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The evolution of laparoscopic surgery for rectal prolapse.

Christopher Harmston1, Oliver Jones

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Rectal prolapse surgery has evolved, with new techniques improving outcomes for both external and internal rectal prolapse. Laparoscopic ventral rectopexy is now a key treatment, focusing on functional results.

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Area of Science:

  • Colorectal surgery
  • Gastroenterology
  • Surgical innovation

Background:

  • External rectal prolapse involves full-thickness rectal extrusion, typically treated surgically with a focus on reduction rather than function.
  • Internal rectal prolapse, a rectal wall folding during defecation without external protrusion, can cause obstructed defecation or fecal incontinence.
  • Historically, internal rectal prolapse surgery had a poor reputation due to suboptimal results and the perception of it being an incidental finding.

Purpose of the Study:

  • To outline the evolution of surgical treatments for rectal prolapse.
  • To discuss the application of laparoscopic ventral rectopexy in managing external rectal prolapse.
  • To review the evaluation and treatment strategies for patients with internal rectal prolapse.

Main Methods:

  • Review of surgical techniques for external rectal prolapse, including laparoscopic ventral rectopexy.
  • Analysis of the re-appraisal of internal rectal prolapse treatment based on functional outcomes.
  • Examination of new evidence regarding the morphology of symptomatic internal rectal prolapse.

Main Results:

  • Surgical techniques now emphasize functional outcomes in rectal prolapse treatment.
  • Laparoscopic ventral rectopexy is a significant advancement for external rectal prolapse.
  • Current evidence challenges the notion of internal rectal prolapse as untreatable or incidental.

Conclusions:

  • The treatment of rectal prolapse has advanced significantly, with a shift towards functional improvement.
  • Laparoscopic ventral rectopexy represents a key development in managing external rectal prolapse.
  • Symptomatic internal rectal prolapse is now recognized as a treatable condition with evolving therapeutic approaches.