Treatment of rectal prolapse

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Rectal prolapse etiology is debated, with theories including pelvic fascia defects (sliding hernia) and rectal intussusception.
• Anatomical defects associated with prolapse include pelvic floor issues, rectal malposition, deep cul-de-sac of Douglas, redundant rectosigmoid, and anal sphincter laxity.

Purpose of the Study:

• To review the understanding of rectal prolapse etiology and surgical treatment options.
• To evaluate the effectiveness and limitations of common surgical procedures for rectal prolapse.

Main Methods:

• Review of existing literature on rectal prolapse etiology and surgical techniques.
• Discussion of commonly employed surgical procedures like Ivalon sponge repair (UK), Ripstein technique (USA), and abdominal proctopexy with sigmoid resection.

Main Results:

• Surgical procedures like Ivalon sponge repair, Ripstein technique, and abdominal proctopexy have shown acceptable morbidity and mortality rates.
• A significant drawback across all current surgical repairs is the persistent issue of fecal incontinence in approximately 50% of patients.
• Faradic stimulation of the sphincter has not significantly improved continence post-surgery.

Conclusions:

• Current surgical interventions for rectal prolapse address anatomical defects but do not consistently restore fecal continence.
• The high rate of persistent incontinence highlights a critical unmet need in rectal prolapse management.