Skip to main content
SpringerLink
Log in

Der Rektumprolaps des Erwachsenen

Rectal prolapse in adults

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die Ätiologie des Rektumprolaps ist nach wie vor unklar. Die Diagnostik ist in der Regel durch die Inspektion gegeben. Mögliche begleitende Erkrankungen sollten vor der Therapie bekannt sein. Die ideale chirurgische Therapie würde eine komplette Wiederherstellung der Anatomie des Beckenbodens, Behebung der funtionellen Störungen (Inkontinenz, Obstipation) erwarten bei geringer Morbidität, ohne Rezidive und dazu kostengünstig. Von dieser Forderung sind wir weit entfernt. Die möglichen Therapieoptionen über einen perineal/transanalen bzw. über abdominalen Zugang—mit oder ohne Rektosigmoidresektion—sind in ihrer Effektivität nur schwer vergleichbar. Gute prospektiv-randomisierte Studien liegen zur Beantwortung der Fragen nicht vor. Als bestmögliche Option mag heute die abdominale Resektionsrektopexie gelten, bevorzugt auf laparoskopischem Weg.

Abstract

The etiology of rectal prolapse is unclear. Diagnosis is easy by local inspection. The ideal surgery would repair the prolapse, correct any functional problems such as incontinence or constipation, be minimally invasive and cost-effective, and result in minimal morbidity and recurrence. The best surgical repair remains controversial—whether by the transanal/perineal or abdominal approach—with or without resection and rectopexy. There are no prospective-randomized studies that convincingly answer the numerous questions. The best possible option today seems to be the abdominal/laparoscopic method with a resection rectopexy according to Frykman and Goldberg.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Faria J, Thorson AG (2001) Perineal approaches for rectal prolapse. Clin Col Rect Surg 243–252

  2. Plusa SM, Clarig JA, Balaij V (1995) Physiological changes after Delorme’s procedure for full thickness rectal prolapse. Br J Surg 82:1475–1478

    CAS  PubMed  Google Scholar 

  3. Chow PK, HO YH (1996) Abdominal resection rectopexy versus Delorme’s procedure. Comparison of clinical and physiological outcome. Int J Colorectal Dis 11:201–202

    Article  CAS  PubMed  Google Scholar 

  4. Penninckx F, D Horre A, Sohier S, Kerremanns R (1997) Abdominal resection rectopexy versus Delorme’s procedure for rectal prolapse: a predictible outcome. Int J Colorect Dis 12:49–50

    Article  CAS  Google Scholar 

  5. Senapati A, Nicholls RJ, Phillips RK (1994) Result of Delorme’s procedure for rectal prolapse Dis Col Rectum 37:456–460

  6. Pescatori M, Interisano A, Stolfi VM, Zoffoli M (1998) Delorme’s operation and sphincteroplasty for rectal prolapse and fecal incontinence. Int J Colorect Dis 13:223–227

    Article  CAS  Google Scholar 

  7. Loygue J, Hugier M, Malafosse M, Biotois H (1971) Complete prolapse of the rectum: a report on 140 cases treated by rectopexy. Br J Surg 58:847–848

    CAS  PubMed  Google Scholar 

  8. Mc Kee RF, Lauder JC, Poon FW, Atchison MA, Finlay IG (1992) A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gyn Obstetr 174:145–148

    Google Scholar 

  9. Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J (1971) Nineteen years experience with the one stage repair of rectal prolapse. Ann Surg 173:993–1006

    CAS  PubMed  Google Scholar 

  10. Gregorcyk SG (2003) Perineal proctosigmoidectomy: The procedure of choice for rectal prolapse. Clin Col Rect Surg 262–266

    Google Scholar 

  11. Azimuddin K, Khubchandani I, Rosen L, Stasik J, Riether R, Reed J (2001) Rectal prolapse: A search for the „best operation“. Am J Surg 67:622–627

    CAS  Google Scholar 

  12. Kim D, Tsang C, Wong W, Lowry A, Goldberg S, Madoff R (1999) Complete rectal prolapse: evolution of management and results. Dis Col Rectum 42:460–469

    CAS  Google Scholar 

  13. Madoff R, Mellgren A (1999) One hundred years of rectal prolapse surgery. Dis Col Rectum 42:441–450

    CAS  Google Scholar 

  14. Boccasanta P, Rosati R, Venturi M, Montorsi M, Cioffi U, De Simone M (1998) Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse. Clinical and functional results. Surgic Laparosc Endosc 6:460–465

    Article  Google Scholar 

  15. Deen KJ, Grant E, Billingham C, Keighley MRB (1994) Abdominal resection rectopexy with pelvic floor repair versus perianal rectosigmoidectomy and pelvic floor repair for full thickness rectal prolapse. Br J Surg 81:302

    CAS  PubMed  Google Scholar 

  16. Galili Y, Rabau M (1997) Comparison of polyglycolic and polypropylene mesh for rectopexy in the treatment of rectal prolapse. Eur J Surg 163:445–448

    CAS  PubMed  Google Scholar 

  17. Luukkonen P, Mikkonen U, Jarvinen H (1992) Abdominal rectopexy with sigmoidectomy versus rectopexy alone for rectal prolapse: A prospective, randomized study. Int J Colorect Dis 7:219–222

    CAS  Google Scholar 

  18. Novell JR, Osborne MJ, Winslett M, Lewis AA (1994) Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full thickness rectal prolapse. Br J Surg 81:904–906

    CAS  PubMed  Google Scholar 

  19. Selvaggi F, Scotto di Carlo E, Silvestri L, Festa L, Piegari V (1993) Surgical treatment of rectal prolapse: a randomized study. Br J Surg 80:89

    PubMed  Google Scholar 

  20. Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39

    Article  CAS  PubMed  Google Scholar 

  21. Speakman CTM, Madden MV, Nicholls RJ, Kam MA (1991) Lateral ligament division during rectopexy causes constipation but prevents recurrence: Results of a prospective randomized study. Br J Surg 78:1431–1433

    CAS  PubMed  Google Scholar 

  22. Brazelli M, Bacchoo P, Grant A (2003) Surgery for complete rectal prolapse in adults. In: The Cochrane Library, Issue 3, Oxford

  23. Winde G, Reers B, Nottberg H, Berns T, Meyer J, Bunte H (1993) Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse. Eur J Surg 159:301–305

    CAS  PubMed  Google Scholar 

  24. Eu KW, Seow-Choen F (1997) Functional problems in adult rectal prolapse and controversies in surgical treatment. Br J Surg 84:904–911

    CAS  PubMed  Google Scholar 

  25. Theuerkauff FJ, Beahrs OH, Hill JR (1970) Rectal prolapse. Causation and surgical treatment. Ann Surg 171:81

    Google Scholar 

  26. Hull TL (2003) Rectal prolapse: Abdominal approach. Clin Col Rect Surg. 16:259–262

  27. Frykmann HM (1955) Abdominal rectopexy and primary sigmoid resection for rectal procidentia. Am J Surg 90:780–789

    Article  PubMed  Google Scholar 

  28. Frykmann HM, Goldberg SM (1969) The surgical treatment of rectal procidentia. Surg Gyn Obstetr 129:1225–1230

    Google Scholar 

  29. Ripsein CB (1952) Treatment of massive rectal prolapse. Am J Surg 83:68–71

    Article  PubMed  Google Scholar 

  30. Loygue J, Nordlinger B, Cunci O, Malafose M, Huguet C, Parc R (1984) Rectopexy to the promontory for the treatment of rectal prolapse. Report of 257 cases. Dis Col Rectum 27:356

    CAS  Google Scholar 

  31. Altemeier WA, Ginsefi J, Hoxworth P (1952) Treatment of extensive prolapse of the rectum in aged or debilitated patients. Arch Surg 65:72–80

    CAS  Google Scholar 

  32. Sudeck P (1922) Rektumprolapsoperation durch Auslösen des Rektums aus der excavatio sacralis. Zentralbl Chir 20:698–699

    Google Scholar 

  33. Bermann IR (1992) Sutureless laparoscopic rectopexy for procidentia: technique and implications. Dis Col Rectum 35:689–693

    Google Scholar 

  34. Bruch HP, Herold A, Schiedeck THK, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Col Rectum 42:1189–1195

    CAS  Google Scholar 

  35. Köckerling F, Schneider C, Hohenberger (1996) Rektumprolaps-Verfahrenswahl und minimal-invasive Möglichkeiten. Chirurg 67:471–482

    PubMed  Google Scholar 

  36. Dupree HJ, Roblick UJ, Bruch HP, Schiedeck HTK (2002) Chirurgische Therapie des Rektumprolaps. Visceralchirurgie 37:40–47

    Article  Google Scholar 

  37. Tobin SA, Scott ICH (1994) Delorme operation for rectal prolapse. Br J Surg 81:1681–1684

    CAS  PubMed  Google Scholar 

  38. Pescatori M (1998) Anal continence after surgery for rectal prolapse. Dis Col Rectum 41:526–530

    CAS  Google Scholar 

  39. Yakut M, Kaymakcioglu N, Simsek A (1998) Surgical treatment of rectal prolapse. A retrospektive analysis of 94 cases. Int Surg 83:53–55

    CAS  PubMed  Google Scholar 

  40. Watts AM, Thompson MR (2000) Evaluation of Delorme’s procedure as a treatment for full thickness rectal prolapse. Br J Surg 87:218–222

    Article  CAS  PubMed  Google Scholar 

  41. Lechaux JP, Lechaux D, Perez M (1995) Results of Delorme’s procedure for rectal prolapse. Advantages of a modified technique. Dis Col Rectum 38:301–307

    CAS  Google Scholar 

  42. Agachan F, Pfeifer J, Joo JS (1997) Results of perineal procedures for the treatment of rectal prolapse. Am Surg 63:9–12

    CAS  PubMed  Google Scholar 

  43. Yoshioka K, Ogunbiyi OA, Keighley MR (1998) Pouch perineal rectosigmoidectomy gives better functional results than conventional rectosigmoidectomy in elderly patients with rectal prolapse. Br J Surg 85:1525–1526

    Article  CAS  PubMed  Google Scholar 

  44. Williams JG, Rothenberger DA, Madoff RD, Goldberg SM (1992) Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Col Rectum 35:830–834

    CAS  Google Scholar 

  45. Ramanujam PJ, Venkatesh KS, Fietz MJ (1994) Perineal excision of rectal procidentia in elderly high risk patient. A ten year experience. Dis Col Rectum 37:1027–1030

    CAS  Google Scholar 

  46. Köhler A, Athanasiadis S (2001) The value of posterior levator repair in the treatment of anorectal incontinence due to rectal prolapse a clinical and manometric study. Langenbecks Arch Surg 386:188–192

    Article  PubMed  Google Scholar 

  47. Siproudis L, Bellissant E, Juguet F (1998) Rectal adaption to distension in patients with overt rectal prolapse. Br J Surg 85:1527–1532

    Article  PubMed  Google Scholar 

  48. Ramanujam PJ, Venkatesh K (1988) Perineal excision of rectal prolapse with posterior levator ani repair in the elderly high risk patients. Dis Col Rectum 31:704–707

    CAS  Google Scholar 

  49. Zbar A, Takashima S, Hasegawa T, Kitabayashi K (2002) Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Tech Coloproctol 6:109–116

    Article  CAS  PubMed  Google Scholar 

  50. Sainio AP, Halme LE, Husa AI (1991) Anal encirclement with polypropylene mesh for rectal prolapse and incontinence. Dis Col Rectum 34:905–908

    CAS  Google Scholar 

  51. Hunt TM, Fraser IA, Maybury NK (1985) Treatment of rectal prolapse by sphincteric support using silastic rods. Br J Surg 72:491–492

    CAS  PubMed  Google Scholar 

  52. Earnshaw JJ, Hopkinson BR (1987) Late results of silicon rubber perianal suture for rectal prolapse. Dis Col Rectum 30:86–88

    CAS  Google Scholar 

  53. Jackamann FR, Francis JN, Hopkinson BR (1980) Silicon rubber band treatment of rectal prolapse. Ann R Coll Surg Engl 62:386–387

    PubMed  Google Scholar 

  54. Madbouly KM, Senagore AJ, Delaney CP, Duepree HJ, Brady KM, Fazio VW (2003) Clinically based management of rectal prolapse. Surg Endosc 17:99–103

    Article  CAS  PubMed  Google Scholar 

  55. Schiedeck TH, Schwandner O, Scheele J, Farke S, Bruch HP (2004) Rectal prolapse: which surgical option is appropriate Langenbecks. Arch Surg (in press)

    Google Scholar 

  56. Senagore AJ (2003) Management of rectal prolapse: The role of laparoscopic approach. Semin Laparasc Surg 10:197–202

    Google Scholar 

  57. Wells C (1959) New operation for rectal prolapse. J R Soc Med 52:602–603

    CAS  Google Scholar 

  58. Athanasiadis S, Heiligers J, Kuprian A, Heumüller L (1995) Chirurgische Therapie des Rectumprolapses mittels Rectopexie und Resektion. Einfluss der Resektionsbehandlung auf postoperative Obstipation und Schliessmuskelfunktion—eine Follow-up-Studie bei 112 Patienten. Chirurg 66:27–33

    CAS  PubMed  Google Scholar 

  59. Paetzel C, Strotzer M, Fürst A, Rentsch M, Lenhart M, Feuerbach S (2001) Dynamisches MR zur Diagnose kombinierter funktioneller Störungen des Beckenbodens. Röfo Fortschr Geb Röntgenstr 173:410–415

  60. Lienemann A, Anthuber C, Baron A, Kohz P, Reiser M (1997) Dynamic MR colpocystorectography assessing pelvic-floor descent. Eur Rad 7:1309–1317

    Article  CAS  Google Scholar 

  61. Agachan F, Reissman P, Pfeifer J, Weiss EG, Nogueras JJ, Wexner S (1997) Comparison of three perineal procedures for the treatment of rectal prolapse. South Med J 90:925–930

    CAS  PubMed  Google Scholar 

  62. Boccasanta P, Rosati R, Venturi M, Cioffi U, De Simone M, Peracchia A (1999) Surgical treatment of complete rectal prolapse: results of abdominal and perineal approaches Laparoendosc. Adv Surg Tech A 9:235–238

    CAS  Google Scholar 

  63. Schoetz DJ, Veidenheimer MC (1985) Rectal prolapse, Pathogenesis and clinical features. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Butterworths London 303–308

  64. Watts JD, Rothenberger Da, Goldberg SM (1985) Rectal prolapse, Treatment. In: Henry MM, Swash M (eds) Coloproctology and the pelvic floor. Butterworths London 308–339

  65. Hutzel L, Paetzel C, Spatz H, Fürst A (2002) Dynamisches Beckenboden MRT und konventionelle Defäkographie: Möglichkeiten und Grenzen. Visceralchirurgie 37:23–29

    Article  Google Scholar 

  66. Gordon PH (1992) Rectal procidentia. In: Gordon PH, Nivatvongs S (eds) Principles and prractice of surgery for the colon rectum and anus. Qual Med Publ, pp 449–481

  67. Goligher JC (1980) Prolapse of the rectum. In: Surgery of the Anus, Rectum and Colon. Bailliere Tindall, London, pp 224–258

  68. Vasilevsky CA, Goldberg SM (1987) The use of the intraluminal stapling device in perineal rectosigmoidectomy for rectal prolapse. In: Ravitch MM, Streicher F (eds) Principles and Practice of Surgical Stapling. Chicago, Year Book, pp 480–486

  69. Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M (2003) Delorme’s procedure for rectal prolapse. Dis Col Rectum 46:1260–1265

    Article  Google Scholar 

  70. Moschcowitz AV (1912) The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gyn Obstet 15:7–12

    Google Scholar 

  71. Hansen H (1996) Beckenbodeninsuffizienz als interdisziplinäre Aufgabe. Chirurg 67:498–504

    PubMed  Google Scholar 

  72. Delorme R (1900) Sur le traitement des prolapsus de la muqueuse rectale ou recto-colique. Bull Soc Chirurgiens Paris 26:459

    Google Scholar 

  73. Kimmins M, Evett B, Isler J, Billingham R (2001) The Altemeier repair, outpatient treatment of rectal prolapse. Dis Col Rectum 44:565–570

    CAS  Google Scholar 

  74. Ripstein CB (1972) Definitive corrective surgery. Dis Col Rectum 15:334–346

    CAS  Google Scholar 

  75. Gordon PH, Hoexter B (1978) Complication of Ripsteins procedure. Dis Col Rectum 21:277–280

    CAS  Google Scholar 

  76. Morgan CN, Porter NH, Klugman DJ (1972) Ivalon (polyvinyl alcohol) sponge in the repair of complete rectal prolapse. Br J Surg 59:841–846

    CAS  PubMed  Google Scholar 

  77. Yoshioka K, Heyen F, Keighley MRB (1989) Functional results after abdominal rectopexy for rectal prolapse. Dis Col Rectum 32:835–838

    CAS  Google Scholar 

  78. Allen-Mersh TG, Turner MJ, Mann CV (1990) Effect of Ivalon rectopexy on bowel habit and rectal wall. Dis Col Rectum 33:550–553

    CAS  Google Scholar 

  79. Kupfer CA, Goligher JC (1970) One hundred consecutive cases of complete prolapse of the rectum treated by operation. Br J Surg 57:481–487

    Google Scholar 

  80. Penfold JCB, Hawley PR (1972) Experiences of Ivalon sponge implant for complete rectal prolapse at St. Mark’s Hospital 1960–1970. Br J Surg 59:846–848

    CAS  PubMed  Google Scholar 

  81. Parks AG, Porter NH, Hardcastle J (1969) The syndrome of the descending perineum. Procee Roy Soc Med 59:477–482

    Google Scholar 

  82. Parks AG, Swash M, Urich H (1977) Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18:656–665

    CAS  PubMed  Google Scholar 

  83. Holmstrom B, Ahlberg J, Bergstrand O, Goran B, Ewerth S (1978) Results of the treatment of rectal prolapse operated according to Ripstein. Acta Chir Scand [Suppl] 482:51–52

  84. Keighley MRB, Fielding JWL (1983) Management of faecal incontinence and results of surgical treatment. Br J Surg 70:463–468

    CAS  PubMed  Google Scholar 

  85. Christensen J, Kirkegaard P (1981) Complete prolapse of the rectum treated by modified Orr operation. Dis Col Rectum 24:90–92

    Google Scholar 

  86. Madoff R, Williams J, Wong W (1992) Long term functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterology 87:101–104

    CAS  Google Scholar 

  87. Aminev AM, Malyskev J (1964) Rectal prolapse. Am J Proctol 15:355–360

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Chirurgische Klinik, Städtisches Krankenhaus München-Bogenhausen

    W. Heitland

  2. Chirurgische Klinik, Städtisches Krankenhaus München-Bogenhausen, Englschalkinger Straße 77, 81927 , München

    W. Heitland

Authors
  1. W. Heitland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Heitland.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heitland, W. Der Rektumprolaps des Erwachsenen. Chirurg 75, 882–889 (2004). https://doi.org/10.1007/s00104-004-0932-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-004-0932-7

Schlüsselwörter

Keywords

Search

Navigation