Page 24 - WJOLS - Laparoscopic Journal

WJOLS

Inamull Hasan SA Shaikh 10.5005/jp-journals-10033-1255
REVIEW ARTICLE

Surgical Approaches for Rectal Prolapse and

their Comparative Study

Inamull Hasan SA Shaikh

ABSTRACT The etiology is unclear. Rectal prolapse is often asso-
Rectal prolapse is a distressing condition often affecting elderly ciated with obesity, pregnancy, chronic constipation and
patients. Open rectopexy has a proven track record in the treat- other conditions that lead to increased abdominal pressure.
ment of this condition but may be complicated by significant The most common anatomic varieties in patients with
morbidity. The benign nature of the disease and reduced pain and rectal prolapse are redundant sigmoid, diastases of the
pulmonary complications of the laparoscopic approach makes elevator ani, loss of the vertical position of the rectum and
this an attractive operation in this patient group. Laparoscopic 1,2
prosthesis fixation rectopexy and lateral ligament suspension its sacral attachments and a deep cul-de-sac. A rectal
3,4
with and without colectomy have been described with low recur- prolapse I° is seen in 20 to 50% of healthy individuals.
rence rates, good patient acceptability, symptom improvement,
on both radiological and physiological assessments. Currently, OPERATION PROCEDURES
the laparoscopic approach with ventral mesh rectopexy or resec-
tion rectopexy is the two most commonly used techniques. As Multiple operations have been described for the rectal
high quality evidence is missing, an individualized approach is prolapse. In the following section, techniques and results
recommend for every patient considering age, individual health of operations as far as they are performed laparoscopi-
status and the underlying morphological and functional disorders. cally are explained and rated (Table 1).
Keywords: Laparoscopy, Mesh rectopexy, Rectal prolapse, The aim of the operation generally is to correct the
Resection rectopexy, Suture rectopexy. morphologic alteration, and thereby treat the symptoms
How to cite this article: Shaikh IHSA. Surgical Approaches of the patient, e.g. improve incontinence or constipation
for Rectal Prolapse and their Comparative Study. World J Lap and incomplete emptying, depending on what major
Surg 2015;8(3):90-95.
symptoms the patient is suffering from. This can be
Source of support: Nil achieved by three ways:
Conflict of interest: None 1. Fixation of the rectum (rectopexy);
2. Resection or plication of redundant bowel; and
INTRODUCTION 3. Mobilization of the rectum. Most operations com-
bine the two principles of rectal mobilization and
Complete rectal prolapse is defined as protrusion of all rectopexy, some operations add bowel resection.
layers of the rectum through the anal canal, full thick- The approach can be trans anal/perineal or transabdo-
ness rectal prolapse (FRP). A protrusion of mucosa only minal. Abdominal operations seem to result in lower
is called mucosa prolapse (MP). recurrence rates but there are no randomized controlled
A common classification divides three grades as trials substantiating this. Perineal procedures avoid
5,6
follows: laparotomy/laparoscopy, and therefore, may have a lower
1. Rectal prolapse I°: Inner (recto-rectal) intussusception operative risk and morbidity. They may, therefore, be
of the rectum proximal of the anal canal; more suitable for older or high-risk patients with a rele-
2. Rectal prolapse II°: Inner (recto-anal) intussusception vant co-morbidity, although again there are no adequately
into the anal canal; powered RCTs to back these recommendations up.
3. Rectal prolapse III°: Prolapse of the rectum beyond the Virtually all abdominal procedures that were originally
anus (external prolapse).
described via laparotomy can also be performed laparos-
copically. The laparoscopic surgery of rectal prolapse
was first introduced in 1992 and consisted of a suture-
Private Practitioner
Department of General Surgery, Shaikh Polyclinic and Imad less rectopexy with staples without bowel resection. In the
Nursing Home, Raigad, Maharashtra, India meantime, besides the conventional laparoscopic approach,
Corresponding Author: Inamull Hasan SA Shaikh, Private there are new reports of a robotic-assisted approach with
7,8
Practitioner, Department of Surgery, Shaikh Polyclinic and Imad the da Vinci system. The transabdominal operations
Nursing Home, Mahad, Raigad, Maharashtra, India, Phone: differ mainly in the extent of rectal mobilization, the method
09970564719, e-mail: surgeongroup@gmail.com
of rectal fixation and the additional sigmoid resection.
90