[Surgical treatment for defaecation disorders]

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Pelvic Floor Disorders

Background:

• Defecation disorders unresponsive to conservative management may require surgical intervention.
• Surgical treatment is indicated when morphologic pelvic abnormalities are identified.

Purpose of the Study:

• To review surgical treatment options for defecation disorders.
• To evaluate the efficacy of different surgical procedures for rectal prolapse and rectocele.

Main Methods:

• Laparoscopic ventral rectopexy to the promontory is commonly used for internal rectal prolapse, full-thickness rectal prolapse, and rectocele.
• Perineal or perineo-vaginal approaches are considered for rectocele when abdominal surgery is contraindicated or difficult.
• Perineal procedures (Delorme or Altemeier) are options for full-thickness rectal prolapse under similar circumstances.

Main Results:

• Laparoscopic ventral rectopexy is a primary surgical approach for various rectal prolapse and rectocele conditions.
• Perineal approaches offer alternatives for specific patient populations and contraindications.
• The stapled transanal rectal resection (STARR) procedure is not universally recommended for routine use.
• The Sullivan procedure remains a valuable option, particularly for male patients with internal rectal prolapse.

Conclusions:

• Surgical intervention is effective for select defecation disorders with demonstrable pelvic floor abnormalities.
• The choice of surgical approach should be tailored to the specific condition, patient factors, and surgical feasibility.
• While STARR has a role, other procedures like laparoscopic ventral rectopexy and the Sullivan procedure remain important in the surgical armamentarium for defecation disorders.