Annals of Coloproctology

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Original Article

Benign proctology

Three-Dimensional Pelvic Floor Ultrasound Assessment of Pelvic Organ Prolapse: Minimal Levator Hiatus and Levator Ani Deficiency Score: Yongwoo Yune, Hong Yoon Jeong, Duk Hoon Park, Jong Kyun Lee; Ann Coloproctol. 2021;37(5):291-297. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2020.01095.0156

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Purpose
The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage.
Methods
This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe.
Results
There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33±2.49 vs. 8.19±2.92, P<0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P<0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91±2.74 cm² vs. 14.95±2.60 cm², P<0.001). In addition, both MLH and LAD scores tended to increase at each stage.
Conclusion
There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.

Citations

Citations to this article as recorded by

Pelvic floor dysfunction in patients with gestational diabetes mellitus
Mustafa Arslan, Ramazan Kozan
World Journal of Diabetes.2025;[Epub] CrossRef
The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum
Bei Gan, Shan Zheng, Xiuyan Wu, Xuemei Li
Heliyon.2024; 10(4): e25636. CrossRef
Advancements in artificial intelligence for pelvic floor ultrasound analysis
Xinghua Huang
American Journal of Translational Research.2024; 16(4): 1037. CrossRef
Three‐dimensional endovaginal ultrasound assessment using the levator ani deficiency score in primiparas: A replication study
Emilia Rotstein, Vilhelmina Ullemar, Marianne Starck, Gunilla Tegerstedt
Acta Obstetricia et Gynecologica Scandinavica.2023; 102(9): 1236. CrossRef
Correlation between clinical examination and perineal ultrasound in women treated for pelvic organ prolapse
Célia Maheut, Thibaud Vernet, Hugo Le Boité, Hervé Fernandez, Perrine Capmas
Journal of Gynecology Obstetrics and Human Reproduction.2023; 52(9): 102650. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98(C): 107524. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef

Video

Malignant disease, Rectal cancer

Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor: Seung Yoon Yang, Nam Kyu Kim; Ann Coloproctol. 2020;36(6):415-416. Published online December 31, 2020; DOI: https://doi.org/10.3393/ac.2020.06.29

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6 Citations

Abstract PDF Supplementary Material

Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), en-bloc resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

Citations

Citations to this article as recorded by

Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Recent advances in functional bismuth chalcogenide nanomaterials: Cancer theranostics, antibacterial and biosensing
Qian Wang, Jun Du, Ruizhuo Ouyang, Baolin Liu, Yuqing Miao, Yuhao Li
Coordination Chemistry Reviews.2023; 492: 215281. CrossRef
Robotic APR with en bloc TAH/BSO and posterior vaginectomy
M. S. Meece, L. P. Horner, S. J. Danker, A. K. Sinno, N. Paluvoi
Techniques in Coloproctology.2023; 27(12): 1381. CrossRef
Current status and role of robotic approach in patients with low-lying rectal cancer
Hyo Seon Ryu, Jin Kim
Annals of Surgical Treatment and Research.2022; 103(1): 1. CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Outcomes of robotic partial excision of the levator ani muscle for locally advanced low rectal cancer invading the ipsilateral pelvic floor at the anorectal ring level
Seung Yoon Yang, Min Soo Cho, Nam Kyu Kim
The International Journal of Medical Robotics and Computer Assisted Surgery.2021;[Epub] CrossRef

Case Report

A Rare Case of Posterior Horseshoe Abscess Extending to Anterolateral Extraperitoneal Compartment: Anatomical and Technical Considerations: Christianna Oikonomou, Periklis Alepas, Stelios Gavriil, Dimitrios Kalliouris, Konstantinos Manesis, Petros Bouboulis, Dimitrios Filippou, Panagiotis Skandalakis; Ann Coloproctol. 2019;35(4):216-220. Published online May 31, 2019; DOI: https://doi.org/10.3393/ac.2018.03.05

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193 Download
6 Web of Science
10 Citations

Abstract PDF

Perianal abscess and fistula are 2 distinct entities that share a common pathology. A horseshoe fistulous abscess, a complex type of these conditions, occurs when the suppurative inflammation spreads through the deep anal space to the bilateral ischiorectal fossae. Following the intersphincteric plane, this infection may extend to the pararectal space, forming a supralevator abscess. We present a very rare case involving a 52-year-old male patient who was admitted to our surgical department with an extraperitoneal purulent inflammation as a complication following multiple drainage procedures for a posterior horseshoe abscess. Emphasis is given to the anatomical and technical considerations of eradication of anorectal sepsis and the management of complex fistula-in-ano along with a concise review of the literature.

Citations

Citations to this article as recorded by

Acquired Ano-Rectal Sinuses and Fistulas Involving Genito-Urinary Structures in Men: A Case Series
Abhraneel Das, Devesh Malik, Saurav S Bhadoria, Asmita Asmita
Cureus.2025;[Epub] CrossRef
Fused Ischiorectal Phlegmon with Pre- and Retroperitoneal Extension: Case Report and Narrative Literature Review
Laurențiu Augustus Barbu, Liviu Vasile, Liliana Cercelaru, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Stefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Tiberiu Stefăniță Țenea Cojan, Nicolae-Dragoș Mărgăritescu
Journal of Clinical Medicine.2025; 14(14): 4959. CrossRef
Ischiorectal abscess with retroperitoneal extension: masquerading as an appendicular abscess
Kalyani Dnyaneshwar Aher, Minakshi Gadhire, Naman Jain, Prafulla Salunkhe
International Surgery Journal.2025; 12(10): 1886. CrossRef
Innovative dual-access surgical strategy for advanced pelvic Fournier’s gangrene: a retrospective study assessing combined suprapubic and transsacral debridement
Zhi-Min Liu, Guo-Zhong Xiao, Jie Huang, Xin Jin, Neng-Sheng Lai, Xing-Yang Wan, Hong-Cheng Lin
BMC Gastroenterology.2025;[Epub] CrossRef
Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report
Hsiang Teng, Po-Hsien Wu
Medicina.2024; 60(2): 293. CrossRef
Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess
Abenezer S Tedla, Harsh R Parikh, Savni Satoskar, Jigyasha Pradhan, Shailja Kataria, Vinayak S Gowda
Cureus.2024;[Epub] CrossRef
Practical application of the wound healing agent in the treatment of patients with acute paraproctitis
L. A. Lichman, S. E. Katorkin, P. S. Andreev, O. E. Davydova
Ambulatornaya khirurgiya = Ambulatory Surgery (Russia).2024; 21(2): 120. CrossRef
Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report
Amin Dalili, Daryoush Hamidi Alamdari, Alimohamad Dalili, Maryam Sarkardeh, Alireza Rezapanah, Nooshin Tafazoli
WORLD JOURNAL OF PLASTIC SURGERY.2023; 12(1): 58. CrossRef
Adölesanda vajene spontan drene olan anorektal apse: Olgu sunumu
Ali Ekber Hakalmaz, Ayşe Kalyoncu Uçar, Gonca Topuzlu Tekant, Yunus Söylet, Sinan Celayir
Turkish Journal of Pediatric Surgery.2023; 37(3): 119. CrossRef
Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review
Papadopoulos S. Konstantinos, Dimopoulos Andreas, Kordeni Kleoniki, Filis Dimitrios
Annals of Coloproctology.2021; 37(Suppl 1): S11. CrossRef

Original Articles

Short-term Outcomes of an Extralevator Abdominoperineal Resection in the Prone Position Compared With a Conventional Abdominoperineal Resection for Advanced Low Rectal Cancer: The Early Experience at a Single Institution: Seungwan Park, Hyuk Hur, Byung Soh Min, Nam Kyu Kim; Ann Coloproctol. 2016;32(1):12-19. Published online February 29, 2016; DOI: https://doi.org/10.3393/ac.2016.32.1.12

7,935 View
47 Download
11 Web of Science
10 Citations

Abstract PDF

Purpose

This study compared the perioperative and pathologic outcomes between an extralevator abdominoperineal resection (APR) in the prone position and a conventional APR.

Methods

Between September 2011 and March 2014, an extralevator APR in the prone position was performed on 13 patients with rectal cancer and a conventional APR on 26 such patients. Patients' demographics and perioperative and pathologic outcomes were obtained from the colorectal cancer database and electronic medical charts.

Results

Age and preoperative carcinoembryonic antigen (CEA) level were significantly different between the conventional and the extralevator APR in the prone position (median age, 65 years vs. 55 years [P = 0.001]; median preoperative CEA level, 4.94 ng/mL vs. 1.81 ng/mL [P = 0.011]). For perioperative outcomes, 1 (3.8%) intraoperative bowel perforation occurred in the conventional APR group and 2 (15.3%) in the extralevator APR group. In the conventional and extralevator APR groups, 12 (46.2%) and 6 patients (46.2%) had postoperative complications, and 8 (66.7%) and 2 patients (33.4%) had major complications (Clavien-Dindo III/IV), respectively. The circumferential resection margin involvement rate was higher in the extralevator APR group compared with the conventional APR group (3 of 13 [23.1%] vs. 3 of 26 [11.5%]).

Conclusion

The extralevator APR in the prone position for patients with advanced low rectal cancer has no advantages in perioperative and pathologic outcomes over a conventional APR for such patients. However, through early experience with a new surgical technique, we identified various reasons for the lack of favorable outcomes and expect sufficient experience to produce better peri- or postoperative outcomes.

Citations

Citations to this article as recorded by

Abdominoperineal Resection in Prone Versus Supine Position: A Systematic Review and Meta-Analysis
Bernardo Fontel Pompeu, Eric Pasqualotto, Beatriz D'Andrea Pigossi, Matheus Reginato Araujo, Lucas Monteiro Delgado, Lucas Soares de Souza Pinto Guedes, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga
Journal of Laparoendoscopic & Advanced Surgical Techniques.2025; 35(3): 224. CrossRef
Management of left-sided malignant colorectal obstructions with curative intent: a network meta-analysis
Tyler McKechnie, Jeremy E. Springer, Zacharie Cloutier, Victoria Archer, Karim Alavi, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu
Surgical Endoscopy.2023; 37(6): 4159. CrossRef
Prone Versus Supine Position in Abdominoperineal Resection: Outcomes in the Laparoscopic Era
Cecilia Ferrari, Carmen Martinez Sanchez, Jesus Bollo, Pilar Hernandez, Lorena Cambeiro, Claudia Codina, Eduardo Targarona
Journal of Laparoendoscopic & Advanced Surgical Techniques.2021; 31(4): 382. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef
Perioperative and oncological outcomes of abdominoperineal resection in the prone position vs the classic lithotomy position: A systematic review with meta‐analysis
Jose Wilson B. Mesquita‐Neto, Hassan Mouzaihem, Francisco Igor B. Macedo, Lance K. Heilbrun, Donald W. Weaver, Steve Kim
Journal of Surgical Oncology.2019; 119(7): 979. CrossRef
Prone Compared With Lithotomy for Abdominoperineal Resection: A Systematic Review and Meta-analysis
Tyler McKechnie, Yung Lee, Jeremy E. Springer, Aristithes G. Doumouras, Dennis Hong, Cagla Eskicioglu
Journal of Surgical Research.2019; 243: 469. CrossRef
Perineal Wound Complications After Extralevator Abdominoperineal Excision for Low Rectal Cancer
Jia Gang Han, Zhen Jun Wang, Zhi Gang Gao, Guang Hui Wei, Yong Yang, Zhi Wei Zhai, Bao Cheng Zhao, Bing Qiang Yi
Diseases of the Colon & Rectum.2019; 62(12): 1477. CrossRef
Critical and Challenging Issues in the Surgical Management of Low-Lying Rectal Cancer
Aeris Jane D. Nacion, Youn Young Park, Seung Yoon Yang, Nam Kyu Kim
Yonsei Medical Journal.2018; 59(6): 703. CrossRef
EXTRALEVATOR ABDOMINOPERINEAL EXCISION OF THE RECTUM: SHORT-TERM OUTCOMES IN COMPARISON WITH CONVENTIONAL SURGERY
R. A. Murashko, I. B. Uvarov, E. A. Ermakov, V. B. Kaushanskiy, R. V. Konkov, D. D. Sichinava, B. N. Sadikov
Koloproktologia.2017; (4): 34. CrossRef
Extralevator Abdominoperineal Resection in the Prone Position
Young Jin Kim
Annals of Coloproctology.2016; 32(1): 1. CrossRef

Comparison of Long-term Clinical Outcomes according to the Change in the Rectocele Depth between Transanal and Transvaginal Repairs for a Symptomatic Rectocele: Choon Sik Chung, Sang Hwa Yu, Jeong Eun Lee, Dong Keun Lee; J Korean Soc Coloproctol. 2012;28(3):140-144. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.140

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13 Citations

Abstract PDF

Purpose

This study was aimed to compare the results of a transanal repair with those of a transvaginal levatorplasty and to determine the long-term clinical outcomes according to the change in the depth of the rectocele after the procedure.

Methods

Of 50 women who underwent a rectocele repair from March 2005 to February 2007, 26 women (group A) received a transanal repair, and 24 (group B) received a transvaginal repair with or without levatorplasty. At 12 months after the procedures, 45 (group A/B, 22/23 women) among the 50 women completed physiologic studies, including anal manometry and defecography, and clinical-outcome measurements. The variations of the clinical outcomes with changes in the depth of the rectocele were also evaluated in 42 women (group A/B, 20/22) at the median follow-up of 50 months.

Results

On the defecographic findings, the postoperative depth of the rectocele decreased significantly in both groups (group A vs. B, 1.91 ± 0.20 vs. 2.25 ± 0.46, P = 0.040). At 12 months after surgery, 17 women in each group (group A/B, 77/75%) reported improvement of their symptoms. However, only 11 and 13 women (group A/B, 55/59%) of groups A and B, respectively, maintained their improvement at the median follow-up of 50 months. Better results were reported in patients with a greater change in the depth of their rectocele (≥4 cm) after the procedure (P = 0.001)

Conclusion

In both procedures, clinical outcomes might become progressively worse as the length of the follow-up is increased.

Citations

Citations to this article as recorded by

Outcomes of laparoscopic ventral mesh rectopexy versus trans-vaginal repair in management of anterior rectocele, a randomized controlled trial
A. Sanad, A. Sakr, H. Elfeki, W. Omar, W. Thabet, E. Fouda, E. Abdallah, S. A. Elbaz
Techniques in Coloproctology.2025;[Epub] CrossRef
Tratamiento quirúrgico de los prolapsos genitales por vía vaginal
T. Thubert, M. Degez, C. Cardaillac, R. De Tayrac, M. Cosson
EMC - Urología.2024; 56(4): 1. CrossRef
Traitement chirurgical des prolapsus génitaux par voie vaginale
T. Thubert, M. Degez, C. Cardaillac, R. De Tayrac, M. Cosson
EMC - Techniques Chirurgicales - Urologie.2024; 41(3): 1. CrossRef
Laparoscopic or transanal repair of rectocele? Comparison of a reduction in rectocele size
Akira Tsunoda, Tomoko Takahashi, Satoshi Matsuda, Hiroshi Kusanagi
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Prise en charge chirurgicale de la rectocele – mise au point
M. Aubert, D. Mege, R. Le Huu Nho, G. Meurette, I. Sielezneff
Journal de Chirurgie Viscérale.2021; 158(2): 157. CrossRef
Surgical management of the rectocele – An update
M. Aubert, D. Mege, R. Le Huu Nho, G. Meurette, I. Sielezneff
Journal of Visceral Surgery.2021; 158(2): 145. CrossRef
ACG Clinical Guidelines: Management of Benign Anorectal Disorders
Arnold Wald, Adil E. Bharucha, Berkeley Limketkai, Allison Malcolm, Jose M. Remes-Troche, William E. Whitehead, Massarat Zutshi
American Journal of Gastroenterology.2021; 116(10): 1987. CrossRef
Early and late effects of the sequential transfixed stich technique for the treatment of the symptomatic rectocele without rectal mucosa prolapse
Fabio Gaj, Ivano Biviano, Antonello Trecca, Quirino Lai, Jacopo Andreuccetti
Minerva Chirurgica.2020;[Epub] CrossRef
Absence of a rectocele may be correlated with reduced internal anal sphincter function in patients with rectal intussusception and fecal incontinence
Akira Tsunoda, Tomoko Takahashi, Hiroshi Kusanagi
International Journal of Colorectal Disease.2019; 34(10): 1681. CrossRef
Trattamento chirurgico del rettocele
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Tecniche Chirurgiche Addominale.2018; 24(1): 1. CrossRef
Tratamiento quirúrgico de los rectoceles
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Técnicas Quirúrgicas - Aparato Digestivo.2018; 34(1): 1. CrossRef
Surgery for constipation: systematic review and practice recommendations
U. Grossi, E. J. Horrocks, J. Mason, C. H. Knowles, A. B. Williams
Colorectal Disease.2017; 19(S3): 73. CrossRef
Traitement chirurgical des rectocèles
G. Meurette, A. Vénara, P.-A. Lehur
EMC - Techniques chirurgicales - Appareil digestif.2017; 34(4): 1. CrossRef

Case Report

Levator Ani Muscle Posterior Midline Incision Method for Diffrentiation of Anal Fistulas Involving Ischioretal and Pelvirectal Spaces.: Lim, Seok Won; J Korean Soc Coloproctol. 2008;24(1):72-74.; DOI: https://doi.org/10.3393/jksc.2008.24.1.72

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18 Download

Abstract PDF: The difference between anal fistulas involving the ischioretal space and pelvirectal space is that in the former the involvement of the anal fistula is low the levator ani muscle whereas in the latter it is above the levator ani muscle. The levator ani muscle posterior midline incision method, which is introduced here, is thought not to injure the anal sphincter; thus, it does not affect the anal function. The method also allow the surgeon to assess readily and accurately whether or not the fistula has invaded the pelvirectal space.

Original Articles

Transanal Posterior Anorectoplasty of Rectal Prolapse.: Kim, Jong Duck , Ye, Byung Kuk , Jo, Hong Jae , Oh, Nahm Gun; J Korean Soc Coloproctol. 2002;18(5):269-273.

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Abstract PDF: PURPOSE
Many different procedures for rectal prolapse have been described, but optional surgical treatment remains controversial. The aim of this report is to introduce an innovative and effective method of surgical treatment to restore anal continence and anatomic correction of rectal prolapse.
METHODS
Data were retrospectively collected and analyzed on 11 patients (7 male and 4 female) who underwent transanal posterior anorectoplasty for complete rectal prolapse between Jan. 1995 to Dec. 2000. This procedure is summarized to five steps as follows: 1. Partial resection of posterior rectal ampulla. 2. Longitudinal plication with posterior fixation. 3. Posterior levatorplasty. 4. One layer suture as longitudinal fashion. 5. Gant-Miwa operation-like procedure on anterior rectum.
RESULTS
There were no cases of postoperative infection and bleeding. There were no cases of recurrence of the rectal prolapse except 1 case of ant. mucosal prolapse which was successfully treated with one more Gant-Miwa operation-like procedure at postoperative 3 months. Fecal incontinence were in two cases at postoperative 12 months which were estimated as grade 2 by assessment of bowel function by Kirwan.
CONCLUSIONS
Although, the best operation for rectal prolapse remains controversial subject, authors believe that transanal posterior anorectoplasty should be considered as effective new surgical procedure for the treatment of rectal prolapse.

Perineal Rectosigmoidectomy with Levatoroplasty for Rectal Prolapse Early functional outcome.: Yoon, Seo Gue , Lee, Jong Ho , Yoon, Jong Seob , Kim, Kuhn Uk , Kim, Hyun Shig , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2001;17(5):220-226.

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33 Download

Abstract PDF: PURPOSE
This study was designed to analyze the short-term clinical and functional outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse.
METHODS
The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner's constipation score (0-30), Wexner's incontinence score (0-20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3-6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7).
RESULTS
During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated.
CONCLUSIONS
Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea-predominant irritable bowel syndrome.

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