Which Operative Repair is Associated with a Higher Likelihood of Reoperation after Rectal Prolapse Repair?

The rate of reoperation after transabdominal as compared with transperineal repair for rectal prolapse is unknown. We evaluated all patients who underwent surgical treatment for rectal prolapse performed through transabdominal or transperineal repair from the trackable California Inpatient data files and Revisit Analyses during the time period of January 1, 2005, through December 31, 2007. We specifically evaluated rates of reoperation and stoma formation during the 36-month study period. A total of 3400 patient discharges with rectal prolapse from California during the 36-month study period was identified. Of this cohort, 1772 patients had one or more prolapse repairs. Procedures were more likely to be performed through a transabdominal (1035 [58%]) as compared with a transperineal approach (737 [42%]). There was no difference in reoperation for transabdominal (11%) as compared with transperineal procedures (11%; P = 0.9). However, a significantly larger proportion of patients underwent stoma formation after transabdominal (8%) as compared with transperineal repair (5%; P < 0.02). Time to reoperation was not significantly different for patients treated with transabdominal (295 ± 254 days) as compared with transperineal repair (271 ± 246 days; P = 0.6). In conclusion, the risk of reoperation is substantial for both transabdominal and transperineal procedures for rectal prolapse.