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World Journal of Surgery

, Volume 16, Issue 5, pp 826–830 | Cite as

Treatment of complete rectal prolapse: To narrow, to wrap, to suspend, to fix, to encircle, to plicate or to resect?

  • Han C. Kuijpers
World Progress In Surgery

Abstract

Selection of the best surgical procedure for the treatment of complete rectal prolapse is difficult amid the many different techniques for which excellent results are reported. A critical review is given. It is concluded that any surgical procedure with rectal mobilization and fixation as a standard maneuver will lead to a recurrence rate of 2% to 4%. Advocacy of additional maneuvers to make the procedure easier is acceptable if it does not lead to a higher complication rate. But to obtain a better result its benefit has to be proven, either by a large prospective double-blind study, or by tests from the colorectal laboratory. New surgical techniques for rectal prolapse should therefore be based, not only on a low recurrence and complication rate, but also on tests that evaluate the effect of the procedure on fecal continence.

Keywords

Amid Recurrence Rate Complication Rate Como Rectal Prolapse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Choisir le meilleur procédé chirurgical pour traiter le prolapsus total du rectum est d'autant plus difficile qu'il existe de nombreuses méthodes thérapeutiques, toutes vantées dans la litérature pour être la meilleure. Une revue critique des ces procédés est faite. On conclue que toute méthode comportant une mobilisation et une fixation du rectum est suivie de récidive dans 2 à 4% des cas. Recommander des gestes supplémentaires pour faciliter la technique n'est acceptable que si le taux des complications n'augmente pas. Pour prouver que les résultats sont meilleurs, cependant, il faudrait soit réaliser une grande étude prosective à double insu, soit faire des comparaisons par des tests de laboratoire de physiologie colorectale. Des techniques nouvelles de chirurgie du prolapsus rectal devraient être basées non pas sur le taux de récidive ou de complication, mais aussi sur le résultats des tests qui démontrent son efficacité sur la continence fécale.

Resumen

Seleccionar el mejor procedimiento quirúrgico para el tratamiento del prolapso rectal completo es difícil, frente a las numerosas y diversas técnicas, cada una de las cuales reclama excelentes resultados. Se presenta una revisión crítica y se plantea la conclusión de que cualquier procedimiento quirúrgico que implique la movilización y fijación como maniobra estándar, da lugar a una tasa de recurrencia de 2–4%. Es aceptable preconizar maniobras adicionales para una más fácil realización del procedimiento mientras no resulten en incremento de la tasa de complicaciones. Para reclamar un mejor resultado, es necesario comprobar el beneficio mediante un estudio prospectivo y doble ciego mayor o por medio de pruebas funcionales en la laboratorio colorrectal. Las nuevas técnicas quirúrgicas para el tratamiento del prolapso rectal deben fundamentarse no sólo en bajas tasas de recurrencia y de complicaciones, sino también en pruebas funcionales que valoren objetivamente el efecto del procedimiento sobre la continencia fecal.

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References

  1. 1.
    Wassef, R., Rothenberger, D., Goldberg, S.: Rectal prolapse. Curr. Probl. Surg.23:402, 1986Google Scholar
  2. 2.
    Moschcowitz, A.V.: The pathogenesis, anatomy and cure of prolapse of the rectum. Surg. Gynecol. Obstet.15:7, 1912Google Scholar
  3. 3.
    Dietzen, C.D., Pemberton, J.H.: Perineal approaches for the treatment of complete rectal prolapse. Neth. J. Surg.41:140, 1989PubMedGoogle Scholar
  4. 4.
    McCann, F.J.: Note on an operation for the cure of prolapse of the rectum in the female. Lancet1:1072, 1928Google Scholar
  5. 5.
    Porter, N.: Collective results of operations for rectal prolapse. Proc. R. Soc. Med.55:1087, 1962PubMedGoogle Scholar
  6. 6.
    Graham, R.: The operative repair of massive rectal prolapse. Ann. Surg.115:1007, 1942Google Scholar
  7. 7.
    Kuijpers, J.H.C., Lubbers, E.J.C.: The Roscoe-Graham-Goligher procedure for complete rectal prolapse. Neth. J. Surg.35:24, 1983PubMedGoogle Scholar
  8. 8.
    Moore, H.D.: Complete prolapse of the rectum in the adult. Ann. Surg.169:368, 1969PubMedGoogle Scholar
  9. 9.
    Altemeyer, W.A., Culbertson, W.R., Schowengerdt, C., Hunt, J.: Nineteen years' experience with the one-step perineal repair of rectal prolapse. Ann. Surg.173:993, 1971PubMedGoogle Scholar
  10. 10.
    Delorme, R.: Sue le traitement des prolapses du rectum totaux pour l'excision de la mucueuse rectale ou rectocolique. Bull. Mem. Soc. Chir. Paris26:498, 1900Google Scholar
  11. 11.
    Pemberton, J., Stalker, L.K.: Surgical treatment of complete rectal prolapse. Ann. Surg.109:799, 1939Google Scholar
  12. 12.
    Devadhar, D.S.C.: Surgical correction of rectal procidentia. Surgery62:847, 1967PubMedGoogle Scholar
  13. 13.
    Corman, M.L.: Rectal prolapse: surgical techniques. Surg. Clin. North Am.68:1255, 1988PubMedGoogle Scholar
  14. 14.
    Frykman, H.M., Goldberg, S.M.: The surgical treatment of rectal procidentia. Surg. Gynecol. Obstet.129:1225, 1969PubMedGoogle Scholar
  15. 15.
    Solla, J.A., Rothenberger, D.A., Goldberg, S.M.: Colonic resection in the treatment of complete rectal prolapse. Neth. J. Surg.41:132, 1989PubMedGoogle Scholar
  16. 16.
    Kuijpers, J.H.C.: Application of the colorectal laboratory in the diagnosis and treatment of functional constipation. Dis. Colon Rectum33:35, 1990PubMedGoogle Scholar
  17. 17.
    Duthie, G.S., Bartolo, D.C.C.: A comparison between Marlex and resection rectopexy. Neth. J. Surg.41:136, 1989PubMedGoogle Scholar
  18. 18.
    Fielding, L.P., Stewart-Brown, S., Blesovski, L., Kearney, G.: Anastomotic integrety after operations for large-bowel cancer: A multicentre study. Br. Med. J. 411, 1980Google Scholar
  19. 19.
    Kuijpers, J.H.C.: Fecal continence after subtotal to total resection of the rectum. Neth. J. Surg.35:73, 1983PubMedGoogle Scholar
  20. 20.
    Broden, B., Snellman, B.: Procidentia of the rectum studied with cineradiography: A contribution to the discussion of causative mechanism. Dis. Colon Rectum11:330, 1968PubMedGoogle Scholar
  21. 21.
    Kuijpers, J.H.C., DeMorree, H.: Towards a selection of the most appropriate procedure in the treatment of complete rectal prolapse. Dis. Colon Rectum31:355, 1988PubMedGoogle Scholar
  22. 22.
    Kupfer, C.A., Goligher, J.C.: One hundred consecutive cases of complete rectal prolapse of the rectum treated by operation. Br. J. Surg.57:481, 1970Google Scholar
  23. 23.
    Keighley, M.R., Fielding, J.W., Alexander-Williams, J.: Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients. Br. J. Surg.70:229, 1983PubMedGoogle Scholar
  24. 24.
    Leenen, L.P.H., Kuijpers, J.H.C.: Treatment of complete rectal prolapse with foreign material. Neth. J. Surg.41:129, 1989PubMedGoogle Scholar
  25. 25.
    Ripstein, C.B.: A simple effective operation for rectal prolapse. Postgrad. Med.45:201, 1969Google Scholar
  26. 26.
    Gordon, P.H., Hoexter, B.: Complications of the Ripstein procedure. Dis. Colon Rectum21:277, 1978PubMedGoogle Scholar
  27. 27.
    Carter, A.E.: Rectosacral suture fixation for complete rectal prolapse in the elderly, the frail and the demented. Br. J. Surg.70:522, 1983PubMedGoogle Scholar
  28. 28.
    Blatchford, G.J., Perry, R.E., Thorson, A.G., Christensen, M.A.: Rectal prolapse: Rational therapy without foreign material. Neth. J. Surg.41:126, 1989PubMedGoogle Scholar
  29. 29.
    Smith, L.E.: Practical guide to anorectal testing, 1st Edition, New York-Tokyo, Ikagu-Shoin, 1990Google Scholar
  30. 30.
    Kuijpers, J.H.C., Strijk, S.P.: Diagnosis of disturbances of continence and defecation. Dis. Colon Rectum27:658, 1984PubMedGoogle Scholar
  31. 31.
    Fleshman, J.W., Kodner, I.J., Fry, R.D.: Internal intussusception of the rectum: A changing perspective. Neth. J. Surg.41:145, 1989PubMedGoogle Scholar
  32. 32.
    Shorvon, P.J., McHugh, S., Diamant, N.E., Somers, S., Stevenson, G.W.: Defecography in normal volunteers: Results and implications. Gut30:1737, 1989PubMedGoogle Scholar
  33. 33.
    Kuijpers, J.H.C., Schreve, R.H., ten Cate Hoedemakers, H.: Diagnosis of functional disorders of defection causing the solitary rectal ulcer syndrome.Dis. Colon Rectum 29:126, 1986PubMedGoogle Scholar
  34. 34.
    Nicholls, R.J., Simpson, J.N.L.: Anteroposterior rectopexy in the treatment of solitary recta ulcer syndrome without over rectal prolapse. Br. J. Surg.73:222, 1986PubMedGoogle Scholar
  35. 35.
    Yoshioka, K., Hyland, G., Keighley, M.R.B.: Anorectal function after abdominal rectopexy: Parameters of predictive value in identifying return of continence. Br. J. Surg.76:64, 1989PubMedGoogle Scholar
  36. 36.
    Scheuer, M., Kuijpers, J.H.C., Jacobs, P.P.: Postanal repair restores anatomy rather than function. Dis. Colon Rectum32:960, 1989PubMedGoogle Scholar
  37. 37.
    Kuijpers, J.H.C., Scheuer, M.: Disorders of impaired fecal control: A clinical and manometric study. Dis. Colon Rectum33:207, 1990PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 1992

Authors and Affiliations

  • Han C. Kuijpers
    • 1
  1. 1.Department of SurgeryUniversity Hospital NijmegenNijmegenThe Netherlands

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