Rectal Prolapse
Rectal prolapse is a debilitating condition with both functional and anatomic sequelae. There are a myriad of surgical options to repair rectal prolapse with low quality evidence directing the best approach. Surgeons treating rectal prolapse should be fam
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Key Concepts • Individuals with rectal prolapse may complain of a myriad of symptoms: mucus discharge, rectal bulge, rectal bleeding, fecal incontinence, constipation, tenesmus, pelvic and rectal pain and pressure. Correction of the prolapse does not guarantee functional improvement. • Successful outcomes measures after rectal prolapse surgery include both prolapse recurrence rates and functional outcomes. The surgeon should be familiar with different abdominal and perineal procedures to choose the best operation for each individual in the setting of initial and recurrent rectal prolapse. • Laparoscopic ventral rectopexy is associated with functional improvement, low morbidity, and low recurrence rates but has a high learning curve for proficiency and advanced training may be required. • Robotic rectopexy can be offered safely to patients and has advantages when suturing in the pelvis is required. • The paradigm for treatment rectal prolapse in the elderly has changed from perineal to abdominal minimally invasive procedures in elderly and high risk patients. • Rectal prolapse may coexist with vaginal prolapse and multidisciplinary evaluation and treatment should be considered in symptomatic patients.
Introduction Rectal prolapse or procidentia is defined as extrusion of the full thickness of the circular folds of the rectum through the anal muscles beyond the anal verge. If the rectal wall is prolapsed but does not extend beyond the anus, it is called occult
Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-319-25970-3_60) contains supplementary material, which is available to authorized users.
(internal) rectal prolapse or rectal intussusception. Both full-thickness and internal rectal prolapse should be differentiated from mucosal prolapse which occurs when only the rectal or anal mucosa protrudes beyond the anus. Several anatomic conditions are associated with rectal prolapse including a laxity of rectal attachments, a deep Pouch of Douglas cul-de-sac, lack of fixation of the rectum to the sacrum, and a large redundant sigmoid colon (Figure 60-1). The peak incidence of rectal prolapse is reported in women aged 70 and may be associated with a spectrum of pelvic floor disorders such as vaginal prolapse (enterocele, cystocele, rectocele) and urinary incontinence. These disorders are generally attributed to multiparity and pelvic floor weakness [1]. Women are six times as likely as men to present with rectal prolapse [2]. Approximately one-third of female patients are nulliparous and younger women; men with rectal prolapse tend to suffer from disordered defecation, dysmotility, psychiatric comorbidities, eating disorders, and autism or developmental delays [3, 4]. Symptoms of rectal prolapse may include the feeling of a bulge, mucus drainage and/or fecal accidents, constipation, tenesmus, rectal pressure, pelvic pressure and pain, and rectal bleeding. These symptoms can be debilitating and can result in isolation and depression in affected individuals. Fecal incontinence is repor
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