Internal rectal prolapse: Definition, assessment and management in 2016

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Internal rectal prolapse (IRP) is a common pelvic floor disorder often presenting with defecatory or fecal incontinence symptoms.
• Clinical examination alone is insufficient for IRP diagnosis; dynamic MRI defecography aids understanding and management.
• Surgical intervention for IRP requires a multidisciplinary approach after conservative treatments fail.

Purpose of the Study:

• To evaluate the efficacy of laparoscopic ventral mesh rectopexy compared to previous treatments for internal rectal prolapse.
• To establish the current gold standard surgical treatment for IRP.

Main Methods:

• Review of diagnostic modalities including dynamic MRI defecography and the Oxford score.
• Comparison of surgical outcomes between stapled trans-anal rectal resection (STARR) and laparoscopic ventral mesh rectopexy.
• Analysis of functional outcomes, including evacuation and continence, for both procedures.

Main Results:

• STARR procedure shows inconsistent results, with failure rates up to 20% and fecal incontinence in 25% of patients at one year.
• Laparoscopic ventral mesh rectopexy demonstrates high efficacy, resolving evacuation disorders in 65-92% and continence symptoms in 73-97% of patients.
• Laparoscopic ventral mesh rectopexy is associated with significant advantages in addressing functional deficits caused by IRP.

Conclusions:

• Laparoscopic ventral mesh rectopexy is the current gold standard surgical treatment for internal rectal prolapse.
• This approach offers superior functional outcomes for both evacuation and continence compared to STARR.
• Patient selection and multidisciplinary discussion remain crucial for optimal IRP management.