Management Operative Options of Rectal Procidentia

Abstract

Rectal prolapse has a profound effect on quality of life and has been associated with a multitude of surgical treatment options since its original description. It is defined as a full-thickness protrusion of the rectal wall through the anal sphincter. Clinical management is confounded by the fact that whereas 75% of patients with rectal prolapse experience problems with anal incontinence, 25–50% will have significant constipation. Symptoms of anal incontinence may be due to acquired changes in bowel motility or a reduction in resting anal pressure as a result of continual activation of rectoanal inhibition. Rectal prolapse cannot be corrected nonoperatively, although some of the symptoms associated with this condition, such as fecal incontinence, pain, and constipation, can be palliated medically. Surgery is the main form of treatment for rectal prolapse, and many operative procedures have been described in the historical literature, including anal encirclement, mucosal resection, perineal proctosigmoidectomy, anterior resection with or without rectopexy, suture rectopexy alone and a host of procedures involving the use of synthetic or biologic meshes affixed to the presacral fascia, including  ventral rectopexy with mesh. Another important decision involves the choice of pelvic dissection, either posterior or ventral. Here we discuss the procedures that are in common practice and are most commonly reported in the literature.