Surgical management of rectal prolapse: in the era of laparoscopic surgery

Summary BACKGROUND: The purpose of rectal prolapse surgery is to correct the prolapse itself and restore fecal continence. This can be achieved by (1) resection or plication of the redundant bowel and/or (2) fixation of the rectum to sacrum. The rational for rectal fixation is to keep the rectum attached in the desired elevated position until it becomes fixed by scar tissue. A number of surgical procedures have been developed to treat rectal prolapse, but there is no consensus on the operation of choice. This review aims to evaluate the current literature with respect to laparoscopic treatment options for rectal prolapse. METHODS: The surgical treatment of rectal prolapse can be broadly classified into transabdominal approach and perineal approach. Any surgical procedure that involves extensive rectal mobilization and fixation is likely to correct the rectal prolapse with relatively low recurrence rate. RESULTS: As the recurrence rate is generally lower with the abdominal approach, some consider it to be the treatment of choice for rectal prolapse. A multicenter pooled analysis of 643 patients showed no difference in recurrence rates between suture rectopexy and mesh rectopexy. CONCLUSIONS: This review focuses on abdominal procedures with particular emphasis on laparoscopic management. Controversies have not yet been resolved as to which step of the abdominal procedure for full-thickness rectal prolapse makes the greatest contribution to the containment of recurrence rates. The authors concur with the literature suggesting that rectopexy is as effective with sutures as with mesh. A randomized controlled trial has been started to evaluate whether the addition of rectopexy to mobilization of the rectum significantly decreases recurrence rates.