Advertisement

Rectal Prolapse

  • Steven Mills
Chapter

Abstract

Rectal prolapse is a telescoping of the rectum out of the anus; an intussusception is when the telescoping does not protrude through the anal canal. Either condition can be uncomfortable or less commonly painful, and are often associated with varying degrees of embarrassment for the patient. They rarely present with ischemia or necrosis of the rectum; these advanced states represent an emergent situation.

Keywords

Fecal Incontinence Rectal Prolapse Recurrent Prolapse Sigmoid Colectomy Perineal Approach 
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.

Notes

Acknowledgments.

This chapter was authored by Anthony M. Vernava, III and David E. Beck in the previous edition of this textbook.

References

  1. 1.
    Moschcowitz AV. The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gynecol Obstet. 1912;15:7–21.Google Scholar
  2. 2.
    Broden B, Snellman B. Procidentia of the rectum studied with cineradiography: a contribution to the discussion of causative mechanism. Dis Colon Rectum. 1968;11:330–47.PubMedCrossRefGoogle Scholar
  3. 3.
    Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. 2008;8:CD001758.Google Scholar
  4. 4.
    Beck DE, Whitlow CB. Rectal prolapse and intussusception. In: Beck DE, editor. Handbook of colorectal surgery. 2nd ed. New York: Marcel Dekker; 2003. p. 301–24.Google Scholar
  5. 5.
    Spencer RJ. Manometric studies in rectal prolapse. Dis Colon Rectum. 1984;27:523–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Prasad ML, Pearl RK, Abcarian H, Orsay CP, Nelson RL. Perineal proctectomy, posterior rectopexy, and postanal levator repair for the treatment of rectal prolapse. Dis Colon Rectum. 1986;29:547–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Altemeier WA, Culbertson WR, Schowengerdt CJ, Hunt J. Nineteen years’ experience with the one stage perineal repair of rectal prolapse. Ann Surg. 1971;173:993–1006.PubMedCrossRefGoogle Scholar
  8. 8.
    Baig MK, Galliano D, Larach JA, Weiss EG, Wexner SD, Nogueras JJ. Pouch perineal rectosigmoidectomy: a case report. Surg Innov. 2005;12:373–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Ramanujam PS, Venkateh KS. Perineal excision of rectal prolapse with posterior levator ani repair in elderly high risk patients. Dis Colon Rectum. 1988;31:704–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Friedman R, Mugga-Sullam M, Freund HR. Experience with the one stage perineal repair of rectal prolapse. Dis Colon Rectum. 1983;26:789–91.PubMedCrossRefGoogle Scholar
  11. 11.
    Gopal FA, Amshel AL, Shonberg IL, Eftaiha M. Rectal procidentia in elderly and debilitated patients. Experience with the Altemeier procedure. Dis Colon Rectum. 1984;27:376–81.PubMedCrossRefGoogle Scholar
  12. 12.
    Finlay IG, Aitchison M. Perineal excision of the rectum for prolapse in the elderly. Br J Surg. 1991;78:687–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Williams JG, Rothenberger DA, Madoff RD, Goldberg SM. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum. 1992;34:209–16.CrossRefGoogle Scholar
  14. 14.
    Johansen OB, Wexner SD, Daniel N, Nogueras JJ, Jagelman DG. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum. 1993;36:767–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Kim D, Tsang C, Wong W, Lowry A, Goldberg S, Madoff R. Complete rectal prolapse: evolution of management and results. Dis Colon Rectum. 1999;42:460–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Azimuddin K, Khubchandani I, Rosen L, Stasik J, Riether R, Reed J. Rectal prolapse: a search for the “best” operation. Am Surg. 2001;67:622–7.PubMedGoogle Scholar
  17. 17.
    Zbar A, Takashim S, Hasegawa T, Kitabayashi K. Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Tech Coloproctol. 2002;6:109–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Habr-Gama A, Jacob CE, Jorge JM, et al. Rectal procidentia treatment by perineal rectosigmoidectomy combined with levator ani repair. Hepatogastroenterology. 2006;53:213–7.PubMedGoogle Scholar
  19. 19.
    Altomare DF, Binda G, Ganio E, et al. Long-term outcome of Altemeier’s procedure for rectal prolapse. Dis Colon Rectum. 2009;52:698–703.PubMedCrossRefGoogle Scholar
  20. 20.
    Whitlow CB, Beck DE, Opelka FG, Gathright JB, Timmcke AE, Hicks TC. Perineal procedures for prolapse. La State Med J. 1997;149:22–6.Google Scholar
  21. 21.
    Chun SW, Pikarsky AJ, You SY, et al. Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol. 2004;8:3–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Delorme E. Sur le traitement des prolapsus du rectum totaux pour l’excision de la muqueuse rectale ou rectocolique. Bull Mém Soc Chir Paris. 1900;26:499–578.Google Scholar
  23. 23.
    Uhlig BE, Sullivan ES. The modified Delorme operation: its place in surgical treatment for massive rectal prolapse. Dis Colon Rectum. 1979;22:513–21.PubMedCrossRefGoogle Scholar
  24. 24.
    Monson JR, Jones AN, Vowden P, Brennan TG. Delorme’s operation: the first choice in complete rectal prolapse? Ann R Coll Surg Engl. 1986;68:143–6.PubMedGoogle Scholar
  25. 25.
    Senapati A, Nicholls RJ, Chir M, et al. Results of Delorme’s procedure for rectal prolapse. Dis Colon Rectum. 1994;37:456–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Oliver GC, Vachon D, Eisenstar TE, et al. Delorme’s procedure for complete rectal prolapse in severely debilitated patients. Dis Colon Rectum. 1994;37:461–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Tobin SA, Scott IHK. Delorme operation for rectal prolapse. Br J Surg. 1994;81:1681–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Graf W, Ejerblad S, Krog M, et al. Delorme’s operation for rectal prolapse in elderly or unfit patients. Eur J Surg. 1992;158:555–7.PubMedGoogle Scholar
  29. 29.
    Watkins BP, Landercasper J, Belzer GE, et al. Long-term follow-up of the modified Delorme procedure for rectal prolapse. Arch Surg. 2003;138:498–502.PubMedCrossRefGoogle Scholar
  30. 30.
    Lieberth M, Kondylis LA, Reilly JC, Kondylis PD. The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg. 2009;197:418–23.PubMedCrossRefGoogle Scholar
  31. 31.
    Yamana T, Iwadare J. Mucosal plication (Gant–Miwa procedure) with anal encircling for rectal prolapse – a review of the Japanese experience. Dis Colon Rectum. 2003;46:S94–9.PubMedGoogle Scholar
  32. 32.
    Goldman J. Concerning prolapse of the rectum with special emphasis on the operation by Thiersch. Dis Colon Rectum. 1988;31:154–5.CrossRefGoogle Scholar
  33. 33.
    Gabriel WB. Thiersch’s operation for anal incontinence and minor degrees of rectal prolapse. Am J Surg. 1953;86:583–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Labow S, Rubin R, Hoexter B, Salvati E. Perineal repair of procidentia with an elastic fabric sling. Dis Colon Rectum. 1980;23:467–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Williams JG. Perineal approaches to repair of rectal prolapse. Semin Colon Rectal Surg. 1991;2:198–204.Google Scholar
  36. 36.
    Jackaman FR, Francis JN, Hopkinson BR. Silicone rubber band treatment of rectal prolapse. Ann R Coll Surg Engl. 1980;62:386–7.PubMedGoogle Scholar
  37. 37.
    Hunt TM, Fraser IA, Maybury NK. Treatment of rectal prolapse by sphincteric support and using silastic rods. Br J Surg. 1985;72:491–2.PubMedCrossRefGoogle Scholar
  38. 38.
    Poole Jr GV, Pennell TC, Myers RT, Hightower F. Modified Thiersch operation for rectal prolapse. Techniques and results. Am Surg. 1985;51:226–9.PubMedGoogle Scholar
  39. 39.
    Vongsangnak V, Varma JS, Smith AN. Reappraisal of Thiersch’s operation for complete rectal prolapse. J R Coll Surg Edinb. 1985;30:185–7.PubMedGoogle Scholar
  40. 40.
    Earnshaw JJ, Hopkinson BR. Late results of silicone rubber perianal suture for rectal prolapse. Dis Colon Rectum. 1987;30:86–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Khanduja KS, Hardy TG, Aguilar PS, et al. A new silicone prosthesis in the modified Theirsch operation. Dis Colon Rectum. 1988;31:380–3.PubMedCrossRefGoogle Scholar
  42. 42.
    Sainio AP, Halme LE, Husa AI. Anal encirclement with polypropylene mesh for rectal prolapse and incontinence. Dis Colon Rectum. 1991;34:905–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Frykman HM. Abdominal proctopexy and primary sigmoid resection for rectal procidentia. Am J Surg. 1955;90:780–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Watts JD, Rothenberger DA, Buls JG, Goldberg SM, Nivatvongs S. The management of procidentia: 30 years experience. Dis Colon Rectum. 1985;28:96–102.PubMedCrossRefGoogle Scholar
  45. 45.
    Husa A, Sainio P, Smitten K. Abdominal rectopexy and sigmoid resection (Frykman-Goldberg) operation for rectal prolapse. Acta Chir Scand. 1988;154:221–4.PubMedGoogle Scholar
  46. 46.
    Sayfan J, Pinho M, Alexander-Williams J, Keighley MRB. Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse. Br J Surg. 1990;77:143–5.PubMedCrossRefGoogle Scholar
  47. 47.
    McKee RF, Lauder JC, Poon FW, Aichison MA, Finlay IG. A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obstet. 1992;174:145–8.PubMedGoogle Scholar
  48. 48.
    Luukkonen P, Mikkonen U, Jarvinen H. Abdominal rectopexy with sigmoidectomy vs rectopexy alone for rectal prolapse: a prospective randomized study. Int J Colorectal Dis. 1992;7:219–22.PubMedCrossRefGoogle Scholar
  49. 49.
    Canfrere VG, des Barannos SB, Mayon J, Lehar PA. Adding sigmoidectomy to rectopexy to treat rectal prolapse: a valid option? Br J Surg. 1994;581:2–4.Google Scholar
  50. 50.
    Huber FT, Stein H, Siewert JR. Functional results after treatment of rectal prolapse with rectopexy and sigmoid resection. World J Surg. 1995;19:138–43.PubMedCrossRefGoogle Scholar
  51. 51.
    Ashari LH, Lumley JW, Stevenson AR, Stitz RW. Laparoscopically-assisted resection rectopexy for rectal prolapse: ten years’ experience. Dis Colon Rectum. 2005;48:982–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Loygue J, Hugier M, Malafosse M, Biotois H. Complete prolapse of the rectum: a report on 140 cases treated by rectopexy. Br J Surg. 1971;58:847–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Blatchford GJ, Perry RE, Thorson AG, Christensen MA. Rectopexy without resection for rectal prolapse. Am J Surg. 1989;158:574–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Novell JR, Osborne MJ, Winslet MC, Lewis AAM. Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full thickness rectal prolapse. Br J Surg. 1994;81:904–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Ripstein CB, Lanter B. Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg. 1963;157:259–64.PubMedCrossRefGoogle Scholar
  56. 56.
    Gordon PH, Hoexter B. Complications of Ripstein procedure. Dis Colon Rectum. 1978;21:277–80.PubMedCrossRefGoogle Scholar
  57. 57.
    Eisenstadt TE, Rubin RJ, Salvati EP. Surgical treatment of complete rectal prolapse. Dis Colon Rectum. 1979;22:522–3.CrossRefGoogle Scholar
  58. 58.
    Tjandra JJ, Fazio VW, Church JM, Milsom JW, Oakley JR, Lavery IC. Ripstein procedure is an effective treatment for rectal prolapse without constipation. Dis Colon Rectum. 1993;36:501–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Winde G, Reers B, Nottberg H, Berns T, Meyer J, Bunt H. Clinical and functional results of abdominal rectopexy with absorbable mesh graft for treatment of complete rectal prolapse. Eur J Surg. 1993;159:301–5.PubMedGoogle Scholar
  60. 60.
    Schultz I, Mellgren A, Dolk A, Johansson C, Holmstrom B. Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum. 2000;43:35–43.PubMedCrossRefGoogle Scholar
  61. 61.
    Wells C. New operation for rectal prolapse. Proc R Soc Med. 1959;52:602–3.PubMedGoogle Scholar
  62. 62.
    Dulucq JL, Wintringer P, Mahajna A. Clinical and functional outcome of laparoscopic posterior rectopexy (Wells) for full-thickness rectal prolapse. A prospective study. Surg Endosc. 2007;21:2226–30.PubMedCrossRefGoogle Scholar
  63. 63.
    Loygue J, Nordlinger B, Cunci O, Malafosse M, Huguet C, Parc R. Rectopexy to the promontory for the treatment of rectal prolapse. Report of 257 cases. Dis Colon Rectum. 1984;27:356–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Baker R, Senagore AJ, Luchtefeld MA. Laparoscopic-assisted vs. open resection. Rectopexy offers excellent results. Dis Colon Rectum. 1995;38:199–201.PubMedCrossRefGoogle Scholar
  65. 65.
    Heah SM, Hartley JE, Hurleey J, Duthie GS, Monson JR. Laparoscopic suture rectopexy without resection is effective treatment for full-thickness rectal prolapse. Dis Colon Rectum. 2000;43:638–43.PubMedCrossRefGoogle Scholar
  66. 66.
    Kairaluoma MV, Viljakka MT, Kellokumpu IH. Open vs. laparoscopic surgery for rectal prolapse: a case-controlled study assessing short-term outcome. Dis Colon Rectum. 2003;46:353–60.PubMedCrossRefGoogle Scholar
  67. 67.
    Solomon MJ, Young CJ, Eyers AA, Roberts RA. Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg. 2002;89:35–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Purkayastha S, Tekkis P, Athanasiou T, et al. A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum. 2005;48:1930–40.PubMedCrossRefGoogle Scholar
  69. 69.
    Munz Y, Moorthy K, Kudchadkar R, et al. Robotic assisted rectopexy. Am J Surg. 2004;187:88–92.PubMedCrossRefGoogle Scholar
  70. 70.
    Ayav A, Bresler L, Brunaud L, Boissel P. Early results of on-year robotic surgery using the Da Vinci system to perform advanced laparoscopic procedures. J Gastrointest Surg. 2004;8:720–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Ayav A, Bresler L, Hubert J, Brunaud L, Boissel P. Robotic-asisted pelvic organ prolapse surgery. Surg Endosc. 2005;19:1200–3.PubMedCrossRefGoogle Scholar
  72. 72.
    Heemskerk J, de Hoog DE, van Gemert WG, Baeten CG, Greve JW, Bouvy ND. Robot-assisted vs conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum. 2007;50:1825–30.PubMedCrossRefGoogle Scholar
  73. 73.
    de Hoog DE, Heemskerk J, Nieman FH, van Gemert WG, Baeten CG, Bouvy ND. Recurrence and functional results after open versus conventional laparoscopic versus robot-assisted laparoscopic rectopexy for rectal prolapse: a case-control study. Int J Colorectal Dis. 2009;24:1201–6.PubMedCrossRefGoogle Scholar
  74. 74.
    Hool GR, Hull TL, Fazio VW. Surgical treatment of recurrent complete rectal prolapse. Dis Colon Rectum. 1997;40:270–2.PubMedCrossRefGoogle Scholar
  75. 75.
    Fengler SA, Pearl RK, Prasad ML, et al. Management of recurrent rectal prolapse. Dis Colon Rectum. 1997;40:832–4.PubMedCrossRefGoogle Scholar
  76. 76.
    Pikarsky AJ, Joo JS, Wexner SD, et al. Recurrent rectal prolapse: what is the next good option? Dis Colon Rectum. 2000;43:1273–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Steele SR, Goetz LH, Minami S, Madoff RD, Mellgren AF, Parker SC. Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum. 2006;49:440–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Beck DE. Colitis cystica profunda. In: Johnson LR, editor. Encyclopedia of gastroenterology. San Diego: Elsevier Science; 2003. p. 374–5.Google Scholar
  79. 79.
    Guest CB, Reznick RK. Colitis cystica profunda. Review of the literature. Dis Colon Rectum. 1989;32:983–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Torres C, Khaikin M, Bracho J, et al. Solitary rectal ulcer syndrome: clinical findings, surgical treatment, and outcomes. Int J Colorectal Dis. 2007;22:1389–93.PubMedCrossRefGoogle Scholar
  81. 81.
    Ortega AE, Klipfel N, Kelso R, et al. Changing concepts in the pathogenesis, evaluation, and management of solitary rectal ulcer syndrome. Am Surg. 2008;74:967–72.PubMedGoogle Scholar
  82. 82.
    Vaizey CJ, van den Bogaerde JB, Emmanuel AV, Talbot IC, Nicholls RJ, Kamm MA. Solitary rectal ulcer syndrome. Br J Surg. 1998;85:1617–23.PubMedCrossRefGoogle Scholar
  83. 83.
    Beck DE. Surgical therapy for colitis cystica profunda and solitary rectal ulcer syndrome. Curr Treat Options Gastroenterol. 2002;5:231–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Steven Mills
    • 1
  1. 1.Department of SurgeryUniversity of CaliforniaIrvine, OrangeUSA

Personalised recommendations