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Management of patients with rectal prolapse: the 2017 Dutch guidelines

Abstract

Background

Rectal prolapse—both external rectal prolapse and internal rectal prolapse—is a disabling condition. In view of the overwhelming number of surgical procedures described for the treatment of rectal prolapse, a comprehensive update concerning the diagnostic and therapeutic pathway for this condition is required to draw recommendations for clinical practice. This initiative was commissioned by the Dutch Association for Surgery (Nederlandse Vereniging voor Heelkunde) as a multidisciplinary collaboration.

Methods

Nine questions outlining the diagnostic approach, conservative and surgical management of rectal prolapse were selected. A systematic literature search for evidence was then conducted in the Medline and Embase databases.

Results

Recommendations included diagnostic approach, methods to assess complaints of fecal incontinence and/or obstructive defecation and treatment options, both conservative and surgical. A level of evidence was assigned to each statement following the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.

Conclusions

These guidelines for clinical practice are useful in the diagnosis and treatment of rectal prolapse. There are many statements requiring a higher level of evidence due to a lack of studies.

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Acknowledgements

The authors are grateful to the original Dutch drafting committee: S.J. van der Hagen, A. Pronk, R.J.F. Felt-Bersma, M. Stegeman, E.J.L. Bosboom, J.A.J. Kalkdijk, D.A. van Reijn and A.H.P. Meier. The authors’ gratefulness also extends to the advisory group: G.G.A. Malmberg, T. Boele, W.A. Bemelman, S. Festen, D.D.E. Zimmerman. The authors also warmly acknowledge E.A. Rake, H.L. Vreeken, W.A. van Enst.

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Correspondence to E. M. van der Schans.

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van der Schans, E.M., Paulides, T.J.C., Wijffels, N.A. et al. Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol 22, 589–596 (2018). https://doi.org/10.1007/s10151-018-1830-1

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Keywords

  • Rectal prolapse
  • Rectopexy
  • Practice guideline