Anterior Perineal Techniques [2]

  • Charles V. Mann
  • Richard E. Glass


Anterior approaches to the pelvic floor and anal sphincters have been developed, but remain less well-known than posterior techniques. This is surprising when one considers that it is the anterior wall of the rectum that is exposed when the pelvic floor gives way. Rectal prolapse manifests itself by an initial anterior invagination and descent of the rectal wall; mucosal prolapse is most often apparent on the anterior aspect of the lower rectum: childbirth trauma to the recto-vaginal septum and perineal body occurs in the anterior quadrant; solitary rectal ulcer and the mucosal lesions of anal abuse (sexual or otherwise) preferentially occur on the anterior aspects of the rectal lumen. The mechanical effects of stretching, tearing and compression are found most often (and to their greatest extents) on the tissues in front of the rectum and anal canal, and the anal sphincter muscles are shorter and less well-defined anteriorly than they are laterally and posterioly (especially in female subjects).


Pelvic Floor Anal Sphincter Rectal Prolapse Anal Incontinence Posterior Vaginal Wall 
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References and Further Reading

  1. 1.
    Goligher JC (1957) The treatment of complete prolapse of the rectum by the Roscoe Graham operation. Br J Surg 45: 323CrossRefGoogle Scholar
  2. 2.
    Goligher JC (1984) Prolapse of the rectum. In: Surgery of the anus, rectum and colon. Balliere Tindall, London, pp 261–263Google Scholar
  3. 3.
    Graham RR (1942) The operative repair of massive rectal prolapse. Ann Surg 115: 1007PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Hughes ESR, Johnson WR (1980) Abdomino-perineal levator ani repair for rectal prolapse: technique. Aust NZ J Surg 50: 117CrossRefGoogle Scholar
  5. 5.
    Moschcowitz AV (1912) The pathogenesis, anatomy and cure of prolapse of the rectum. Surg Gyn Obstet 15: 17Google Scholar
  6. 6.
    Notaras MJ (1973) The use of mersilene mesh in rectal prolapse repair. Proc R Soc Med 66: 684PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1991

Authors and Affiliations

  • Charles V. Mann
    • 1
    • 2
  • Richard E. Glass
    • 3
  1. 1.The London HospitalWhitechapel, LondonUK
  2. 2.St. Mark’s Hospital for Diseases of the Rectum and ColonLondonUK
  3. 3.Princess Margaret HospitalSwindonUK

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