Surgical management of rectal prolapse

Area of Science:

• Gastroenterology and Surgical Science
• Pelvic Floor Disorders

Background:

• Rectal prolapse involves the full-thickness protrusion of the rectum, leading to discomfort, mucus discharge, and anal sphincter dysfunction.
• Symptoms include a sensation of prolapse, mucus secretion, and potential fecal incontinence due to stretched anal sphincters.
• The condition significantly impacts patient quality of life, necessitating effective management strategies.

Purpose of the Study:

• To review the pathogenesis, clinical presentation, and surgical management options for rectal prolapse.
• To compare the efficacy and recurrence rates of different surgical approaches.
• To evaluate the impact of surgical intervention on associated symptoms like constipation, diarrhea, and incontinence.

Main Methods:

• Review of existing literature on rectal prolapse pathogenesis, clinical features, and surgical treatments.
• Analysis of outcomes for perineal and abdominal surgical repairs, including recurrence rates.
• Examination of combined procedures, such as sigmoid resection with rectopexy for concurrent constipation.
• Comparison of open versus laparoscopic approaches for abdominal rectopexy.

Main Results:

• Perineal repairs are well-tolerated but associated with higher recurrence rates.
• Abdominal repairs, involving sacral fixation of the rectum (mesh or sutures), demonstrate the lowest recurrence rates.
• Surgical correction can improve diarrhea and incontinence in many patients.
• Laparoscopic rectopexy shows comparable morbidity and recurrence to open surgery, with added benefits of reduced hospital stay and complications.

Conclusions:

• Surgical management is the cornerstone of treating rectal prolapse.
• Abdominal rectopexy, particularly laparoscopic, is favored for its lower recurrence rates and patient benefits.
• Addressing comorbidities like constipation during surgery can enhance overall patient outcomes.