Abdominal proctopexy and primary sigmoid resection for rectal procidentia

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A composite surgical procedure is presented for the treatment of rectal procidentia. Eight cases of massive rectal prolapse have been treated by laparotomy with elevation and fixation of the rectum, obliteration of the cul-de-sac and repair of the pelvic floor, plus primary resection of all the excess sigmoid colon with end-to-end anastomosis. It is believed that recurrence is virtually impossible if all of the excess sigmoid colon and mesentery are resected along with the other reparative procedures. The maximal shortening of the redundant sigmoid colon and mesentery will hold the rectum in its normal position since the short remnant of sigmoid has very little mobility. If the redundant sigmoid and mesentery are not resected, the potential remains for recurrence should stress and strain again deepen the cul-de-sac and loosen the rectal supports. The operation described is designed primarily for those patients in whom a radical approach is justifiable to give the best chance for permanent cure.