problem by the same surgeons during the same time period in Cleveland Clinic Florida. A standard questionnaire was used to assess disability which included the number of days to return to partial activity, full activity, and work. RESULTS: Twenty-nine patients who underwent laparoscopy were compared with 31 patients who underwent laparotomy. There were no significant differences in age (70.4 vs 72.5 years) (p = 0.405) or gender (M:F 13:16 vs 20:11) (p = 0.126) between the laparoscopy and laparotomy groups. The operative time was longer for the laparoscopy group than the laparotomy group: 170 vs 131 minutes (p = 0.014). However, the duration of postoperative ileus, hospitalization, time until return to partial activity, time until return to full activity, and time off of work were significantly shorter in the laparoscopy group than in the laparotomy group: 3.3 vs 5.2 days, 6.2 vs 8.7 days, 2.3 vs 4.2 weeks, 4.4 vs 9.3 weeks, and 3.7 vs 7.3 weeks, respectively (p < 0.041 for all). Although the incidence of postoperative complications was not significantly different (24% for laparoscopy vs 29% for laparotomy, p = 0.325), the incidence of postoperative prolonged ileus was statistically significantly lower in the laparoscopy group (3% vs 26%, p = 0.027). CONCLUSION: Laparoscopic colectomy for patients with colorectal adenoma can reduce postoperative ileus, postoperative hospitalization, and disability in terms of a quicker return to partial activity, full activity, and employment. Laparoscopic colectomy should be considered for all patients who have colorectal adenomas which require resection.

Recurrent rectal prolapse: what is the next good option?

PURPOSE: The aim of this study was to assess the clinical and functional outcome of surgery for recurrent rectal prolapse and compare it with the outcome of patients who underwent primary operation for rectal prolapse. METHODS: All patients who underwent surgery for rectal prolapse were evaluated for age, gender, procedure, anorectal manometry and electromyography findings, and morbidity. The results for patients who underwent surgery for recurrent rectal prolapse were compared with a group of patients matched for age, gender, surgeon, and procedure who underwent primary operations for rectal prolapse. RESULTS: A total of 115 patients underwent surgery for rectal prolapse. Twenty-seven patients, 10 initially operated on at this institution and 17 operated on elsewhere, underwent surgery for recurrent rectal prolapse. These 27 patients were compared with 27 patients with primary rectal prolapse operated on in our department. In the recurrent rectal prolapse group, prior surgery included rectopexy in 7 patients, Delorme's procedure in 7 patients, perineal rectosigmoidectomy in 7 patients, anal encirclement procedure in 4 patients, and resection rectopexy in 2 patients. Operations performed for recurrence were perineal rectosigmoidectomy in 14 patients, resection rectopexy in 8 patients, rectopexy in 2 patients, pelvic floor repair in 2 patients, and Delorme's procedure in 1 patient. There were no statistically significant differences between the groups in preoperative incontinence score (recurrent rectal prolapse, 13.6 +/- 7.8 vs. rectal prolapse, 12.7 +/- 7.2; range, 0-20) or manometric or electromyography findings, and there were no significant differences in mortality (0 vs. 3.7 percent), mean hospital stay (5.4 +/- 2.5 vs. 6.9 +/- 2.8 days), anastomotic complications (anastomotic stricture (0 vs. 7.4 percent), anastomotic leak (3.7 vs. 3.7 percent) and wound infection (3.7 vs. 0 percent), postoperative incontinence score (2.8 +/- 4.8 vs. 1.5 +/- 2.7), or recurrence rate (14.8 vs. 11.1 percent) between the two groups at a mean follow-up of 23.9 (range, 6-68) and 22 (range, 5-55) months, respectively. The overall success rate for recurrent rectal prolapse was 85.2 percent. CONCLUSION: The outcome of surgery for rectal prolapse is similar in cases of primary or recurrent prolapse. The same surgical options are valid in both scenarios.