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Surgical Management of Rectal Prolapse
Thandinkosi E. Madiba, MMed(Chir), FCS(SA);
Mirza K. Baig, FRCS;
Steven D. Wexner, MD, FACS, FRCS, FRCS(Edin)
Arch Surg. 2005;140:63-73.
Background The problem of complete rectal prolapse is formidable, with no clear predominant treatment of choice. Surgical management is aimed at restoring physiology by correcting the prolapse and improving continence and constipation with acceptable mortality and recurrence rates. Abdominal procedures are ideal for young fit patients, whereas perineal procedures are reserved for older frail patients with significant comorbidity. Laparoscopic procedures with their advantages of early recovery, less pain, and possibly lower morbidity are recently added options. Regardless of the therapy chosen, matching the surgical selection to the patient is essential.
Objective To review the present status of the surgical treatment of rectal prolapse.
Data Sources Literature review using MEDLINE. All articles reporting on rectopexy were included.
Study Selection Articles reporting on prospective and retrospective comparisons were included. Case reports were excluded, as were studies comparing data with historical controls.
Data Extraction The results were tabulated to show outcomes of different studies and were compared. Studies that did not report some of the outcomes were noted as "not stated."
Data Synthesis Abdominal operations offer not only lower recurrence but also greater chance for functional improvements. Suture and mesh rectopexy produce equivalent results. However, the polyvinyl alcohol (Ivalon) sponge rectopexy is associated with an increased risk of infectious complications and has largely been abandoned. The advantage of adding a resection to the rectopexy seems to be related to less constipation. Laparoscopic rectopexy has similar results to open rectopexy but has all of the advantages related to laparoscopy. Perineal procedures are better suited to frail elderly patients with extensive comorbidity.
Conclusions Abdominal procedures are generally better for young fit patients; the results of all abdominal procedures are comparable. Suture and mesh rectopexy are still popular with many surgeons—the choice depends on the surgeon’s experience and preference. Similarly, the procedure may be done through a laparoscope or by laparotomy. Perineal procedures are preferable for patients who are not fit for abdominal procedures, such as elderly frail patients with significant comorbidities. The decision between perineal rectosigmoidectomy and Delorme procedures will depend on the surgeon’s preference, although the perineal rectosigmoidectomy has better outcomes.
Affiliations: Department of Surgery, University of KwaZulu-Natal, Durban, South Africa (Dr Madiba); and Colorectal Unit (Dr Madiba), Department of Colorectal Surgery (Drs Baig and Wexner), Cleveland Clinic Florida, Weston.
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