Indirect fixation of the rectum to the anterior longitudinal ligament over the sacral promontory was performed at 146 operations for procidentia recti in a homogeneous series of 140 patients. Before fixation the rectum was widely dissected and thoroughly mobilized. The recurrence rate after follow-up intervals of up to 15 years was 3.6 per cent. The procedure is simple to perform and eliminates the hazard of anastomotic breakdown which is associated with excisional methods. The authors regard it as the method of choice in the operative treatment of complete rectal prolapse.
FOR the repair of complete prolapse of the rectum, a distressing disorder with a tendency to deteriorate, many surgical measures, varying widely in their results, have been devised (Goligher, 1967;Frykman and Goldberg, 1969; Baker, 1970;Theuerkauf, Beahrs, and Hill, 1970). The Thiersch operation, even in its modified forms, carries a recurrence rate of about 20 per cent (Baker, I970), and should be reserved for the rare cases in which all other reparative procedures are contra-indicated. Resection of the prolapsed bowel through a perineal approach followed by perineorrhaphy is liable to cause postoperative complications, such as perineal abscess or faecal incontinence of several weeks' duration (Altemeier, Culbertson, and Alexander, 1964). Fixation procedures combined with colonic resection give good results (Khubchandani and Bacon, 1965 ;Frykman and Goldberg, 1969), but the colonic resection increases the technical difficulty of the operation and sometimes reduces bowel continence (Beahrs, Vandertoll, and Baker, 1965)~ thus restricting the indications for the method.
The purpose of the present study is to review a series of 140 cases of complete rectal prolapse treated by a suspension-fixation procedure, with preliminary rectal mobilization and without bowel resection.