Minimally Invasive Surgery for Rectal Prolapse: Laparoscopic Procedures

  • Pierpaolo SileriEmail author
  • Luana Franceschilli
  • Ilaria Capuano
  • Federica Giorgi
  • Gabriele Boehm


Surgical treatment of external rectal prolapse, internal intussusception (or internal rectal prolapse), and rectocele is still a challenging clinical problem in the field of colorectal surgery [1, 2]. These conditions may be associated with various pelvic floor disorders, including motility and morphological/functional disorders, ranging from constipation to fecal incontinence, thus significantly affecting the patients’ quality of life [3, 4]. A large variety of surgical procedures exists. The literature offers abundant publications, the main problem for an informed decision on the perfect surgical technique being an often large variability of patients’ selection, diagnostic assessment and variation within the same surgical technique and materials. As a consequence, the colorectal surgeon still lacks a standardized diagnostic assessment as well as a clear ideal surgical technique [5]. Perineal procedures, such as Delorme’s or perineal rectosigmoidectomy or stapled transanal rectal prolapse resection, are indicated for elderly and frail patients, who are not fit for an intervention under general anesthesia, but they have poor efficacy in terms of functional outcomes and recurrence, which may be up to 26 % [6], and also an increasing risk for postoperative incontinence [7]. Abdominal procedures, on the other side, either open or laparoscopic, employing rectal mobilization and fixation, colonic resection or a combination of both, show lower recurrence rates and better functional results, but may cause postoperative worsening of constipation, mostly due to the full rectal mobilization and the consequent possible autonomic nerve injury, which is responsible for dysmotility and impaired evacuation [8]. Laparoscopic ventral mesh recto(colpo)pexy has been introduced in order to obtain good results in terms of functional outcome of the abdominal procedures while avoiding postoperative constipation and incontinence, offering the advantages of anterolateral mobilization, mesh repair and of the laparoscopic approach compared to the open [9].


Rectal prolapse Laparoscopy Pelvic floor Rectopexy 


  1. 1.
    Festen S, van Geloven AA, D’Hoore A, Lindsey I, Gerhards MF. Controversy in the treatment of symptomatic internal rectal prolapse: suspension or resection? Surg Endosc. 2011;25(6):2000–3.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Jones OM, Cunningham C, Lindsey I. The assessment and management of rectal prolapse, rectal intussusception, rectocoele, and enterocoele in adults. BMJ. 2011;342:c7099.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Wijffels NA, Jones OM, Cunningham C, Bemelman WA, Lindsey I. What are the symptoms of internal rectal prolapse? Colorectal Dis. 2013;15(3):368–73.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Kim M, Reibetanz J, Boenicke L, et al. Quality of life after laparoscopic resection rectopexy. In t J Colorectal Dis. 2012;27:489–95.CrossRefGoogle Scholar
  5. 5.
    Madoff RD, Mellgren A. One hundred years of rectal prolapse surgery. Dis Colon Rectum. 1999;42(4):441–50.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Watts AM, Thompson MR. Evaluation of Delorme’s procedure as a treatment for full-thickness rectal prolapse. Br J Surg. 2000;87(2):218–22.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Bachoo P, Brazzelli M, Grant A. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. 2000;2, CD001758.Google Scholar
  8. 8.
    Orrom WJ, Bartolo DC, Miller R, Mortensen NJ, Roe AM. Rectopexy is an ineffective treatment for obstructed defecation. Dis Colon Rectum. 1991;34(1):41–6.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    D’Hoore A, Cadoni R, Penninckx. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004;91:1500–5.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    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(1):35–9.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Smith SR, Solomon M. Functional comparisons between open and laparoscopic rectopexy. Gastroenterol Clin Biol. 2010;34(10):505–7.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Boccasanta P, Venturi M, Reitano MC, Salamina G, Rosati R, Montorsi M, et al. Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse. Dig Surg. 1999;16(5):415–9.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Byrne CM, Smith SR, Solomon MJ, Young JM, Eyers AA, Young CJ. Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse. Dis Colon Rectum. 2008;51(11):1597–604.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Purkayastha S, Tekkis P, Athanasiou T, Aziz O, Paraskevas P, Ziprin P, Darzi A. A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a meta-analysis. Dis Colon Rectum. 2005;48(10):1930–40.CrossRefGoogle Scholar
  15. 15.
    Cadeddu F, Sileri P, Grande M, De Luca E, Franceschilli L, Milito G. Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature. Tech Coloproctol. 2012;16(1):37–53.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Magruder JT, Efron JE, Wick EC, Gearhart SL. Laparoscopic rectopexy for rectal prolapse to reduce surgical-site infections and length of stay. World J Surg. 2013;37(5):1110–4.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Wijffels N, Cunningham C, Dixon A, Greenslade G, Lindsey I. Laparoscopic ventral rectopexy for external rectal prolapse is safe and effective in the elderly. Does this make perineal procedures obsolete? Colorectal Dis. 2011;13:561–6.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Cutait D. Sacro-promontory fixation of the rectum for complete rectal prolapse. Proc R Soc Med. 1959;52:105.Google Scholar
  19. 19.
    Wexner SD. Rectopexy without mesh. In: Gaspari AL, Sileri P, editors. Pelvic floor disorders: surgical approach. New York: Springer; 2013.Google Scholar
  20. 20.
    Blatchford GJ, Perry RE, Thorson AG, Christensen MA. Rectopexy without resection for rectal prolapse. Am J Surg. 1989;158(6):574–6.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Rose R, Schneider C, Scheidbach H, Yildirim C, Bruch HPKJ, Barlehner E, et al. Laparoscopic treatment of rectal prolapse: experience gained in a prospective multicenter study. Langenbecks Arch Surg. 2002;387:130–7.CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Siproudhis L, Bellisant E, Jugeut F. Rectal adaptation to distention in patients with overt rectal prolapse. Br J Surg. 1998;85:1527–32.CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Wilson J, Engledow A, Crosbie J, Arulampalam T, Motson R. Laparoscopic nonresectional suture rectopexy in the management of full-thickness rectal prolapse: substantive retrospective series. Surg Endosc. 2011;25(4):1062–4.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Sayfan J, Pinho M, Alexander-Williams J, Keighley MR. Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex mesh rectopexy. Br J Surg. 1990;77:143–5.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Speakman CT, Madden MV, Nicholas RJ, Kamm KA. Lateral ligament division during rectopexy causes constipation but prevents recurrence; results of a prospective randomized study. Br J Surg. 1991;78:1431–3.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Scaglia M, Fasth S, Hallgren T, Nordgren S, Oresland TL. Abdominal rectopexy for rectal prolapse: influence of surgical technique on functional outcome. Dis Colon Rectum. 1994;37:805–13.CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Carter AE. Retro sacral suture fixation for complete prolapse rectum in the elderly, the frail and the demented. Br J Surg. 1983;70:522–3.CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Frykman HM, Goldberg SM. The surgical treatment of rectal procidentia. Surg Gynecol Obstet. 1969;129(6):1225–30.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Lechaux JP, Atienza P, Goasguen N, Lechaux D, Bars I. Prosthetic rectopexy to the pelvic floor and sigmoidectomy for rectal prolapse. Am J Surg. 2001;182(5):465–9.CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Stevenson ARL, Stitz RW, Lumley JW. Laparoscopic assisted resection-rectopexy for rectal prolapse: early and medium follow-up. Dis Colon Rectum. 1998;41:46–54.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Xynos E, Chrysos E, Tsiaoussis J, Epanomeritakis E, Vassilakis J-S. Resection rectopexy for rectal prolapse. The laparoscopic approach. Surg Endosc. 1999;13:862–4.CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Roblick UJ, Bader FG, Jungbluth T, Laubert T, Bruch HP. How to do it—laparoscopic resection rectopexy. Langenbecks Arch Surg. 2011;396(6):851–5.CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Husa A, Sainio P, von Smitten K. Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse. Acta Chir Scand. 1988;154(3):221–4.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Luukkonen P, Mikkonen U, Järvinen H. Abdominal rectopexy with sigmoidectomy vs rectopexy alone for rectal prolapse: a prospective, randomized study. Int J Colorectal Dis. 1992;7:219–22.CrossRefPubMedCentralGoogle Scholar
  35. 35.
    Infantino A. Mesh rectopexy (Ripstein, Orr-Loygue, Wells, Frykman-Goldberg). In: Gaspari AL, Sileri P, editors. Pelvic floor disorders: surgical approach. New York: Springer; 2013.Google Scholar
  36. 36.
    Chen CC, Ridgeway B, Paraiso MF. Biologic grafts and synthetic meshes in pelvic reconstructive surgery. Clin Obstet Gynecol. 2007;50:383–411.CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Shah BC, Tiwari MM, Goede MR, et al. Not all biologics are equal! Hernia. 2011;15:165–71.CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Loygue J, Nordlinger B, Cunci O, Malafosse M, Hugue C, Parc R. Rectopexy to the promontory for the treatment of rectal prolapse. Dis Colon Rectum. 1984;27:356–9.CrossRefPubMedCentralGoogle Scholar
  39. 39.
    Samaranayake CB, Luo C, Plank AW, Merrie AE, Plank LD, Bissett IP. Systematic review on ventral rectopexy for rectal prolapse and intussusception. Colorectal Dis. 2010;12(6):504–12.CrossRefPubMedCentralGoogle Scholar
  40. 40.
    Collinson R, Wijffels N, Cunningham C, Lindsey I. Laparoscopic ventral rectopexy for internal rectal prolapse: short-term functional results. Colorectal Dis. 2010;12:97–104.CrossRefGoogle Scholar
  41. 41.
    D’Hoore A, Penninckx F. Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006;20:1919–23.CrossRefGoogle Scholar
  42. 42.
    Abet E, Lehur PA, Wong M. Sexual function and laparoscopic ventral rectopexy for complex rectocoele. Colorectal Dis. 2012;14:721–6.CrossRefGoogle Scholar
  43. 43.
    Sileri P, Franceschilli L, De Luca E. Laparoscopic ventral rectopexy for internal rectal prolapse using biological mesh: postoperative and short-term functional results. J Gastrointest Surg. 2012;16:622–8.CrossRefPubMedCentralGoogle Scholar
  44. 44.
    Smart NJ, Pathak S, Boorman P. Synthetic or biologic mesh use in laparoscopic ventral mesh rectopexy-a systematic review. Colorectal Dis. 2013;15:650–4.CrossRefPubMedCentralGoogle Scholar
  45. 45.
    Formijne Jonkers HA, Draaisma WA, Wexner SD, Broeders IA, Bemelman WA, Lindsey I, Consten EC. Evaluation and surgical treatment of rectal prolapse: an international survey. Colorectal Dis. 2013;15(1):115–9.CrossRefPubMedCentralGoogle Scholar
  46. 46.
    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(5):501–7.CrossRefPubMedCentralGoogle Scholar
  47. 47.
    Wells C. New operation for rectal prolapse. Proc R Soc Med. 1959;52:602–3.PubMedPubMedCentralGoogle Scholar
  48. 48.
    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(12):2226–30.CrossRefPubMedCentralGoogle Scholar
  49. 49.
    Himpens J, Cadière GB, Bruyns J, Vertruyen M. Laparoscopic rectopexy according to Wells. Surg Endosc. 1999;13:139–41.CrossRefPubMedCentralGoogle Scholar
  50. 50.
    Longo A, Boller B, Crafa F, Perrone F. Pelvic organ prolapse suspension. In: Gaspari AL, Sileri P, editors. Pelvic floor disorders: surgical approach. New York: Springer; 2013.Google Scholar
  51. 51.
    Ceci F, Spaziani E, Corelli S. Technique and outcomes about a new laparoscopic procedure: the Pelvic Organ Prolapse Suspension (POPS). G Chir. 2013;34(5-6):141–4.PubMedPubMedCentralGoogle Scholar
  52. 52.
    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(11):1825–30.CrossRefPubMedCentralGoogle Scholar
  53. 53.
    Mantoo S, Podevin J, Regenet N, Rigaud J, Lehur PA, Meurette G. Is robotic-assisted ventral mesh rectopexy superior to laparoscopic ventral mesh rectopexy in the management of obstructed defaecation? Colorectal Dis. 2013;15(8):e469–75.CrossRefPubMedCentralGoogle Scholar
  54. 54.
    Germain A, Perrenot C, Scherrer ML, Ayav C, Brunaud L, Ayav A, Bresler L. Long-term outcome of robotic-assisted laparoscopic rectopexy for full-thickness rectal prolapse in elderly patients. Colorectal Dis. 2014;16(3):198–202.CrossRefGoogle Scholar
  55. 55.
    Salman M, Bell T, Martin J, Bhuva K, Grim R, Ahuja V. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg. 2013;79(6):553–60.PubMedPubMedCentralGoogle Scholar

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Authors and Affiliations

  • Pierpaolo Sileri
    • 1
    Email author
  • Luana Franceschilli
    • 1
  • Ilaria Capuano
    • 1
  • Federica Giorgi
    • 1
  • Gabriele Boehm
    • 1
  1. 1.Department of SurgeryUniversity of Rome Tor Vergata, Policlinico Tor VergataRomeItaly

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