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Surgical management of rectal prolapse
Thandinkosi E Madiba1, Mirza K Baig, Steven D Wexner
1Department of Surgery, University of KwaZulu-Natal, Durban, South Africa. madiba@ukzn.ac.za
Archives of Surgery (Chicago, Ill. : 1960)
|January 19, 2005
Summary
Surgical treatment for rectal prolapse varies by patient fitness. Abdominal procedures offer better outcomes for younger patients, while perineal approaches suit frail elderly individuals. Laparoscopic surgery provides advantages in recovery and pain management.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Surgical Innovation
Background:
- Complete rectal prolapse presents a significant surgical challenge with no single preferred treatment.
- Current surgical goals include correcting prolapse, improving continence and constipation, and minimizing mortality and recurrence.
- Patient selection is crucial, with abdominal procedures for fit individuals and perineal procedures for the frail elderly.
Purpose of the Study:
- To conduct a comprehensive review of the current surgical treatment options for rectal prolapse.
- To evaluate the efficacy and outcomes associated with various surgical techniques.
Main Methods:
- A literature review was performed using MEDLINE, including all articles on rectopexy.
- Prospective and retrospective comparative studies were included; case reports and historical control comparisons were excluded.
- Study results were tabulated and compared to assess outcomes, noting any missing data.
Main Results:
- Abdominal operations demonstrate lower recurrence rates and improved functional outcomes compared to other methods.
- Suture and mesh rectopexy yield comparable results; polyvinyl alcohol (Ivalon) sponge rectopexy is largely abandoned due to infection risks.
- Laparoscopic rectopexy offers similar outcomes to open procedures with added laparoscopic benefits; perineal procedures are best for frail patients.
Conclusions:
- Abdominal procedures are generally superior for younger, fit patients, with comparable outcomes across different abdominal techniques.
- Suture and mesh rectopexy remain popular choices, with the decision influenced by surgeon experience and preference.
- Perineal procedures are recommended for elderly patients with comorbidities, with perineal rectosigmoidectomy showing better outcomes than Delorme procedures.