EP153 - The prevalence of connective tissue diseases among patients with rectal prolapse presenting for ventral mesh rectopexy: A single institution study

Purpose/Background: Rectal prolapse is characterized by full-thickness protrusion of the rectum through the anus. It occurs in roughly 5% of the population and is more common in females. It can be associated with a variety of symptoms including fecal incontinence, constipation, and pain. Ventral mesh rectopexy is a surgical procedure used to correct the rectal prolapse. While the association between connective tissue diseases and pelvic organ prolapse has been studied, there is little data examining the relationship between connective tissue diseases and rectal prolapse, especially in regard to prevalence, surgical management and recurrence rates.

Methods/Interventions: This is a single institution analysis of a prospectively maintained institutional colorectal surgery database between 01/01/2018 and 09/30/2023. Patients diagnosed with rectal prolapse who underwent ventral mesh rectopexy (VMR) were identified. The primary outcome was diagnosis of a connective tissue disorder. The secondary outcome was recurrent rectal prolapse. Recurrence was defined as patients presenting for VMR during the study period with history of previous surgery for rectal prolapse and patients undergoing initial VMR during the study period who later recurred.

Results/Outcomes: 131 patients with rectal prolapse undergoing ventral mesh rectopexy were identified. 16 patients (12%) had a diagnosis of one or more connective tissue diseases. The most common connective tissue disease was rheumatoid arthritis (7/131, 5.3%), followed by Raynaud’s syndrome (6/131, 4.6%), Sjogren syndrome (3/131, 2.3%), systemic lupus erythematosus (2/131, 1.5%), scleroderma (2/131, 1.5%), and Ehlers-Danlos syndrome (1/131, 0.76%). These prevalence rates are greater than those found within the general population. A total of 19 patients had recurrent rectal prolapse. Only 1 patient with a diagnosis of connective tissue disease experienced recurrence compared to 18 patients with recurrent rectal prolapse and no diagnosis of connective tissue disease (6.25% vs 15.65%, p > 0.05).

Conclusion/Discussion: Data from this single-institution analysis suggest a higher prevalence of various connective tissue diseases among patients with rectal prolapse presenting for ventral mesh rectopexy compared to the general population. While this does not appear to affect recurrence, future studies are needed to evaluate the relationship between connective tissue diseases and rectal prolapse and determine if early interventions, such as pelvic floor physical therapy, can lead to prevention.