[Surgical treatment for defaecation disorders]

Surgical treatment for defaecation disorders. Defaecation disorder that resists to conservative management can be treated surgically, if morphologic pelvic disorders are demonstrated. Most authors perform laparoscopic ventral rectopexy to the promontory to treat internal rectal prolapse, full-thickness rectal prolapse and/ or rectocele. A perineal or perineo vaginal approach is proposed in some cases of patients presenting with a rectocele, where an abdominal approach is impossible or difficult (severe adhesions), or when general anaesthesia is contra-indicated. For the same reasons, a perineal approach is performed in patients with full-thickness rectal prolapse, either a Delorme or an Altemeier procedure. As North American authors, we think that a stapled trans anal rectal resection, or STARR procedure, in order to treat an internal rectal prolapse or a rectocele does not help patient to be proposed routinely: there is still a place for the Sullivan procedure, namely in male patients with internal rectal prolapse.