Sex-Specific Outcome Profiles in Abdominal and Perineal Rectal Prolapse Repair

Purpose Rectal prolapse is markedly less common in men than in women, yet both sexes are managed using the same surgical algorithms. The study evaluates sex-specific functional outcomes, recurrence, and complications following abdominal and perineal rectal prolapse repair. Methods This retrospective single-center cohort included adults undergoing full-thickness rectal prolapse surgery between 2013 and 2023 with 12- and 36-month follow-up. Quality of life (EQ-VAS), constipation (CCCS), and fecal incontinence (Wexner) were assessed preoperatively and postoperatively. Outcomes were compared between women and men overall and stratified by operative approach. Recurrence and complications (Clavien-Dindo) were analyzed using Fisher’s exact tests; exploratory univariate logistic regression was performed for recurrence. Results A total of 180 patients were analyzed (162 women, 18 men). Men were younger and more often treated with an abdominal approach. Baseline fecal incontinence was more severe in women, while baseline quality of life and constipation were comparable. Surgery significantly improved all functional domains at 1 and 3 years (all p < 0.001). Change-from-baseline effects did not differ significantly by sex, including within approach strategies. Recurrence and complication rates were low and did not differ significantly between sexes. Conclusion Functional improvement after rectal prolapse repair was substantial in both sexes, without statistically significant sex-specific differences in treatment effect, recurrence, or complications.