EP808 - Rectal prolapse in young individuals: risk factors and outcomes

Image or Table (Do Not add text here):

Purpose/Background: Rectal prolapse is rare in patients under 45 years old. The underlying pathophysiology of rectal prolapse is likely different from those occurring in older individuals. The aim of this study is to describe associated clinical factors and characteristics of rectal prolapse in young individuals and to determine their surgical outcomes.

Methods/Interventions: A retrospective study was conducted at a high volume tertiary colorectal referral center. Patients < 45 years who underwent surgical intervention for rectal prolapse from 2008 to 2024 were included. Patients with diagnosis of rectocele only were excluded. Sociodemographic and clinical risk factors for rectal prolapse that were determined a priori were collected from a prospectively maintained database. The nature of rectal prolapse and duration of symptoms, concomitant urogenital prolapse, as well as surgical approach were investigated. The main outcome of interest was rectal prolapse recurrence. Descriptive statistics were used, and a cox proportional hazard regression analysis was performed to assess clinical risk factors for rectal prolapse recurrence.

Results/Outcomes: In total, 91 individuals < 45 years were included. The average age was 29.8±8.4 years and 77 (84.6%) were females. The average BMI was 25.9±6.0 kg/m2. Sixty-nine (74.8%) patients had a psychiatric diagnosis, of which the majority (n=50, 54.9%) were on pharmacotherapy. Depression (n=54, 59.3%) was the most common psychiatric diagnosis, followed by anxiety (n=39, 42.9%), psychotic disorder (n=36, 39.6%) and eating disorder (n=14, 15.4%). Majority of patients (n=73, 80.2%) presented with constipation and 57 (62.6%) were on laxatives. Of the 77 female patients, the majority (n=50, 64.9%) were nulliparous. Connective tissue disease was present in 18 (19.8%) patients. The average time from symptom onset to evaluation by a colorectal surgeon was 14 (IQR 7-48) months. Almost all patients (n=81, 89.0%) had full thickness rectal prolapse (vs mucosal prolapse), and 39 (42.9%) had concomitant urogenital prolapse. Thirty-nine (42.9%) had prior pelvic surgeries and 20 (22.0%) patients presented with recurrent rectal prolapse following previous surgical repair. The most commonly performed procedure was ventral mesh rectopexy (n=49, 53.8%), followed by suture rectopexy (n=21, 23.1%) and resection rectopexy (n=20, 22.0%). Thirty-one (34.1%) cases involved combined repair with a urogynecologist. Redundant sigmoid was noted intraoperatively in 47 (51.6%) of patients. At a median follow-up of 39 (IQR 14.9-95.9) months, 25 (27.5%) patients experienced recurrence of rectal prolapse, with average time to recurrence 14.9 (IQR 8.3-23.1) months. Majority (n=21, 84%) underwent redo surgical repair of recurrence. On cox proportional hazard analysis, controlling for clinically important risk factors, diagnosis of psychotic disorder (aHR 2.55, 95%CI 1.05-6.19) and history of prior prolapse repair (aHR 2.82, 95%CI 1.14-6.99) were associated with increased risk of recurrence.

Conclusion/Discussion: Young individuals with rectal prolapse have a high risk of recurrence. Presence of a psychiatric co-morbidity and prior surgical repair of a rectal prolapse were independent risk factors for rectal prolapse recurrence in this population. A better understanding of the risk factors for young patients with rectal prolapse and outcomes in this population will help clinicians counsel patients regarding nature of disease and expectations following surgical intervention.