The entire rectum extends out of the anus. This may be due to our small sample size. There was no mortality. Outcome data included operative time, length of postoperative hospital stay, postoperative complications, 30-day mortality and recurrence. We do not endorse non-Cleveland Clinic products or services. PubMed Google Scholar. There was no mortality. 1. In terms of recurrence, the overall recurrence rate of 14 % at 1 year in the current study compares favorably with previous studies of perineal repair in which prolapse recurred in 6.4–16 % of patients at significantly shorter follow-up times [1, 4, 12]. Get useful, helpful and relevant health + wellness information. The hernia sac is entered, and the prolapse is delivered. Therefore, accurate history and recognition of physical examination findings is of paramount importance. Rectal prolapse occurs when the rectum (the last section of the large intestine) falls from its normal position within the pelvic area and sticks out through the anus. Both the Delorme’s and Altemeier’s procedures are done via the anus and no external incision is needed, however there may be some bruising around the anus. Hemorrhoids can produce anal itching and pain, discomfort and bright red blood on toilet tissue. Thus, pelvic floor pathology was more common in patients who underwent Altemeier procedure [9/22 (41 %) vs. 3/53 (6 %), p = 0.0004]. As with perineal rectosigmoidectomy, Delorme… Selection of the appropriate surgical technique for a patient with rectal prolapse is difficult, and the quality of outcomes relates to several factors: expected surgical mortality and morbidity, the chance of recurrent prolapse and the effect of the surgery on anorectal function. Kaplan–Meier analyses were performed to evaluate the relationship between time of recurrence and treatment group. Abdominal procedure refers to making an incision in the abdominal muscles to view and operate in the abdominal cavity. Dis Colon Rectum 51:162–172, Rockwood TH, Church JM, Fleshman JW et al (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Among patients who had a Delorme’s procedure, three combined procedures were performed: one vaginal prolapse repair, one cystocele repair and one anal plication. All procedures performed in studies involving human participants were in accordance with ethical standards of, Cleveland Clinic Foundation, Cleveland, Ohio, USA. At first, this can occur during or after bowel movements and is a temporary condition. Semin Colon Rectal Surg March 2010 21:37-44. Fiber, fluids, stool softeners and mild laxatives can be used. The median hospital stay was longer in Altemeier’s group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. Since there are few data comparing surgical outcomes and quality of life (QOL) following different types of perineal repair of rectal prolapse, the best choice of technique remains unclear. Prolapses longer than 15 cm are treated preferably with an Altemeier. The median hospital stay was longer in the Altemeier group [4 (1–44) days vs. 3 (0–14) days; p = 0.01]. Find the latest information from the globally recognized leader in digestive diagnosis, treatments and surgical innovations. Cleveland Clinic is a non-profit academic medical center. The aim of our study was to compare the short-term outcomes and QOL after the two perineal procedures in patients with rectal prolapse. Two-thirds (66 %) of patients were classified as American Society of Anaesthesiologists grade III and IV (Table 1). The Altemeier’s Operation Altemeier’s operation (perineal rectosigmoidectomy) is a surgical procedure used to correct a full-thickness rectal prolapse. Rectopexy can also be performed laparoscopically through small keyhole incisions, or robotically, making recovery much easier for patients. Overall, recurrence rates did not differ significantly between the perineal and abdominal approaches (20 vs. 26%, P = 0.8). Continuous measures were described as means and standard deviations, or median and range. Correspondence to Surgery puts the rectum back in place.There are a number of ways to do rectal prolapse surgery. Church & G. Ozuner, You can also search for this author in This can happen in a surgery in which a segment of the bowel is removed and the two ends of the remaining bowel are reconnected. Ann Surg 230:575–586, Agachan F, Reissman P, Pfeifer J, Weiss EG, Nogueras JJ, Wexner SD (1997) Comparison of three perineal procedures for the treatment of rectal prolapse. The specimen is then amputated, and the anastomosis can be completed with either a suture or staple without tension. There were fewer recurrences after Altemeier's than Delorme's procedure [Fig. Altmeier for rectal prolapse published in ASCRS text book Video Created by Jeff Mino, Brooke Gurland, Massarat Zutshi, Tracy Hull Peri-operative data on 43 consecutive female patients were reviewed. Tech Coloproctol 19, 521–525 (2015). It has a higher recurrence rate than does the Altemeier procedure, probably because we do not enter the peritoneal cavity. Several studies have shown the safety of a perineal approach in elderly high-risk patients [4, 5]; however, the recurrence rates are significantly higher when compared with abdominal repairs [4, 6]. During the more commonly performed form of this procedure (Altemeier procedure), the surgeon pulls the rectum through the anus, removes a portion of the rectum and sigmoid and attaches the remaining rectum to the large intestine (colon). 85 When comparing the various perineal options (perineal rectosigmoidectomy, perineal rectosigmoidectomy with levatorplasty, and Delorme procedure), … Nine patients who underwent Altemeier repair for rectal prolapse had concomitant combined procedures. Rectal prolapse vexes surgeons because of the multiple procedures described for treatment. Poster presentation at the annual meeting of the American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 17–21, 2014. However, over time – because of an ordinary amount of standing and walking – the end of the rectum may even extend out of the anal canal spontaneously, and may need to be pushed back up into the anus by hand. However, in most patients, surgery fixes the prolapse. Avoiding constipation postoperatively is a key to maintaining the reduction until healing occurs. We report our experience with this procedure in six elderly candidates who have undergone the Delorme procedure at the UCLA Center for Health Sciences in the past year. Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane.The blood flows in one direction and the dialysate flows in the opposite. The recurrence rates were similar for Altemeier’s procedure and Delorme’s procedure (24 vs. 31%, P = 0.4). The Altemeier procedure can be followed by an anastomotic leak but should have lower recurrence rates. The two main types of dialysis, hemodialysis and peritoneal dialysis, remove wastes and excess water from the blood in different ways. Other risks and complications from surgeries to repair rectal prolapse include: After surgery, constipation and straining should be avoided. Surgeon preference is the major component in determining which type of procedure is done. All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Seventy-five patients (93 % female) underwent rectal prolapse surgery: 22 Altemeier and 53 Delorme, mean age 72 ± 15 years. No. Fisher’s exact test or Cochran–Armitage trend test was used to assess the associations between the surgery type and categorical measures. Rectal prolapse can also occur in infants – which could be a sign of cystic fibrosis – and in older children. 3, 4. The rectum starts to drop down but does not extend out the anus (internal prolapse). Introduction. (The word "prolapse" means a falling down or slipping of a body part from its usual position.). The Delorme procedure entails a mucosal sleeve resection, proximal to the dentate line, with longitudinal rectal muscular plication. Lack of healing where the two ends of bowel reconnect. Rectal prolapse results from a slippage of the attachments of the last portion of the large intestine. https://doi.org/10.1053/j.scrs.2009.10.007. Early rectal prolapse can look like internal hemorrhoids that have slipped out of the anus (i.e., prolapsed), making it difficult to tell these two conditions apart. Dis Colon Rectum 42:460–466, Zbar AP, Takashima S, Hasegawa T, Kitabayashi K (2002) Perineal rectosigmoidectomy (Altemeir procedure): a review of physiology technique and outcome. Urinary retention (inability to pass urine). Article  A Delorme’s procedure doesn’t usually cause much pain afterwards. It could be expected to have lower complication than the alternative Altemeier proctosigmoidectomy, but may have high recurrence. There was no mortality. Dis Colon Rectum 43:9–16, Fazio VW, O’Riordain MG, Lavery IC et al (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. The Delorme procedure entails a mucosal sleeve resection, proximal to the dentate line, with longitudinal rectal muscular plication. Rectal procedures are often used in older patients and in patients who have more medical problems. PubMed  A prior study comparing Delorme versus Altemeier repairs showed comparable length of postoperative hospital stay, but a significant increase in postoperative morbidity with Altemeier procedure [11]. It explains the benefits, risks and any alternatives to surgery. In conclusion, in patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. These are rarely life-threatening symptoms. Humans are capable of flexibly converting symbolic instructions into novel behaviors. The patients are generally high-risk patients as shown by their age and the distribution of ASA scores. Rectal prolapse vexes surgeons because of the multiple procedures described for treatment. The Delorme procedure avoids resection and therefore a full-thickness anastomosis. One patient had a cystocele which was repaired at the time of Altemeier procedure. The overall postoperative complication rate was 12 % (n = 9). Abdominal and rectal (also called perineal) surgery are the two most common approaches to rectal prolapse repair. Perineal procedures continue to comprise between 50 and 60 % of the procedures performed for rectal prolapse in the USA [7]. Conclusions: Both the Altemeier and Delorme procedures are effective treatments for rectal prolapse, which can improve the postoperative quality of life. There are some limitations to our study. Altemeier procedure: full thickness excision of rectum + part of sigmoid colon Delorme procedure: mucosal resection + plication of muscle layer of rectum Although there is interest in laparoscopic approach and abdominal approach is thought to have lower recurrence rates than the perineal approach, there is no evidence to support superiority of abdominal over … In the Altemeier group, there were four patients with anastomotic leaks requiring a reoperation (two ileostomy, one end colostomy and one oversewn). Furthermore, incontinence, bowel function and QOL were similar between groups. - 45.77.194.89. Being able to see the prolapse helps your doctor confirm the diagnosis and plan treatment. Altemeier’s procedure. The objective of this study was to determine the recurrence rate and associated risk factors of full-thickness rectal prolapse in the long term after Delorme’s procedure.Patients and Methods. Policy. PubMed  Among 22 patients who underwent Altemeier, 4 were stapled and 18 were handsewn. Part of Springer Nature. Rather, it is a demonstration of what outcomes the perineal procedures for rectal prolapse are capable of producing. Tech Coloproctol 6:109–116, Riansuwan W, Hull TL, Bast J, Hammel JP, Church JM (2010) Comparison of perineal operations with abdominal operations for full-thickness rectal prolapse. The appearance of circumferential, concentric folds of Thiersch wire procedure), mucosal sleeve resection (the Delorme rectal mucosa serves to differentiate rectal prolapse from hemor- procedure), and perineal rectosigmoidectomy (the Altemeier pro- rhoids, in which the folds (sulci) occur in a radial pattern, yield- cedure). Altemeier perineal rectosigmoidectomy. There was no mortality in either group. Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier. Elderly patients and those with multiple comorbid conditions are usually treated with a perineal approach as this minimizes operative risk and the significance of postoperative complications [2]. ... (Delorme procedure) is more typically done for short prolapses. We abstracted age at surgery, gender, American Society of Anesthesiologist (ASA) score and body mass index (BMI). Ann Surg 173:993–1006, PubMed Central  Google Scholar, Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years’ experience with the one-stage perineal repair of rectal prolapse. Colorectal Dis 15:858–870. Last reviewed by a Cleveland Clinic medical professional on 05/07/2018. The advantage of posterior levatorplasty is that it recreates the anorectal angle, which seems to improve anal continence. In fact, the best chance for preventing prolapse from returning is to make a lifetime effort to avoid straining and any activities that increase abdominal pressure. Total FIQL score was calculated by adding the subscales together. The two most common rectal approaches are the Altemeier and Delorme procedures: As with any surgery, anesthesia complications, bleeding and infection are always risks. Kaplan–Meier curve for recurrence-free survival. The four patients with anastomosis leak had a handsewn anastomosis. Dis Colon Rectum 47:103–107, CAS  Advertising on our site helps support our mission. The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier’s rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. © 2021 Springer Nature Switzerland AG. Rectal prolapse surgery is a procedure to repair rectal prolapse, which occurs when the last part of the large intestine (the rectum) stretches and protrudes from the anus. Techniques in Coloproctology Sixteen patients (28.0%) relapsed after operation, including 10 patients in the Altemeier group and 6 patients in the Delorme group, without statistically significant difference (P=0.134). All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. Short-term outcomes and QOL were compared. 6 • Patients were followed for a median of 36 months . (The word \"prolapse\" means a falling down or slipping of a body part from its usual position.) 3: 24/102 (24%) vs 31/99 (31%)], but this difference was not statistically significant [hazard ratio (HR) 0.81; 95% CI 0.47–1.38; P = 0.4)]. American Society of Colon and Rectal Surgeons. However, surgery will be necessary to repair the prolapse. volume 19, pages521–525(2015)Cite this article. Bleeding, primarily from the sacral venous plexus but also potentially from the mesenteric vascular supply divided as part of the procedure. Perineal vs abdominal approaches • Found higher recurrence rates for suture rectopexy vs resection rectopexy (46% vs 18%), but was not statistically significant Furthermore, the functional data are limited due to the low response rate to the questionnaire. A total of 75 patients (93 % female) with a mean age of 72 ± 15 years underwent perineal rectal prolapse surgery: 22 an Altemeier proctosigmoidectomy and 53 a Delorme procedure. Rectal Prolapse Surgery: Choosing the Correct Approach. Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier. Because of the variety of potential problems, urologists, urogynecologists and other specialists often team together to share evaluations and make joint treatment decisions. The prolapsed rectum is thereafter plicated resulting in … Resection is preferred for patients who have severe constipation. In Altemeier repair, the outer cylinder of bowel is divided approximately 1.5–2.0 cm proximal to the dentate line. The study involved adult patients with rectal prolapse treated with Delorme’s surgery between 2000 and 2012 and followed up prospectively in an outpatient unit. The Altemeier group had a higher rate of overall postoperative complications (22 vs. 7 %, Fisher’s exact test, p = 0.04) (Table 2). Only a portion of the rectal lining is pushed through the anus. Fecal incontinence refers to leakage of mucus, blood or stool from the anus. All tests were performed at a significance level of 0.05. In an Altemeier perineal rectosigmoidectomy, a full-thickness circumferential incision is made in the prolapsed rectum about 1-2 cm from the dentate line (see the image below). The two samples t test was used to evaluate the relationship between surgery type and continuous measures. Google Scholar, Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD (1999) Complete rectal prolapse: evolution of management and results. There are several surgical approaches. Elagili, F., Gurland, B., Liu, X. et al. Rectal prolapse can occur as a result of many conditions, including: The symptoms of rectal prolapse include the feeling of a bulge or the appearance of reddish-colored mass that extends outside the anus. Medical complications of surgery: heart attack, Worsening or development fecal incontinence. Altemeier vs Delorme procedure. Categorical measures were summarized using frequencies and percentiles. In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. Of 75 patients, 22 underwent an Altemeier (perineal proctosigmoidectomy) procedure and 53 patients underwent a Delorme procedure. The median operative time was also longer in Altemeier group, but this difference was not significant [Altemeier 80 (53–231) min vs. Delorme 59 (40–174) min, p = 0.19, t test]. It is retrospective and so the choice of operation was not random, but based on the length of the prolapse and the individual surgeons preferences and experience. The CGQL score, used to evaluate overall QOL, includes three items: current QOL, current health and current level of energy, each self-reported on a scale of 0–10 (0, worst; 10, best). Short-term … Perineal Rectosigmoidectomy (Altemeier Procedure) + + + Expected Benefits + + Preferred over an abdominal approach in high-risk patients. Sixty-six percentage of patients were ASA grade III or IV (Table 1). Lower values reflect diminished quality [9]. Patients who did not complete the questionnaires before and after surgery were not analyzed. Dis Colon Rectum 44:565–570, Senapati A, Gray R, Middleton L et al (2013) PROSPER: a randomized comparison of surgical treatments for rectal prolapse. First, your doctor will take your medical history and will perform a rectal exam. In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum. Advertising on our site helps support our mission. Recurrence was defined as full-thickness prolapse of the rectal wall. It also explains what you can expect when you come to hospital. Both are associated with a low mortality rate, but a high recurrence rate [15, 16]. The rectal muscular plication stabilizes the reduction in the prolapse, and the mucosal anastomosis seals the procedure. South Med J 90:925–932, Kimmins MH, Evetts BK, Isler J, Billingham R (2001) The Altemeier repair: outpatient treatment of rectal prolapse. Operative Treatment of Rectal Prolapse: Perineal Approach (Altemeier and Modified Delorme Procedures) Valerie Bauer DEFINITION Rectal prolapse is a “falling down” of the rectum caused by weakness in surrounding supportive tissues. Altemeier’s procedure is one of the well-known peri-neal operations to treat full-thickness rectal prolapse; it removes the prolapse without a pexy and performs only a partial reconstruction of the pouch of Douglas. We do not endorse non-Cleveland Clinic products or services. We assessed epidemiological data, Wexner constipation and incontinence score, recurrence patterns, and ris… Spinal anesthesia or an epidural (anesthesia that blocks pain in a certain part of the body) may be used instead of general anesthesia in these patients. The surgeon’s choice depends on patient’s age, other existing health problems, the extent of the prolapse, results of the exam and other tests and the surgeon’s preference and experience with certain techniques. Article  It is difficult to find publications that compare patient’s QOL after perineal rectal prolapse surgery. The term "rectal prolapse" can describe three types of prolapse: Rectal prolapse is common in older adults who have a long-term history of constipation or a weakness in the pelvic floor muscles. Rectal prolapse occurs when the rectum (the lower end of the large intestine) falls from its normal position within the pelvic area. The two most common types of abdominal repair are rectopexy (fixation [reattachment] of the rectum) and resection (removal of a segment of intestine) followed by rectopexy. After a median follow-up of 13 (1–88) months, the rate of recurrent prolapse was 14 % (n = 11) [Altemeier 2 (9 %) vs. Delorme 9 (16 %) p = 0.071]. J Am Coll Surg 203:322–327, Varma MG, Wang JY, Berian JR, Patterson TR, McCrea GL, Hart SL (2008) The constipation severity instrument: a validated measure. At follow-up any change in pelvic floor … However, in patients with lesser amount of prolapse or who are immunosuppressed (e.g., high-dose steroids, other medication), a Delorme is the preferred operation. The aim of our study was to compare the short-term outcome and QOL of two perineal procedures in patients with rectal prolapse.All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. A waiver of consent was obtained from the Institutional Review Board. Success can vary depending on the condition of supporting tissues and the age and health of the patient. Fecal incontinence is another symptom. The CSI consists of 16 questions that ascertain severity by means of a total score (range 0–73) and the following subtypes of constipation: obstructive defecation (range 0–28), colon inertia (0–29), or pain (0–14) [8]. Delorme procedure has the advantages of shorter operation time and … The scores are added, and the final CGQL utility score obtained by dividing by 30 (0 worst; 1 best) [10]. In patients who were in a nursing home or unable to respond clearly to questions, follow-up was based on last clinic visit. The trade-off is a higher risk of recurrence and possibly poor function. Because of this, the study is not really a fair comparison of the techniques. Doctors can use several tests to diagnose rectal prolapse and other pelvic floor problems, and to help determine the best treatment for you. In particular, there were four patients with anastomotic leaks after an Altemeier, all needed reoperation and three required a stoma. 92 This concomitant levatorplasty achieves not only a more significant improvement in continence but also a lower short-term recurrence rate than either the Delorme procedure or perineal rectosigmoidectomy alone. World J Surg 34:1116–1122, Schoetz DJ (2006) Evolving practice patterns in colon and rectal surgery. The most common perineal operations are the Delorme procedure (mucosal sleeve resection with rectal muscular plication) and the Altemeier perineal proctosigmoidectomy (transanal proctectomy with coloanal anastomosis) [3]. Patients undergoing a Delorme procedure for full-thickness rectal prolapse had a lower overall postoperative complication rate and shorter length of hospital stay than those having an Altemeier operation. Our study confirmed these hypotheses although the differences we showed were not always significant. Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier, https://doi.org/10.1007/s10151-015-1337-y. METHODS: All patients with full-thickness rectal prolapse admitted to our institution and undergoing Delorme and Altemeier procedures from 2005 to 2013 were identified using an institutional, IRB-approved rectal prolapse database. The CGQL scores in each group were 0.6 ± 0.2 and 0.5 ± 0.3, respectively (p = 0.59), and were not changed by the surgery. However, surgery is usually necessary to repair the prolapse. It is usually performed under general anesthesia and is the approach most often used in healthy adults. Selection of the appropriate surgical technique for a Comparing perineal repairs for rectal prolapse: Delorme versus Altemeier | springermedizin.de The inner cylinder of the rectum and sigmoid is placed on traction, and mesenteric vessels are sequentially ligated and divided. Delorme’s procedure is safe and effective even in large incarcerated rectal prolapse. The Delorme operation involves mucosal stripping and muscle plication of the rectal prolapse and is performed externally under regional or general anesthesia. A drip is normally in place for 24 hours after the operation. Hemorrhoids are swollen blood vessels that develop in the anus and lower rectum. Of the 75 patients, 25 (33 %) completed the pre- and postoperatively standardized questionnaire, including the CSI, the FIQL and CGQL. In the present study we evaluated the results of Alte-meier’s procedure in a sequential series of patients with During this procedure, the surgeon pulls the rectum through the anus, removes a portion of the rectum and sigmoid colon and attaches the remaining rectum to the large intestine (colon). Policy, Cleveland Clinic is a non-profit academic medical center. Postoperative complication rate was 12 % (n = 9) [Altemeier 5 (22 %) vs. Delorme 4 (7 %), p = 0.04]. G. Ozuner. Google Scholar, Madiba T, Baig M, Wexner S (2005) Surgical management of rectal prolapse. Patients are allowed to eat and drink as soon as they feel able after the operation (usually the same day). In addition, patients that recur after a Delorme procedure can undergo another similar transanal procedure without compromising the vascular supply of the rectum. Similarly, failure to resect all prolapsing bowel in the Altemeier operation predisposes to recurrent prolapse. Kaplan–Meier analysis is presented in Fig. Straining during constipation secondary to functional disorders of elimination (anismus) and anatomic causes of outlet … Ten percent of patients had follow-up by direct phone call and 90 % by office visit. There are two main perineal-based approaches for rectal prolapse, the Delorme and Altemeier procedures . In some cases of very minor, early prolapse, treatment can begin at home with the use of stool softeners. Complete recovery can usually be expected in a month; however, patients should avoid straining and heavy lifting for at least 6 months. There was no significant difference between the surgery groups in intraoperative blood loss and postoperative stool frequency (Table 1). Eight had stage IV pelvic organ prolapse and underwent a combined repair with urogynecology. Altemeier’s procedure removes the prolapsed rectum “from below” and can be done without an abdominal incision. In patients where abdominal repair of rectal prolapse is judged to be unwise, a Delorme procedure offers short-term control of the prolapse with low risk of complications and with reasonable function. After a median follow-up of 13 (1–88) months, no significant difference in full-thickness rectal prolapse recurrence rate between these two procedures was noted [Delorme 9/53 (16 %) vs. Altemeier 2/22 (9 %), p = 0.71]. Our data are also consistent with a previous randomized trial in which the recurrence rate of the Delorme group was similar to the Altemeier group [13]. It is more common in women than in men, and even more common in women over the age of 50 (postmenopausal women), but occurs in younger people too. You may be asked to "strain" while sitting on a commode to mimic an actual bowel movement. Tests used to evaluate and make treatment decisions include: In some cases of very minor, early prolapse, treatment can begin at home with the use of stool softeners and by pushing the fallen tissue back up into the anus by hand. This occurs as a result of the rectum stretching the anal muscle. Patients were asked to complete a standardized questionnaire, including the Constipation Severity Index (CSI), the Fecal Incontinence Quality of Life Scale (FIQL) and Cleveland Global Quality of Life (CGQL) before and after the operation.

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