[All-layer prolapse of the anorectum]

Complete prolapse or procidentia of the rectum describes the extrusion of the entire thickness of the rectal wall through the anus. A number of factors have been alleged to be important in the production of procidentia; at present stress is placed on the concept of intussuception. A large number of operative procedures, designed to correct this condition, reflect the unsatisfactory nature of the results hitherto achieved. The author's personal preference is a transperitoneal approach whenever feasible (Well's Procedure) with sacro-fixation. If a perineal approach is unavoidable for medical reasons the Thiersch-Procedure in Stelzner's modification (placement of the ring below the pelvic floor muscles) yields acceptable results. In seemingly hopeless recurrent cases, the procedure of Sarafoff can prove to be successful.