EP647 - Short-Term Outcomes After Abdominal and Perineal Procedures for Rectal Prolapse

Purpose/Background: Several operative approaches exist for rectal prolapse, including perineal and abdominal procedures. Comparative data on perioperative outcomes across techniques remain limited. We sought to evaluate short-term outcomes after commonly performed rectal prolapse operations at a tertiary referral center.

Methods/Interventions: All patients undergoing rectal prolapse surgery between 2014-2025 were identified. Procedures were grouped into perineal (Altemeier, Delorme) and abdominal (resection rectopexy, suture rectopexy, ventral mesh rectopexy) approaches. Collected variables included age, sex, and BMI, as well as operative duration and procedure type. Thirty-day outcomes analyzed were length of stay, readmission, reoperation, mortality, and procedure-specific complications such as anastomotic leak, surgical-site infection (SSI), abscess, ileus, renal or cardiovascular events, bowel obstruction, and postoperative nausea/vomiting (PONV). Comparisons among the five procedure groups were performed using the Kruskal-Wallis test for continuous variables and the Chi-square or Fisher-Freeman-Halton exact test for categorical variables. A p < 0.05 was considered statistically significant.

Results/Outcomes: A total of 233 patients were included: Altemeier (n = 49), Delorme's (n = 31), resection rectopexy (n = 14), suture rectopexy (n = 71), and ventral mesh rectopexy (n = 68). Median age differed significantly among groups (p < 0.001), highest in the Altemeier cohort (83 years, IQR 75-87) and lowest after resection rectopexy (48 years, IQR 28-63). Median BMI also varied (p = 0.02), with the ventral mesh rectopexy group showing the highest values (25.1 kg/m², IQR 21.2-29.9). Median operative time differed markedly across procedures (p < 0.001), ranging from 71 minutes (Delorme's) to 195 minutes (ventral mesh rectopexy). Median length of stay was longest following Altemeier (3 days, IQR 2-4) and shortest after Delorme's and ventral mesh rectopexy (1 day, IQR 1-2; p < 0.001).

Overall 30-day morbidity included readmission in 18 patients (7.7%) and reoperation in 6 (2.6%), with no mortality reported except one death in the Altemeier group. Rates of surgical-site infection, abscess, anastomotic leak, ileus, PONV, renal, cardiovascular, and obstructive complications did not differ significantly among procedures (all p > 0.05). The only significant difference was observed for renal complications (p = 0.02), driven by higher rates in the resection rectopexy group (14.3%).

Conclusion/Discussion: Both abdominal and perineal approaches for rectal prolapse were safe and associated with low perioperative morbidity and mortality. The Altemeier and Delorme procedures were performed in an older cohort and were associated with a slightly longer hospital stay, while abdominal repairs, particularly ventral mesh rectopexy, had longer operative times but similarly favorable short-term outcomes. These findings highlight that procedure selection should be individualized based on patient age, comorbidity, and functional status, rather than concern for major postoperative risk. Despite procedural differences in age, BMI, operative time, and LOS, overall 30-day outcomes were excellent across all techniques, supporting the perioperative safety and effectiveness of both perineal and abdominal approaches in contemporary practice.

Table 1. Patient Characteristics and 30-Day Outcomes Following Abdominal and Perineal Procedures for Rectal Prolapse
*Anastomotic leak in this case occurred after a stapled cecorectal anastomosis (EEA 28 mm) performed during laparoscopic subtotal colectomy, in addition to suture rectopexy.

BMI, body mass index; IQR, interquartile range; LOS, length of stay; PONV, postoperative nausea and vomiting; SSI, surgical site infection.