Internal rectal prolapse (IRP) is a common disease causing defecation disorder. Surgical treatment should be considered when non-surgical treatment is ineffective, the symptoms are gradually aggravated, and the quality of life is impaired. However, there are many operative methods and different postoperative outcomes for IRP. This paper will discuss the effect of different surgical procedures of transabdominal and transperineal for IRP.

A retrospective cohort study was used. Patients with constipation who were diagnosed with IRP and met ODS in Daping Hospital, Army Medical University from January 2000 to December 2018 were selected, and the clinical data and follow-up results of all patients were collected and analyzed retrospectively. All patients were divided into transabdominal procedure group (n=69) and transperineal procedure group (n=101). The transabdominal procedure group was divided into transabdominal rectopexy group (n=28) and transabdominal rectopexy + sigmoidectomy group (n=41). Evaluation indexes: perioperative related indexes (including operation time, intraoperative bleeding, postoperative hospitalization days, hospitalization expenses and postoperative complications) and functional indexes (improvement of constipation symptoms and quality of life). The clinical outcomes and effect of different surgical procedures were analyzed and compared.

The operation time, blood loss, postoperative hospitalization days and hospitalization expenses in the transabdominal procedure group were higher than those in the transperineal procedure group (t=3.124, 1.497, 0.524, 1.765; P＜0.001). There was no significant difference in early postoperative complications between the two groups (χ²=0.141, P＞0.05), but the late postoperative complications in the transabdominal procedure group were higher than those in the transperineal procedure group (χ²=0.844, P=0.009). The postoperative recurrence rate of transperineal operation group was higher than that of abdominal operation group (χ²=4.777, P=0.029). The Wexner constipation scores after surgery were lower in both groups (t=22.126, 31.324; P＜0.001). The operation time, bleeding volume, postoperative hospitalization days and hospitalization expenses in the transabdominal rectopexy group were lower than those in the transabdominal rectopexy + sigmoidectomy group (t=1.782, 0.926, 0.421, 3.41; P＜0.05). There was no significant difference in early and late postoperative complications, recurrence rate between the two groups (χ²=0.129, 0.333, 0.885; P＞0.05). There was no significant difference in postoperative Wexner constipation score, subjective effectiveness and satisfaction in the two groups (t=-0.386, χ²=0.430; P＞0.05).

Both transabdominal and transperineal surgery can achieve better postoperative efficacy in the treatment of IRP. Transabdominal approach has better constipation remission and lower recurrence rate, while transperineal surgery still has the advantages of lower complication rate and better health economics. Additional sigmoidectomy did not improve constipation and postoperative outcomes in the transabdominal surgery.