Open AccessLong‐term clinical outcome of surgery for solitary rectal ulcer syndrome
Author(s) -
Sitzler P.J.,
Kamm M. A.,
Nicholls R. J.,
Mckee R. F.
Publication year - 1998
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.1998.00854.x
Subject(s) - medicine , stoma (medicine) , colostomy , surgery , coloanal anastomosis , anastomosis , constipation , ileostomy , retrospective cohort study , colorectal cancer , cancer
Background When severe symptoms of solitary rectal ulcer syndrome persist despite medical management, surgery may be necessary. Methods A retrospective review was carried out of 81 patients undergoing surgery for solitary rectal ulcer syndrome in the 10‐year period from 1984 to 1993 to determine the long‐term outcome at a minimum follow‐up of 12 months. Of the 81 patients, 15 were excluded from further analysis (11 were followed up for less than 12 months, two died and two were lost to follow‐up). Sixty‐six patients were studied (median age 38 (range 15–77) years; 53 female). Of these, 49 underwent rectopexy, nine Delorme's operation, two anterior resection and four creation of a stoma as the initial operation. Results At a median follow‐up of 90 (range 12–177) months, the rectopexy had failed in 22 of 49 patients; 19 of these patients underwent further surgery, including rectal resection with coloanal anastomosis (four with three failures), colostomy (11) and other procedures (four). Ultimately, 14 required a stoma. Constipation was the indication for a stoma in nine of the 11 patients who had colostomy as the first procedure after failure of rectopexy. Nine patients had Delorme's operation as the first procedure. At median follow‐up of 38 (range 19–107) months, there were four failures. Two of these ultimately required a stoma. Of the seven patients who underwent anterior resection as the initial or subsequent procedure, a stoma was finally necessary in four. Anterior resection used as a salvage procedure was not successful. The overall stoma rate was 30 per cent (20 patients). Of 11 symptoms assessed before operation only incontinence and incomplete evacuation were related to a poor outcome following surgery. Conclusion Antiprolapse operations result in a satisfactory long‐term outcome in about 55–60 per cent of patients having surgery for solitary rectal ulcer syndrome. Results of anterior resection are disappointing. © 1998 British Journal of Surgery Society Ltd