Surgery for complete (full-thickness) rectal prolapse in adults

Area of Science:

• Gastroenterology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Complete (full-thickness) rectal prolapse is a debilitating condition affecting older adults.
• Current surgical options for rectal prolapse lack a consensus-based best practice.
• Pelvic floor defects underlie full-thickness rectal prolapse, necessitating surgical correction.

Purpose of the Study:

• To systematically assess the comparative effectiveness of diverse surgical repair techniques for complete (full-thickness) rectal prolapse.
• To identify optimal surgical strategies based on available randomized controlled trial (RCT) data.
• To evaluate outcomes including prolapse recurrence, incontinence, and constipation.

Main Methods:

• Comprehensive literature search of multiple databases (Cochrane, MEDLINE, EMBASE, PubMed) and handsearches up to February 2015.
• Inclusion of 15 randomized controlled trials (RCTs) involving 1007 adult participants.
• Independent data extraction and quality assessment by two reviewers focusing on recurrence, residual prolapse, incontinence, and constipation.

Main Results:

• Laparoscopic rectopexy demonstrated fewer postoperative complications and shorter hospital stays compared to open rectopexy.
• Division of lateral ligaments was associated with reduced prolapse recurrence but increased postoperative constipation.
• Bowel resection during rectopexy correlated with lower constipation rates; rectal mobilization alone showed higher recurrence than rectopexy.

Conclusions:

• The current evidence base for surgical rectal prolapse repair is limited by small sample sizes and methodological weaknesses in RCTs.
• Clinically significant differences between various surgical techniques remain largely unquantifiable.
• Further large-scale, rigorous trials with longer follow-up are essential to establish optimal surgical treatment for full-thickness rectal prolapse.