Anal encirclement with polypropylene mesh for rectal prolapse and incontinence.

Seventeen selected patients (mean age, 74 years)--14 with rectal prolapse and 3 with persisting anal incontinence after previous operations--underwent high anal encirclement with polypropylene mesh. There was no operative mortality. Prolapse recurred in 2 (15 percent) of the 13 patients followed up for 6 months or more (mean, 3.5 years). Three (27 percent) of the 11 patients with associated anal incontinence improved functionally, as did the three operated on for persisting incontinence, but only one patient regained normal continence. No breakage, cutting out, or infection related to the mesh was observed. Because of the risk of fecal impaction encountered in three of our patients, the procedure is not advocated for severely constipated patients. Despite the somewhat disappointing results regarding restoration of continence, we find this method useful in patients with rectal prolapse who are unfit for more extensive surgery, in controlling the prolapse to an acceptable degree.

Recovery of anal sphincter function following transabdominal repair of rectal prolapse: cause of improved continence?

Twenty-eight patients with complete rectal prolapse underwent anorectal manometry before and 6 months and 1-2 years after abdominal rectopexy and sigmoid resection in a study of the mechanisms responsible for postoperatively improved anal continence. Preoperatively, 22 patients reported defective and control. Seven patients (all with minor incontinence) regained normal control and eight other patients achieved improved continence after surgery. Anal resting, squeeze, and voluntary contraction pressures were significantly lower for defective than for normal control, with a significant rise in these pressures at 6 months after the operation, except for those incontinent patients in whom continence was not improved. No further pressure rise was seen later. Improvement of continence was not accompanied by changes in rectal sensation or reflexive functions of the internal anal sphincter. These results suggest that recovery of the resting and voluntary contraction functions of the sphincter muscles was the cause of continence improvement observed after surgery. Anal manometry was unable to predict outcome of function. Therefore, supplementary procedures for restoration of continence are not advisable, although patients with only minor incontinence are likely to regain full continence after rectopexy alone.

Carcinoma of the rectum in Finland--changes in two decades. An epidemiologic and clinical study.

Data from all new cases of rectal carcinoma diagnosed in Finland in 1975 were compared with corresponding data from 1953-1956. Operability increased from 67 to 90% and, among surgically treated cases, resectability for cure from 60 to 66%. In major resection for cure, restorative surgery increased from 10.2 to 21.8%. The surgical mortality diminished (16-5%). Of the 1975 series, 25% were classified as tumour stage A, and 43, 11 and 22% as B, C and D, respectively. Relative 5-year survival rose overall from 20% in the 1953-1956 cases to 38% in those from 1975, and following resection with curative intent from 52 to 59%. Crude survival rates among the patients with tumour resected for cure rose from 54 to 61% in stage A and from 15 to 43% in stage B, but were unchanged in stage C, 22 v. 21%. Our figures were comparable with available reports on rectal carcinoma in defined populations. The reasons for longer survival were increased operability and resectability and reduced surgical mortality. Improved quality of tumour staging in national statistics is mandatory for valid comparisons of treatment results.