[Advances in surgical treatment of rectal prolapse: perspectives from the evolution of surgical approaches]

Rectal prolapse is a common pelvic floor disorder. Its pathogenesis primarily involves the degeneration and impairment of the supporting tissues of the rectum, leading to their laxity and consequent displacement of the rectum. As the pelvic cavity is a complex system consisting of gynecology, urology, and coloproctology, rectal prolapse often coexists with other pelvic relaxation disorders, such as perineal descent, pelvic floor hernias, and uterovaginal prolapse. Traditionally, pelvic-related disciplines have operated independently, creating disciplinary boundaries that restricted perspectives to single specialties. This compartmentalization focuses narrowly on repairing specific anatomical structures while neglecting the integrity of the pelvic floor system, thereby hampering the diagnosis and comprehensive management of pelvic floor disorders. This is a key reason for the high recurrence rates and poor long-term outcomes associated with traditional surgical approaches. The Integral Theory Paradigm (ITP) views the pelvic floor as an indivisible functional unit, emphasizing pelvic floor dysfunction caused by laxity of muscles, fasciae, and ligaments. By providing an interdisciplinary theoretical foundation, it has significantly advanced systematic innovations in the research, diagnosis, and treatment of pelvic floor disorders. Since the 21st century, with the development of the Integral Theory and membrane anatomy, the adoption of autologous fascial ligament reconstruction techniques has brought new prospects for the surgical management of rectal prolapse.