Rectal prolapse: which surgical option is appropriate?

Abstract

Numerous surgical procedures have been suggested to treat rectal prolapse. In elderly and high-risk patients, perineal approaches such as Delorme's procedure and perineal rectosigmoidectomy (Altemeier's procedure) have been preferred, although the incidence of recurrence and the rate of persistent incontinence seem to be high when compared with transabdominal procedures. Functional results of transabdominal procedures, including mesh or suture rectopexy and resection-rectopexy, are thought to be associated with low recurrence rates and improved continence. Transabdominal procedures, however, usually imply rectal mobilization and fixation, colonic resection, or both, and some concern is voiced that morbidity, in terms of infection or leakage, and mortality could be increased. If we focus on surgical outcome, our own experience of laparoscopic resection-rectopexy for rectal prolapse shows that the laparoscopic approach is safe and effective, and functional results with respect to recurrence are favorable. However, the controversy "which operation is appropriate?" cannot be answered definitely, as a clear definition of rectal prolapse, the extent of a standardized diagnostic assessment, and the type of surgical procedure have not been identified in published series. Randomized trials are needed to improve the evidence with which the optimal surgical treatment of rectal prolapse can be defined.

Laparoscopic resection rectopexy for rectal prolapse: a single-center study during 16 years

“…Throughout the past century, more than 100 different surgical techniques have been introduced to treat patients with rectal prolapse [2]. In principle, perineal can be distinguished from abdominal approaches.…”

Day case laparoscopic rectopexy is feasible, safe, and cost effective for selected patients

“…The choice between perineal and abdominal operations for this condition depends on patient comorbidity. Both perineal rectosigmoidectomy and Delorme's procedure have good outcomes for elderly patients unfit to undergo transabdominal procedures despite the higher incidence of recurrence and rate of persistent incontinence [1][2][3]. Abdominal rectopexy can be performed with or without resection of the sigmoid and may involve the use of a mesh or sutures to anchor the rectum to the sacrum [2].…”

The current role of imaging techniques in faecal incontinence

“…Patients with a rectal prolapse may achieve restoration of continence after rectopexy [75]. Patients with an EAS defect at imaging may benefit from anterior anal sphincter repair [74].…”