Recurrent Rectal Prolapse

Abstract

Rectal prolapse has been a challenging problem for surgeons throughout history, and represents a clinical entity that is poorly understood. There are a multitude of operations that have been described for the management of rectal prolapse, and include abdominal and perineal approaches. Transabdominal approaches involve repair of loose presacral rectal attachments with or without resection of redundant sigmoid colon, while the perineal approach eliminates the redundant rectum (perineal proctectomy) or rectal mucosa (Delorme). Each procedure has its advantages and disadvantages; however, the ultimate goal should be a safe, complete, and durable correction of the anatomic and physiologic problem. Despite multiple operations available, recurrence rates have consistently been reported as high as 50%.1–4 Given these data, it may be surprising to learn that there are few studies that have specifically addressed the management of recurrent rectal prolapse.5–8 Each of these studies is a retrospective review, where no algorithm was followed and patients with recurrent prolapse were treated according to the discretion of the operative surgeon. The management of recurrent rectal prolapse requires a basic understanding of the operative procedures utilized for rectal prolapse repair, and it has been suggested that the operation chosen for primary repair of the rectal prolapse may influence the type of operative repair for recurrence.