Minimally Invasive Surgery for Rectal Prolapse: Laparoscopic Procedures

Abstract

Surgical treatment of external rectal prolapse, internal intussusception (or internal rectal prolapse), and rectocele is still a challenging clinical problem in the field of colorectal surgery [1, 2]. These conditions may be associated with various pelvic floor disorders, including motility and morphological/functional disorders, ranging from constipation to fecal incontinence, thus significantly affecting the patients’ quality of life [3, 4]. A large variety of surgical procedures exists. The literature offers abundant publications, the main problem for an informed decision on the perfect surgical technique being an often large variability of patients’ selection, diagnostic assessment and variation within the same surgical technique and materials. As a consequence, the colorectal surgeon still lacks a standardized diagnostic assessment as well as a clear ideal surgical technique [5]. Perineal procedures, such as Delorme’s or perineal rectosigmoidectomy or stapled transanal rectal prolapse resection, are indicated for elderly and frail patients, who are not fit for an intervention under general anesthesia, but they have poor efficacy in terms of functional outcomes and recurrence, which may be up to 26 % [6], and also an increasing risk for postoperative incontinence [7]. Abdominal procedures, on the other side, either open or laparoscopic, employing rectal mobilization and fixation, colonic resection or a combination of both, show lower recurrence rates and better functional results, but may cause postoperative worsening of constipation, mostly due to the full rectal mobilization and the consequent possible autonomic nerve injury, which is responsible for dysmotility and impaired evacuation [8]. Laparoscopic ventral mesh recto(colpo)pexy has been introduced in order to obtain good results in terms of functional outcome of the abdominal procedures while avoiding postoperative constipation and incontinence, offering the advantages of anterolateral mobilization, mesh repair and of the laparoscopic approach compared to the open [9].