Skip to main content Skip to main navigation menu Skip to site footer

The functional and physical state of the anal sphincter complex in the patients with rectal prolapse in the post-surgery period


Purpose: The work was aimed at comparative studying of the functional and physical state of the patients with rectal prolapse after surgical treatment with various surgical techniques and at identifying the most optimal procedure technique.

Patients and methods: The authors observed 49 patients (32 women, or 65.3 %) aged 22 — 83 years (the median age of women was 46.1 ± 1.3 years old, of men — 48.7 ± 1.4 years old) with the rectal prolapse of varying severity. The Delorme’s procedure was indicated for 28 patients (57.1 %). Perianal proctosigmoidectomy (the Altemeier’s surgery) was performed in 12 patients (24.5 %). In the young patients, preference was given to the Ripstein’s abdominal surgery (nine patients; 18.4 %). To objectively assess the physical state of the anal sphincter apparatus, traditional sphincterometry was performed using S4402 sphincterometer with a nonperfusing sensor (Pro Medika GmbH, Germany), and the functional state of the sphincter complex was subjectively assessed using the Wexner’s score scale.

Results: The best results were obtained after the Delorme’s procedure (p<0.05), while the worse results were obtained in the young patients after the Ripstein’s surgery (p<0.05).

Conclusion: The obtained results may be used for assessing the functional and physical state of the anal sphincter complex in the surgical treatment of the patients with the rectal prolapse syndrome, especially in those with ASFs of varying severity.


  1. Parks AG, Swash M, Urich H. Sphincter denervation in anorectal incontinence and rectal prolapse. Gut. 1977. 18:656 doi:10.1136/gut.18.8.656
  2. Fomenko OY, Shelygin YA, Popov AA, et al. Funktsionalnoe sostoyanie myshts tazovogo dna u bolnykh s rektotsele [The functional state of the pelvic floor muscles in the patients with rectocele]. The Russian Bulletin of the obstetrician-gynecologist. 2017;17(3):43–48. 201717343-48.
  3. Moschowitz AV. The pathogenesis, Anatomy and Cure of prolapse of the Rectum. Surg. Gynec. Obstet. 1912;15:7–21.
  4. Podmarenkova LF, Aliyeva EI, Poletov NN, et al. Rol funktsionalnykh metodov issledovaniya zapiratelnogo apparata pryamoi kishki v vyyavlenii patogeneticheskikh mekhanizmov analnoi inkontinentsii [The role of functional methods for studying the rectum obturator apparatus for identifying the pathogenetic mechanisms of anal incontinence]. Coloproctology. 2006;2(16):24–30.
  5. Aliev EA, Akhmedova EV. Prolaps tazovykh organov [Prolapse of the pelvic organs]. Coloproctology. 2016;2(56):42–47.
  6. Regadas FSP, Abedrapo M, Cruz JV, et al. Apex technique in the treatment of obstructed defecation syndrome associated with rectal intussusception and full rectal mucosa prolapse. Dis. ColonRectum. 2014;57:1324-1328 doi: 10.1097/DCR.0000000000000229
  7. Aliev EA. Prichiny i profilaktika nedostatochnosti analnogo sfinktera [The reasons for and prevention of anal sphincter failure]. Bulletin of the National Pirogov Medical Surgical Center. 2011;1(6):48–53.
  8. Koughnett JM, Wexner SD. Current management of fecal incontinence: choosing amongst treatment options to optimize outcomes. World Journal of Gastroenterology. 2013;19(48):9216–9230 doi:10.3748/wjg.v19.i48.9216
  9. Hori T, Yasukawa D, Machimoto T, et al. Surgical options for full-thickness rectal prolapse: current status and institutional choice. Ann Gastroenterol. 2018;31(2):188–197. doi:10.20524/aog.2017.0220
  10. Naldini G, Fabiani B, Menconi C, et al. Treatment of obstructed defecation syndrome due to rectocele and rectal intussus caption with a high volume stapler. Tech Coloproctol. 2018;22(1):53–58. doi:10.1007/s10151-017-1696-7.
  11. Kohler A, Athanasiadis S. The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse – a clinical and sphincterometric study. Langenbeck's Arch Surg. 2001;386(3):188–192.
  12. Regadas FSP, Murad-Regadas SM, Wexner SD, et al. Anorectal threeâ€dimensional endosonography and anal manometry in assessing anterior rectocele in women: a new pathogenesis concept and the basic surgical principle. Colorectal Dis. 2007;9:80–85.
  13. Zbar AP, Aslam M, Hider A, et al. Comparison of vector volume manometry with conventional manometry in anorectal dysfunction. Tech Coloproctol. 1998;2:84–90.
  14. Menekse E, Ozdogan M, Karateke F, et al. Laparoscopic rectopexy for solitary rectal ulcer syndrome without overt rectal prolapse: a case report and review of the literature. Ann ItalChir. 2014;85:pii/S2239253X14022208.
  15. Koizumi N, Kobayashi H, Fukumoto K. Massive chronic irreducible rectal prolapse successfully treated with Altemeier's procedure. J. Surg Case Rep. 2018;4:rjy064. doi: 10.1093/jscr/rjy064

How to Cite

Imanova, S. S. (2020). The functional and physical state of the anal sphincter complex in the patients with rectal prolapse in the post-surgery period. Bali Medical Journal, 9(3), 640–644.




Search Panel

Solmaz Soltan Imanova
Google Scholar
BMJ Journal