Abstracts
1998 Digestive Disease Week

#1008

CONTINENCE FUNCTION IN PATIENTS WITH RECTAL PROLAPSE: PRE- AND POSTOPERATIVE MANOMETRIC FINDINGS. S.M.Muehldorfer, K.E. Matzel*, U. Stadelmaier*, Th. Schneider, E.G. Hahn. Depts. of Medicine and Surgery*, University of Erlangen-Nuremberg, Germany.

Rectal prolapse is a distressing disease of mostly elderly women because it is frequently associated with incontinence. The etiology remains uncertain, although many theories have been proposed. The operative procedure attempts to regain continence. We investigated changes in anorectal manometry preoperatively in 31 patients and postoperatively in 23 patients with rectal prolapse and in 10 healthy subjects. The mean age of the patient group was 56 years, ranging from 22 to 72 years. The type of operative repair was Wells procedure in all patients. The median time after operation was 2 years, ranging from 5 to 66 months. Preoperatively 42% of patients were suffering from grade II and III incontinence, while postoperatively only 8% reported major incontinence. Comparing preoperative with postoperative manometry data there was no difference in anal sphincter length (3.0 cm). Anal sphincter resting pressure raised postoperatively (22 mmHg vs. 31 mmHg) but did not reach normal values of healthy subjects (49 mmHg). Squeeze pressure (40 mmHg vs. 84 mmHg; p<0.005) significantly increased in the postoperative group. Balloon awareness (40 ml vs. 30 ml) and the urge to defecate (100 ml vs. 80 ml) changed insignificantly and were evoked with larger balloon volumes compared with the control group. Rectal compliance was significantly elevated in both groups (12.1 ml/mmHg vs. 12.3 ml/mmHg - healthy subjects 4.4 ml/mmHg; p < 0.005). Rectoanal inhibitory reflex could not be evoked in the preoperative and postoperative patient group in 32 and 35% respectively. In conclusion, we were able to demonstrate a rise of the internal and external anal sphincter pressure in patients with rectal prolapse after rectopexy with an improvement in continence. Disturbed rectal sensation, elevated rectal compliance and impaired reflex activity were unchanged after operation.

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