Skip to main content

Advertisement

SpringerLink
Log in

Management of patients with rectal prolapse: the 2017 Dutch guidelines

  • Clinical Guidelines
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

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.

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

Similar content being viewed by others

References

  1. Wijffels NA, Collinson R, Cunningham C, Lindsey I (2010) What is the natural history of internal rectal prolapse? Color Dis 12:822–830. https://doi.org/10.1111/j.1463-1318.2009.01891.x

    Article  CAS  Google Scholar 

  2. Dvorkin LS, Knowles CH, Scott MS et al (2005) Rectal intussusception: characterization of symptomatology. Dis Colon Rectum 48:824–831. https://doi.org/10.1007/s10350-004-0834-2

    Article  PubMed  Google Scholar 

  3. Podzemny V, Pescatori LC, Pescatori M (2015) Management of obstructed defecation. World J Gastroenterol 21:1053–1060. https://doi.org/10.3748/wjg.v21.i4.1053

    Article  PubMed  PubMed Central  Google Scholar 

  4. Brouwers M, Kho M, Browman G et al (2010) AGREE next steps consortium. AGREE II: advancing guideline development, reporting and evaluation in healthcare. CMAJ 182:E839–E842. https://doi.org/10.1503/cmaj.090449

    Article  PubMed  PubMed Central  Google Scholar 

  5. Roovers JP, Everhardt E, Dietz V et al (2014) Dutch national guideline prolapse. NVOG

  6. Schünemann H, Brozk J, Guyatt G, Oxman A (2013) GRADE handbook. http://gdt.guidelinedevelopment.org/app/handbook/handbook.html. Accessed 1 Dec 2017

  7. Goei R, van Engelshoven J, Schouten H et al (1989) Anorectal function: defecographic measurement in asymptomatic subjects. Radiology 173:137–141. https://doi.org/10.1148/radiology.173.1.2780999

    Article  CAS  PubMed  Google Scholar 

  8. Freimanis M, Wald A, Caruana B, Bauman D (1991) Evacuation proctography in normal volunteers. Invest Radiol 26:581–585

    Article  CAS  PubMed  Google Scholar 

  9. Selvaggi F, Pesce G, Scotto Di Carlo E et al (1990) Evaluation of normal subjects by defecographic technique. Dis Colon Rectum 33:698–702

    Article  CAS  PubMed  Google Scholar 

  10. Shorvon PJ, Mchugh S, Diamant NE et al (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Faucheron JL, Barot S, Collomb D et al (2014) Dynamic cystocolpoproctography is superior to functional pelvic MRI in the diagnosis of posterior pelvic floor disorders: results of a prospective study. Color Dis 16:O240–O247. https://doi.org/10.1111/codi.12586

    Article  Google Scholar 

  12. Beer-Gabel M, Carter D (2015) Comparison of dynamic transperineal ultrasound and defecography for the evaluation of pelvic floor disorders. Int J Colorectal Dis 30:835–841. https://doi.org/10.1007/s00384-015-2195-9

    Article  PubMed  Google Scholar 

  13. Steensma AB, Oom DM, Burger CW, Schouten WR (2010) Assessment of posterior compartment prolapse: a comparison of evacuation proctography and 3D transperineal ultrasound. Colorectal Dis 12:533–539. https://doi.org/10.1111/j.1463-1318.2009.01936.x

    Article  CAS  PubMed  Google Scholar 

  14. Weemhoff M, Kluivers KB, Govaert B et al (2013) Transperineal ultrasound compared to evacuation proctography for diagnosing enteroceles and intussusceptions. Int J Colorectal Dis 28:359–363. https://doi.org/10.1007/s00384-012-1567-7

    Article  CAS  PubMed  Google Scholar 

  15. Regadas FSP, Haas EM, Abbas MA et al (2011) Prospective multicenter trial comparing echodefecography with defecography in the assessment of anorectal dysfunction in patients with obstructed defecation. Dis Colon Rectum 54:686–692. https://doi.org/10.1007/DCR.0b013e3182113ac7

    Article  PubMed  Google Scholar 

  16. Grasso RF, Piciucchi S, Quattrocchi CC et al (2007) Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography. Ultrasound Obstet Gynecol 30:86–94. https://doi.org/10.1002/uog.4047

    Article  CAS  PubMed  Google Scholar 

  17. Perniola G, Shek C, Chong CCW et al (2008) Defecation proctography and translabial ultrasound in the investigation of defecatory disorders. Ultrasound Obstet Gynecol 31:567–571. https://doi.org/10.1002/uog.5337

    Article  CAS  PubMed  Google Scholar 

  18. ‘t Hoen LA, Utomo E, Schouten WR et al (2017) The fecal incontinence quality of life scale (FIQL) and fecal incontinence severity index (FISI): validation of the Dutch versions. Neurourol Urodyn 36:710–715. https://doi.org/10.1002/nau.23003

    Article  PubMed  Google Scholar 

  19. Bols EMJ, Hendriks HJM, Berghmans LCM et al (2013) Responsiveness and interpretability of incontinence severity scores and FIQL in patients with fecal incontinence: a secondary analysis from a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 24:469–478. https://doi.org/10.1007/s00192-012-1886-9

    Article  CAS  Google Scholar 

  20. Altomare DF, Spazzafumo L, Rinaldi M et al (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Color Dis 10:84–88. https://doi.org/10.1111/j.1463-1318.2007.01262.x

    Article  CAS  Google Scholar 

  21. Gosselink MP, Adusumilli S, Harmston C et al (2013) Impact of slow transit constipation on the outcome of laparoscopic ventral rectopexy for obstructed defaecation associated with high grade internal rectal prolapse. Color Dis 15:749–756. https://doi.org/10.1111/codi.12443

    Article  Google Scholar 

  22. Sze EHM, Hobbs G (2009) Efficacy of methylcellulose and loperamide in managing fecal incontinence. Acta Obstet Gynecol Scand 88:766–771. https://doi.org/10.1080/00016340902993320

    Article  CAS  PubMed  Google Scholar 

  23. Ehrenpreis E, Chang D, Eichenwald E (2007) Pharmacotherapy for fecal incontinence: a review. Dis Colon Rectum 50:641–649. https://doi.org/10.1007/s10350-006-0778-9

    Article  PubMed  Google Scholar 

  24. Scarlett Y (2004) Medical management of fecal incontinence. Gastroenterology 126:S55–S63. https://doi.org/10.1053/j.gastro.2003.10.007

    Article  PubMed  Google Scholar 

  25. Santoro G, Eitan B, Pryde A, Bartolo D (2000) Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum 43:1676–1682

    Article  CAS  PubMed  Google Scholar 

  26. Hicks C, Weinstein M, Wakamatsu M et al (2014) In patients with rectoceles and obstructed defecation syndrome, surgery should be the option of last resort. Surgery 155:659–667. https://doi.org/10.1016/j.surg.2013.11.013

    Article  PubMed  Google Scholar 

  27. Choi J, Hwang Y, Salum M et al (2001) Outcome and management of patients with large rectoanal intussusception. Am J Gastroenterol 96:740–744. https://doi.org/10.1111/j.1572-0241.2001.03615.x

    Article  CAS  PubMed  Google Scholar 

  28. Hwang YH, Person B, Choi JS et al (2006) Biofeedback therapy for rectal intussusception. Tech Coloproctol 10:11–16. https://doi.org/10.1007/s10151-006-0244-7

    Article  CAS  PubMed  Google Scholar 

  29. Rao SSC, Rao SC (2014) Current and emerging treatment options for fecal incontinence. J Clin Gastroenterol 48:752–764

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Chan DSY, Saklani A, Shah PR et al (2012) Rectal irrigation: a useful tool in the armamentarium for functional bowel disorders. Color Dis 14:748–752. https://doi.org/10.1111/j.1463-1318.2011.02797.x

    Article  CAS  Google Scholar 

  31. Cunin D, Siproudhis L, Desfourneaux V et al (2013) No surgery for full-thickness rectal prolapse: what happens with continence? World J Surg 37:1297–1302. https://doi.org/10.1007/s00268-013-1967-z

    Article  PubMed  Google Scholar 

  32. Mercer-Jones MA, D’Hoore A, Dixon AR et al (2014) Consensus on ventral rectopexy: report of a panel of experts. Color Dis 16:82–88. https://doi.org/10.1111/codi.12415

    Article  CAS  Google Scholar 

  33. Young MT, Jafari MD, Phelan MJ et al (2015) Surgical treatments for rectal prolapse: how does a perineal approach compare in the laparoscopic era? Surg Endosc 29:607–613. https://doi.org/10.1007/s00464-014-3707-3

    Article  PubMed  Google Scholar 

  34. van Iersel JJ, Paulides TJC, Verheijen PM et al (2016) Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse. World J Gastroenterol 22:4977–4987. https://doi.org/10.3748/wjg.v22.i21.4977

    Article  PubMed  PubMed Central  Google Scholar 

  35. Schwandner O, Hillemanns P (2016) Indikation, technik und ergebnisse der STARR-operation. Der Chir 87:909–917. https://doi.org/10.1007/s00104-016-0265-3

    Article  CAS  Google Scholar 

  36. Mäkelä-Kaikkonen J, Rautio T, Klintrup K et al (2014) Robotic-assisted and laparoscopic ventral rectopexy in the treatment of rectal prolapse: a matched-pairs study of operative details and complications. Tech Coloproctol 18:151–155. https://doi.org/10.1007/s10151-013-1042-7

    Article  PubMed  Google Scholar 

  37. Ohazuruike NL, Martellucci J, Menconi C et al (2014) Short-term results after STARR versus internal Delorme for obstructed defecation: a non-randomized prospective study. Updates Surg 66:151–156. https://doi.org/10.1007/s13304-014-0247-2

    Article  CAS  PubMed  Google Scholar 

  38. Boccasanta P, Venturi M, Roviaro G (2011) What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum 54:77–84. https://doi.org/10.1007/DCR.0b013e3181e8aa73

    Article  PubMed  Google Scholar 

  39. Isbert C, Reibetanz J, Jayne DG et al (2010) Comparative study of contour transtar and STARR procedure for the treatment of obstructed defecation syndrome (ODS)—feasibility, morbidity and early functional results. Color Dis 12:901–908. https://doi.org/10.1111/j.1463-1318.2009.01932.x

    Article  CAS  Google Scholar 

  40. Renzi A, Brillantino A, Di Sarno G et al (2016) Evaluating the surgeons’ perception of difficulties of two techniques to perform STARR for obstructed defecation syndrome. Surg Innov 23:563–571. https://doi.org/10.1177/1553350616656281

    Article  PubMed  Google Scholar 

  41. Tou S, Brown SR, Nelson RL (2015) Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Database Syst Rev 11:CD001758. https://doi.org/10.1002/14651858.CD001758.pub3

    Article  Google Scholar 

  42. 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. https://doi.org/10.1046/j.0007-1323.2001.01957.x

    Article  CAS  PubMed  Google Scholar 

  43. Boccasanta P, Rosati R, Venturi M et al (1998) Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse: clinical and functional results. Surg Laparosc Endosc 8:460–465

    Article  CAS  PubMed  Google Scholar 

  44. Deen K, Grant E, Billingham C, Keighley M (1994) Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg 81:302–304

    Article  CAS  PubMed  Google Scholar 

  45. Senapati A, Gray RG, Middleton LJ et al (2013) PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Color Dis 15:858–868. https://doi.org/10.1111/codi.12177

    Article  CAS  Google Scholar 

  46. Karas JR, Uranues S, Altomare DF et al (2011) No rectopexy versus rectopexy following rectal mobilization for full-thickness rectal prolapse: a randomized controlled trial. Dis Colon Rectum 54:29–34. https://doi.org/10.1007/DCR.0b013e3181fb3de3

    Article  PubMed  Google Scholar 

  47. Luukkonen P, Mikkonen U, Järvinen H (1992) Abdominal rectopexy with sigmoidectomy vs. rectopexy alone for rectal prolapse: a prospective, randomized study. Int J Color Dis 7:219–222

    Article  CAS  Google Scholar 

  48. McKee R, Lauder J, Poon F et al (1992) A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obs 174:148–148

    Google Scholar 

  49. Ramage L, Georgiou P, Tekkis P, Tan E (2015) Is robotic ventral mesh rectopexy better than laparoscopy in the treatment of rectal prolapse and obstructed defecation? A meta-analysis. Tech Coloproctol 19:381–389. https://doi.org/10.1007/s10151-015-1320-7

    Article  CAS  PubMed  Google Scholar 

  50. De Hoog DENM, Heemskerk J, Nieman FHM et al (2009) Recurrence and functional results after open versus conventional laparoscopic versus robot-assisted laparoscopic rectopexy for rectal prolapse: a case–control study. Int J Color Dis 24:1201–1206. https://doi.org/10.1007/s00384-009-0766-3

    Article  Google Scholar 

  51. Mehmood RK, Parker J, Bhuvimanian L et al (2014) Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior? Int J Colorectal Dis 29:1113–1118. https://doi.org/10.1007/s00384-014-1937-4

    Article  PubMed  Google Scholar 

  52. Youssef M, Thabet W, El Nakeeb A et al (2013) Comparative study between Delorme operation with or without postanal repair and levateroplasty in treatment of complete rectal prolapse. Int J Surg 11:52–58. https://doi.org/10.1016/j.ijsu.2012.11.011

    Article  PubMed  Google Scholar 

  53. Chun SW, Pikarsky AJ, You SY et al (2004) Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol 8:3–9. https://doi.org/10.1007/s10151-004-0042-z

    Article  CAS  PubMed  Google Scholar 

  54. Evans C, Stevenson A, Sileri P et al (2015) A multicenter collaboration to assess the safety of laparoscopic ventral rectopexy. Dis Colon Rectum 58:799–807. https://doi.org/10.1097/DCR.0000000000000402

    Article  PubMed  Google Scholar 

  55. Rickert A, Kienle P, Kuthe A et al (2012) A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair. Langenbeck’s Arch Surg 397:1225–1234. https://doi.org/10.1007/s00423-012-1009-6

    Article  CAS  Google Scholar 

  56. Li J, Ji Z, Zhang W, Li L (2015) The comparison of lightweight mesh and standard mesh in incisional hernia repair with the open sublay technique: the results of a meta-analysis. Surg Laparosc Endosc Percutan Tech 25:238–244. https://doi.org/10.1097/SLE.0000000000000144

    Article  PubMed  Google Scholar 

  57. Conze J, Krones CJ, Schumpelick V, Klinge U (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbeck’s Arch Surg 392:453–457. https://doi.org/10.1007/s00423-006-0065-1

    Article  Google Scholar 

  58. Ladurner R, Chiapponi C, Linhuber Q, Mussack T (2011) Long term outcome and quality of life after open incisional hernia repair-light versus heavy weight meshes. BMC Surg 11:25. https://doi.org/10.1186/1471-2482-11-25

    Article  PubMed  PubMed Central  Google Scholar 

  59. Schmidbauer S, Ladurner R, Hallfeldt K, Mussack T (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10:247–253

    CAS  PubMed  Google Scholar 

  60. Rothenhoefer S, Herrle F, Herold A et al (2012) DeloRes trial: study protocol for a randomized trial comparing two standardized surgical approaches in rectal prolapse—Delorme’s procedure versus resection rectopexy. Trials. https://doi.org/10.1186/1745-6215-13-155

    Article  PubMed  PubMed Central  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    E. M. van der Schans, T. J. C. Paulides & E. C. J. Consten

  2. Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands

    N. A. Wijffels

Authors
  1. E. M. van der Schans
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. J. C. Paulides
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. A. Wijffels
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. C. J. Consten
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. M. van der Schans.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-018-1830-1

Keywords

Search

Navigation