[Rectal prolapse--choice of procedure and minimal invasive possibilities]

Diagnostic and pathomorphological findings support the notion that external and internal rectal prolapse with and without solitary rectal ulcer are merely different stages of one and the same disease. In view of the fact that, in the last resort, the aetiology of this disease remains largely unknown, the differential approach to therapeutic decision-making makes it necessary to give careful consideration to the individual situation of the patient, age, sex, case history and current findings. Although considerably in excess of 100 different surgical techniques have been reported for the treatment of rectal prolapse, only very few have finally been accepted in practice. In very old and high-risk patients, extra-abdominal corrective procedures (Delorme's procedure, peri-anal rectosigmoidal resection) performed under spinal or peridural anaesthesia, are given preference, despite the fact that the recurrence rate and the rate of persistent incontinence is higher than that seen with transabdominal techniques. In the case of younger patients and older patients unburdened by risk factors, the trans-abdominal procedures offer better functional results and lower recurrence rates. Here, anterior and posterior rectopexy and resection of the sigmoid with rectopexy are the most widely practiced procedures. With the further development of minimal invasive surgery, laparoscopic techniques are now also available, with the aid of which anterior and posterior rectopexy and intracorporeal sigmoid resection can be performed safely and reliably. These techniques will very likely further encourage the trend towards transabdominal procedures for the correction of rectal prolapse. These operative procedures may also be indicated in selected cases, in whom conservative treatment of intussusception and/or solitary rectal ulcer has failed.