Recent Management Of Rectal Prolapse

Choosing the surgical approach in full-thickness adult rectal prolapse is dependent upon many factors, including patient age, attendant comorbidity, presence or absence of significant constipation (and sigmoid redundancy), associated faecal incontinence, associated genital prolapse, gender, body habitus and the surgeon’s procedural familiarity and expertise. In general, coloproctologists will have their stock abdominal and perineal approaches, which may be modified in accordance with presentation, including some form of abdominal rectopexy in relatively fit patients and a perineal approach for those with worse performance status. Of the abdominal approaches, it would appear that mesh utilisation has disappeared in favour of a suture rectopexy and that process is better performed to the lumbosacral disc by rectosacropexy rather than with presacral fixation. There is little difference between either the laparoscopic or the open approach, dependent upon surgical expertise. Technical aspects of carrying the procedure to the territory of the lateral ligaments is controversial : adequate dissection posteriorly to the levator plate and limitation of the anterior dissection through the fascia of Denonvilliers is adequate, with the impression that the laparoscopic suture rectopexy in male patients is superior given the 3-fold higher recurrence rate in men compared with women when open abdominal rectopexy is employed. The choice for sigmoidectomy still seems to be based on a somewhat subjective assessment of the severity of attendant constipation and impression on contrast enema, computed tomography, colonoscopy or at surgery regarding the presence of sigmoid redundancy