Abstract
Rectal prolapse is a debilitating condition with both functional and anatomic sequelae. There are a myriad of surgical options to repair rectal prolapse with low quality evidence directing the best approach. Surgeons treating rectal prolapse should be familiar with both abdominal and perineal surgery for both primary and secondary prolapse procedures and individualize the treatments. There is a trend towards more durable abdominal procedures for elderly and infirm patients. Multidisciplinary evaluation and surgical repair can be performed safely in patients with both vaginal and rectal prolapse.
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References
Peters 3rd WA, Smith MR, Drescher CW. Rectal prolapse in women with other defects of pelvic floor support. Am J Obstet Gynecol. 2001;184(7):1488–94. discussion 1494–5.
Kairaluoma MV, Kellokumpu IH. Epidemiologic aspects of complete rectal prolapse. Scand J Surg. 2005;94(3):207–10.
Marceau C, Parc Y, Debroux E, Tiret E, Parc R. Complete rectal prolapse in young patients: psychiatric disease a risk factor of poor outcome. Colorectal Dis. 2005;7(4):360–5.
Mitchell N, Norris ML. Rectal prolapse associated with anorexia nervosa: a case report and review of the literature. Int J Eat Disord. 2013;1:39.
Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD. Complete rectal prolapse: evolution of management and results. Dis Colon Rectum. 1999;42(4):460–6. discussion 466–9.
Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW, Dietz DW. Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum. 2006;49(7):1052–8.
Snooks SJ, Henry MM, Swash M. Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles. Gut. 1985;26(5):470–6.
Madoff RD, Mellgren A. One hundred years of rectal prolapse surgery. Dis Colon Rectum. 1999;42(4):441–50.
Varma M, Rafferty J, Buie WD, Standards Practice Task Force of American Society of Colon and Rectal Surgeons. Practice parameters for the management of rectal prolapse. Dis Colon Rectum. 2011;54(11):1339–46.
Pescatori M, Spyrou M, Pulvirenti d’Urso A. A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis. 2007;9(5):452–6.
Renzi A, Izzo D, Di Sarno G, De Iuri A, Bucci L, Izzo G, et al. Cinedefecographic findings in patients with obstructed defecation syndrome. A study in 420 cases. Minerva Chir. 2006;61(6):493–9.
Myers JO, Rothenberger DA. Sugar in the reduction of incarcerated prolapsed bowel. Report of two cases. Dis Colon Rectum. 1991;34(5):416–8.
Hamalainen KJ, Raivio P, Antila S, Palmu A, Mecklin JP. Biofeedback therapy in rectal prolapse patients. Dis Colon Rectum. 1996;39(3):262–5.
Gourgiotis S, Baratsis S. Rectal prolapse. Int J Colorectal Dis. 2007;22(3):231–43.
Deen KI, Grant E, Billingham C, Keighley MR. Abdominal resection rectopexy with pelvic floor repair versus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse. Br J Surg. 1994;81(2):302–4.
Senapati A, Gray RG, Middleton LJ, Harding J, Hills RK, Armitage NC, et al. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68.
Kuijpers HC. Treatment of complete rectal prolapse: to narrow, to wrap, to suspend, to fix, to encircle, to plicate or to resect? World J Surg. 1992;16(5):826–30.
Lieberth M, Kondylis LA, Reilly JC, Kondylis PD. The Delorme repair for full-thickness rectal prolapse: a retrospective review. Am J Surg. 2009;197(3):418–23.
Tsunoda A, Yasuda N, Yokoyama N, Kamiyama G, Kusano M. Delorme’s procedure for rectal prolapse: clinical and physiological analysis. Dis Colon Rectum. 2003;46(9):1260–5.
Liberman H, Hughes C, Dippolito A. Evaluation and outcome of the Delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum. 2000;43(2):188–92.
Chun SW, Pikarsky AJ, You SY, Gervaz P, Efron J, Weiss E, et al. Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Tech Coloproctol. 2004;8(1):3–8. discussion 8–9.
Altomare DF, Binda G, Ganio E, De Nardi P, Giamundo P, Pescatori M, et al. Long-term outcome of Altemeier’s procedure for rectal prolapse. Dis Colon Rectum. 2009;52(4):698–703.
Graf W, Karlbom U, Pahlman L, Nilsson S, Ejerblad S. Functional results after abdominal suture rectopexy for rectal prolapse or intussusception. Eur J Surg. 1996;162(11):905–11.
Khanna AK, Misra MK, Kumar K. Simplified sutured sacral rectopexy for complete rectal prolapse in adults. Eur J Surg. 1996;162(2):143–6.
Novell JR, Osborne MJ, Winslet MC, Lewis AA. Prospective randomized trial of Ivalon sponge versus sutured rectopexy for full-thickness rectal prolapse. Br J Surg. 1994;81(6):904–6.
Bachoo P, Brazzelli M, Grant A. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. 2000;(2)(2):CD001758.
Aitola PT, Hiltunen KM, Matikainen MJ. Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach. Dis Colon Rectum. 1999;42(5):655–60.
Frykman HM, Goldberg SM. The surgical treatment of rectal procidentia. Surg Gynecol Obstet. 1969;129(6):1225–30.
Sayfan J, Pinho M, Alexander-Williams J, Keighley MR. Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex rectopexy for rectal prolapse. Br J Surg. 1990;77(2):143–5.
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(4):219–22.
Tou S, Brown SR, Malik AI, Nelson RL. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev. 2008;(4)(4):CD001758.
Hsu A, Brand MI, Saclarides TJ. Laparoscopic rectopexy without resection: a worthwhile treatment for rectal prolapse in patients without prior constipation. Am Surg. 2007;73(9):858–61.
El Muhtaseb MS, Bartolo DC, Zayiae D, Salem T. Colonic transit before and after resection rectopexy for full-thickness rectal prolapse. Tech Coloproctol. 2014;18(3):273–6.
Formijne Jonkers HA, Draaisma WA, Wexner SD, Broeders IA, Bemelman WA, Lindsey I, et al. Evaluation and surgical treatment of rectal prolapse: an international survey. Colorectal Dis. 2013;15(1):115–9.
Gurland B. Ventral mesh rectopexy: is this the new standard for surgical treatment of pelvic organ prolapse? Dis Colon Rectum. 2014;57(12):1446–7.
Ripstein CB, Lanter B. Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg. 1963;157:259–64.
Winde G, Reers B, Nottberg H, Berns T, Meyer J, Bunte H. Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse. Eur J Surg. 1993;159(5):301–5.
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.
McMahan JD, Ripstein CB. Rectal prolapse. An update on the rectal sling procedure. Am Surg. 1987;53(1):37–40.
Roberts PL, Schoetz Jr DJ, Coller JA, Veidenheimer MC. Ripstein procedure. Lahey Clinic experience: 1963–1985. Arch Surg. 1988;123(5):554–7.
D’Hoore A, Cadoni R, Penninckx F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse. Br J Surg. 2004;91(11):1500–5.
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.
Mackenzie H, Dixon AR. Proficiency gain curve and predictors of outcome for laparoscopic ventral mesh rectopexy. Surgery. 2014;156(1):158–67.
van Geluwe B, Wolthuis A, Penninckx F, D’Hoore A. Lessons learned after more than 400 laparoscopic ventral rectopexies. Acta Chir Belg. 2013;113(2):103–6.
Badrek-Al Amoudi AH, Greenslade GL, Dixon AR. How to deal with complications after laparoscopic ventral mesh rectopexy: lessons learnt from a tertiary referral centre. Colorectal Dis. 2013;15(6):707–12.
Rajamaheswari N, Agarwal S, Seethalakshmi K. Lumbosacral spondylodiscitis: an unusual complication of abdominal sacrocolpopexy. Int Urogynecol J. 2012;23(3):375–7.
Draaisma WA, van Eijck MM, Vos J, Consten EC. Lumbar discitis after laparoscopic ventral rectopexy for rectal prolapse. Int J Colorectal Dis. 2011;26(2):255–6.
Formijne Jonkers HA, Maya A, Draaisma WA, Bemelman WA, Broeders IA, Consten EC, et al. Laparoscopic resection rectopexy versus laparoscopic ventral rectopexy for complete rectal prolapse. Tech Coloproctol. 2014;18(7):641–6.
Panis Y. Laparoscopic ventral rectopexy: resection or no resection? That is the question…. Tech Coloproctol. 2014;18(7):611–2.
Mehmood RK, Parker J, Bhuvimanian L, Qasem E, Mohammed AA, Zeeshan M, et al. Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior? Int J Colorectal Dis. 2014;29(9):1113–8.
Rondelli F, Bugiantella W, Villa F, Sanguinetti A, Boni M, Mariani E, et al. Robot-assisted or conventional laparoscopic rectopexy for rectal prolapse? Systematic review and meta-analysis. Int J Surg. 2014;12 Suppl 2:S153–9.
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.
Fang SH, Cromwell JW, Wilkins KB, Eisenstat TE, Notaro JR, Alva S, et al. Is the abdominal repair of rectal prolapse safer than perineal repair in the highest risk patients? An NSQIP analysis. Dis Colon Rectum. 2012;55(11):1167–72.
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.
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(5):561–6.
Germain A, Perrenot C, Scherrer ML, Ayav C, Brunaud L, Ayav A, et al. Long-term outcome of robotic-assisted laparoscopic rectopexy for full-thickness rectal prolapse in elderly patients. Colorectal Dis. 2014;16(3):198–202.
Hotouras A, Ribas Y, Zakeri S, Bhan C, Wexner SD, Chan CL, et al. A systematic review of the literature on the surgical management of recurrent rectal prolapse. Colorectal Dis. 2015. doi:10.1111/codi.12946.
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(4):440–5.
Hool GR, Hull TL, Fazio VW. Surgical treatment of recurrent complete rectal prolapse: a thirty-year experience. Dis Colon Rectum. 1997;40(3):270–2.
Ding JH, Canedo J, Lee SH, Kalaskar SN, Rosen L, Wexner SD. Perineal rectosigmoidectomy for primary and recurrent rectal prolapse: are the results comparable the second time? Dis Colon Rectum. 2012;55(6):666–70.
Jackson SL, Weber AM, Hull TL, Mitchinson AR, Walters MD. Fecal incontinence in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 1997;89(3):423–7.
Riansuwan W, Hull TL, Bast J, Hammel JP. Combined surgery in pelvic organ prolapse is safe and effective. Colorectal Dis. 2010;12(3):188–92.
Watadani Y, Vogler SA, Warshaw JS, Sueda T, Lowry AC, Madoff RD, et al. Sacrocolpopexy with rectopexy for pelvic floor prolapse improves bowel function and quality of life. Dis Colon Rectum. 2013;56(12):1415–22.
Ayav A, Bresler L, Brunaud L, Zarnegar R, Boissel P. Surgical management of combined rectal and genital prolapse in young patients: transabdominal approach. Int J Colorectal Dis. 2005;20(2):173–9.
VanderPas Lamb S, Massengill J, Sheridan MJ, Stern LE, von Pechmann W. Safety of combined abdominal sacral colpopexy and sigmoid resection with suture rectopexy: a retrospective cohort study. Female Pelvic Med Reconstr Surg. 2015;21(1):18–24.
Ortega AE, Klipfel N, Kelso R, Petrone P, Roman I, et al. Changing concepts in the pathogenesis, evaluation, and management of solitary rectal ulcer syndrome. Am Surg. 2008;74(10):967–72.
Lee TH, Hong SJ, Lee JS. Thickened internal anal sphincter has been reported to be a typical finding in solitary rectal ulcer syndrome. J Neurogastroenterol Motil. 2015;21(1):140–1.
Rao SS, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, et al. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil. 2015;27(5):594–609.
Vaizey CJ, van den Bogaerde JB, Emmanuel AV, Talbot IC, Nicholls RJ, et al. Solitary rectal ulcer syndrome. Br J Surg. 1998;85(12):1617–23.
Waniczek D, Rdes J, Rudzki MK, Piecuch J, Rubicz N, et al. Effective treatment of solitary rectal ulcer syndrome using argon plasma coagulation. Prz Gastroenterol. 2014;9(4):249–53.
Evans C, Ong E, Jones OM, Cunningham C, Lindsey I. Laparoscopic ventral rectopexy is effective for solitary rectal ulcer syndrome when associated with rectal prolapse. Colorectal Dis. 2014;16(3):O112–6.
Badrek-Amoudi AH, Roe T, Mabey K, Carter H, Mills A, et al. Laparoscopic ventral mesh rectopexy in the management of solitary rectal ulcer syndrome: a cause for optimism? Colorectal Dis. 2013;15(5):575–81.
Beck DE. Surgical therapy for colitis cystica profunda and solitary rectal ulcer syndrome. Curr Treat Options Gastroenterol. 2002;5(3):231–7.
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Delorme procedure (WMV 207357 kb)
Perineal rectosigmoidectomy (Altemeier procedure) (WMV 228700 kb)
Rectopexy for rectal prolapse (WMV 106278 kb)
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Gurland, B., Zutshi, M. (2016). Rectal Prolapse. In: Steele, S.R., Hull, T.L., Read, T.E., Saclarides, T.J., Senagore, A.J., Whitlow, C.B. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-25970-3_60
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