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Session:: ePosters-Sun1230-M3: Pelvic Floor

EP386 - Surgical approach and outcomes of rectal prolapse repair in patients with connective tissue disorders

Sunday, May 10, 2026
1:08 PM - 1:13 PM ET

    ePoster Presenter(s)

  • Charlotte M. Rajasingh, MD,MS

    Fellow
    Cleveland Clinic Foundation
    Cleveland Clinic Foundation
    Cleveland Heights, OH, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    View ePoster

    • Author(s)

  • RS

    Rebecca Spivak, BS

    Medical Student
    Drexel University College of Medicine
    Merion Station, Pennsylvania, United States

    Disclosure information not submitted.

  • Kristen A. Ban, MD MS FACS FASCRS

    Assistant Professor of Surgery
    Cleveland Clinic
    Fairview Park, Ohio, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Anna R. Spivak, DO

    Colorectal Surgeon
    Cleveland Clinic Foundation
    Cleveland Clinic Foundation
    Cleveland, OH, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Purpose/Background: Connective tissue disorders (CTDs) are associated with rectal prolapse, surgical complications like anastomotic leak and prolapse recurrence, and comorbidities such as pulmonary hypertension that increase perioperative risk. We evaluated how operative approach for rectal prolapse repair in patients with CTDs has evolved over time and how postoperative outcomes vary between patients undergoing abdominal versus perineal repairs.

Methods/Interventions: An-IRB approved retrospective cohort analysis of patients with full thickness external prolapse and a diagnosis of a CTD who had rectal prolapse repair at three affiliated tertiary/quaternary care hospitals from 2010 to 2025. The primary outcomes were the type of repair and secondary outcomes were postoperative complications and recurrent prolapse.

Results/Outcomes: Of the 44 patients meeting inclusion criteria, systemic sclerosis was the most prevalent CTD (n=20), followed by Ehlers-Danlos syndrome (n=14), CREST syndrome (n=7), and Mixed Connective Tissue Disease (n=3). From 2010 to present, there was an overall increase in the number of cases with a non-significant trend towards more abdominal operations (2010-2014: 62.5% vs. 2020-2025: 78.3%, Figure 1). This corresponded with a decrease in the share of patients categorized as an ASA-4 at the time of surgery and with an increase in the fraction of multi-compartment repairs (Figure 1).

In the comparison of abdominal (n=32) and perineal (n=12) repairs, perineal repair patients tended to be older with a higher ASA score (Table 1). A greater share of patients who had perineal repairs had systemic sclerosis as their CTD diagnosis (75.0%) compared with patients who had abdominal operations (34.4%). In both groups, approximately one-third of cases were for a recurrent prolapse (abdominal: 31.3% vs. perineal: 33.3%, p>0.99). Most patients who had abdominal operations had a ventral mesh rectopexy (n=68.7%) while most patients who had perineal repairs had an Altemeier proctosigmoidectomy (n=75%).

Postoperatively, patients who underwent perineal repairs had a higher rate of postoperative complications (abdominal: 15.6% vs. perineal 50.0%, p=0.05) and a higher recurrence rate (abdominal:15.6% vs. perineal:41.7%, p=0.04). Some patients in both cohorts complained of significant postoperative incontinence (abdominal: 21.9% vs. perineal: 33.3%, p=0.37). Of all patients who had identified recurrence in the study period (n=10), 7 underwent repeat surgical repair.

Conclusion/Discussion: Patients with CTDs have medical comorbidities that may impact the choice of operative approach. However, an abdominal approach, when feasible, is well tolerated and durable, especially since many of these patients have multi-compartment prolapse. Tailoring the operative approach to balance patient risk with the advantages of a given approach is essential in managing these complex patients.

Prolapse repair trends over time
Patient characteristics