Rectal Prolapse: Review According to the Personal Experience

Abstract

The aim of treatment of rectal prolapse is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. Faced with a multitude of options, the choice of an optimal treatment is difficult. It is best tailored to patient and surgeon. Numerous procedures have been described and are generally categorized into perineal or abdominal approaches. In general, an abdominal procedure has associated with lower recurrence and better functional outcome than perineal procedures. The widespread success of laparoscopic surgery has led to the development of laparoscopic procedures in the treatment of complete rectal prolapse. In Korea, there has been a trend toward offering perineal procedures because of the high incidence of rectal prolapse in young males and its being a lesser procedure. Delorme-Thiersch procedure has appeal as a lesser procedure for patients of any age or risk category, especially for elderly low-risk patients, patients with constipation or evacuation difficulties, young males, and patients with symptomatic hemorrhoids or mucosal prolapse. Laparoscopic suture rectopexy is recommended for either low-risk female patients or patients who are concerned with postoperative aggravation of their incontinence.

Thiersch Procedure for Rectal Prolapse: Experiences From a Single Institution

“…Yoon proposed a combined Delorme-Thiersch procedure for rectal prolapse; this combined procedure had comparatively improved outcomes for high-risk patients in his series, and no recurrence was reported during a mean follow-up period of 22 months. 15 Gupta proposed another combined method: Thiersch's procedure and subanodermal coagulation. The recurrence rate is 7.9% (3/38) after 2 years follow-up.…”

Emergency Perineal Rectosigmoidectomy for Gangrenous Rectal Prolapse: a Single-Centre Experience with Review of Literature

“…Anastomotic leakage has been found to be very rare. [7]. Agachan et al reported that addition of levatorplasty during Altemeier's procedure leads to less chances of recurrence.…”

Simultaneous Delorme's procedure and inter-sphinteric prosthetic implant for the treatment of rectal prolapse and faecal incontinence: Preliminary experience and literature review

“…This explains why patients with rectal prolapse suffer from not only a prolapsed rectum but also associated dysfunction. A large percentage of patients suffering from rectal prolapse also complain from faecal incontinence (FI), obstructed defecation and chronic constipation; in this patients the frequent straining during defecation induces an injury of the rectal mucosa, often leading to rectal ulcer development [3]. FI in external rectal prolapse has two different components: the prolapsed mucosa generates a continuous secretion that causes a soiling that can be serous-mucous as well as seroushaematic in case of mucosal ulcers and erosions; the stretching of the muscles induces a progressive weakness of the sphincters affecting their resting tone and reducing their contractile strength.…”