Surgical management of rectal prolapse

Surgical management of rectal prolapse can be divided into 2 categories:

• abdominal approach
  • yields superior results and lower recurrence rates, but has morbidity and mortality rates
  • involves adequate mobilization of the rectum and appropriate fixation of the rectum (e.g. - rectopexy)
  • rectopexy can be performed using suture and/or mesh
  • posterior or anterior approach can be used
  • can be performed with open or laparoscopic approaches.
    • laparoscopic approach, when performed by an experienced surgeon, appears to have lower complication rates (ie, fewer wound complications and lower rates of nerve damage) and has outcomes that compare favourably with those of open repair.
• perineal
  • reserved for patient who cannot tolerate intra-abdominal methods
  • can be performed under a spinal anaesthetic
  • two most commonly used perineal approaches are the Altemeier and Delorme procedures
    • both procedures shorten the rectum and thereby reduce the rate of recurrent prolapse (1,2,3)

Reference:

• (1) Jones OM, Cunningham C, Lindsey I. The assessment and management of rectal prolapse, rectal intussusception, rectocoele, and enterocoele in adults. BMJ. 2011;342:c7099.
• (2) American Academy of Family physicians (AAFP). FP Comprehensive 2016 - Board Preparation. Anorectal conditions. Rectal prolapse