We hypothesize that abdominal operation will have a lower risk of recurrence when managing recurrent rectal prolapse and should be considered for patients when risks of surgery are permissible for the abdominal operation even in cases when a first repair was done via perineal approach. Our study aimed to evaluate the re-recurrence rate after a second rectal prolapse surgery and to identify risk factors related to it.

We conducted an IRB-approved retrospective multicentric cohort study of patients who underwent surgery to treat a recurrent full-thickness rectal prolapse, between 2010 and 2023, in the Department of Colon and Rectal at our institution. To mitigate selection bias, we included only patients who underwent recurrent rectal prolapse surgery to treat the first recurrence. We excluded patients who underwent recurrent rectal prolapse surgery to treat a second or more recurrence. A total of 164 patients met our inclusion criteria. Data was retrospectively obtained by reviewing clinical and operative charts. Patients were stratified into two groups: patients who had a re-recurrence and patients who did not have a re-recurrence. Univariate and multivariate analyses were performed to select independent re-recurrence risk factors.

Of 129 patients who met the inclusion criteria, 48 (37%) underwent a perineal repair and 81 (63%) underwent an abdominal operation. With a mean follow-up of 17.5 months, the overall re-recurrence rate was 26% (34 cases).  Comparing patients who had a re-recurrence with patients who did not, the univariate analysis found that factors associated with re-recurrence were: mean age (70.9 vs 67.1 years old, p=0.22), baseline constipation (11.8% vs 27.4% 0.10), shorter time since previous prolapse surgery (192 vs 280 mean days p=0.05), perineal approach at previous prolapse surgery (64.7% vs 43.2% p=0.05), and perineal approach at recurrent rectal prolapse surgery ( 58.8% vs 29.5% p=0.005). When performing multivariate analysis, the perineal approach at recurrent rectal prolapse surgery was the only risk factor independently associated with re-recurrence OR 4.63, CI 1.52, 15.5, p=0.009) (table 1). Moreover, we conducted a subgroup analysis of patients who underwent abdominal procedures, and no differences in re-recurrence rate were found comparing open vs minimally invasive procedures (p=0.188) (table 2).

When analyzing several potential clinical and surgical risk factors associated with a re-recurrence after recurrent rectal prolapse surgery, surprisingly the only factor that was independently associated with re-recurrence was performing a perineal repair at the recurrent rectal prolapse surgery. This finding demonstrates that abdominal procedure for recurrent rectal prolapse has decreased re-recurrence risk which is not influenced by previous operation. It confirms our hypothesis that abdominal repair is superior for recurrent prolapse and can be offered to the patients to decrease the risk of another recurrence in the appropriate patients.

When treating recurrent rectal prolapse, surgeons are encouraged to customize the operative approach to each patient and include the patient in the shared decision-making weighing risk factors of risk of surgery and recurrence when choosing an appropriate procedure.

Continence 12S (2024) 101671
DOI: 10.1016/j.cont.2024.101671