Rectal prolapse surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2]

Overview

Rectal prolapse surgery has two different approaches: Abdominal surgery (lower recurrence rate and better functional outcomes) or perineal surgery (in elderly patients, significant comorbidities, high risk patients for general anesthesia, previous pelvic surgery or radiation).

Surgery

Surgical management is indicated when conservative managements have failed.^[1]^[2]

Abdominal surgery:

Afford a lower recurrence rate with potentially better functional outcomes and below methods may be used:^[3]

Ventral mesh rectopexy
Posterior suture rectopexy (with or without sigmoid resection)
Posterior mesh rectopexy

Perineal surgery:

Elderly patients, patients with significant comorbidities, patients who are high risk for general anesthesia, previous extensive pelvic surgery or radiation^[4]^[5]

Thiersch procedure: using a prothesis that narrows the anus
Delorme procedure: peels off the herniated mucosa, plicates the exposed muscular layer, and sutures the anorectal mucosa
Altemeier procedure (perineal sigmoid colorectal resection): the protruded rectum is resected 2cm above the dentate line and the mesentery of the sigmoid colon is pulled and ligated
Gant_Miwa procedure: herniated mucosa is plicated by ligation, muscle layer is sutured and the anal opening is narrowed by a prothesis (not widely accepted)

References

↑ Flum AS, Golladay ES, Teitelbaum DH (2010). “Recurrent rectal prolapse following primary surgical treatment”. Pediatr. Surg. Int. 26 (4): 427–31. doi:10.1007/s00383-010-2565-x. PMC 2862483. PMID 20238206.
↑ Dolejs SC, Sheplock J, Vandewalle RJ, Landman MP, Rescorla FJ (2017). “Sclerotherapy for the management of rectal prolapse in children”. J. Pediatr. Surg. doi:10.1016/j.jpedsurg.2017.10.015. PMID 29103788.
↑ Vogler SA (2017). “Rectal Prolapse”. Dis. Colon Rectum. 60 (11): 1132–1135. doi:10.1097/DCR.0000000000000955. PMID 28991075.
↑ Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE (2014). “Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies”. J. Gastrointest. Surg. 18 (5): 1059–69. doi:10.1007/s11605-013-2427-7. PMID 24352613.
↑ Shin EJ (2011). “Surgical treatment of rectal prolapse”. J Korean Soc Coloproctol. 27 (1): 5–12. doi:10.3393/jksc.2011.27.1.5. PMC 3053504. PMID 21431090.

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[pmid20238206-1] Flum AS, Golladay ES, Teitelbaum DH (2010). “Recurrent rectal prolapse following primary surgical treatment”. Pediatr. Surg. Int. 26 (4): 427–31. doi:10.1007/s00383-010-2565-x. PMC 2862483. PMID 20238206.

[pmid29103788-2] Dolejs SC, Sheplock J, Vandewalle RJ, Landman MP, Rescorla FJ (2017). “Sclerotherapy for the management of rectal prolapse in children”. J. Pediatr. Surg. doi:10.1016/j.jpedsurg.2017.10.015. PMID 29103788.

[pmid28991075-3] Vogler SA (2017). “Rectal Prolapse”. Dis. Colon Rectum. 60 (11): 1132–1135. doi:10.1097/DCR.0000000000000955. PMID 28991075.

[pmid24352613-4] Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE (2014). “Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies”. J. Gastrointest. Surg. 18 (5): 1059–69. doi:10.1007/s11605-013-2427-7. PMID 24352613.

[pmid21431090-5] Shin EJ (2011). “Surgical treatment of rectal prolapse”. J Korean Soc Coloproctol. 27 (1): 5–12. doi:10.3393/jksc.2011.27.1.5. PMC 3053504. PMID 21431090.

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