eMedicine Specialties > General Surgery > Colorectal

Rectal Prolapse: Follow-up

Author: Lisa S Poritz, MD, Assistant Professor, Department of Surgery, Section of Colon and Rectal Surgery, Milton S Hershey Medical Center, Pennsylvania State University
Contributor Information and Disclosures

Updated: Jul 22, 2009

Outcome and Prognosis

Anterior resection

The recurrence rate for anterior resection without sacral fixation is about 7-9%, with a morbidity rate of 15-29%. This recurrence rate is higher than for other abdominal procedures.

Marlex rectopexy

Recurrence rates range from 2-10% with morbidity rates of 3-29%. Continence is improved in 50-70% of patients. Constipation is not improved and may worsen after this operation.

Suture rectopexy

Results are similar to Marlex rectopexy.

Resection rectopexy

The recurrence rate for this procedure is 3-4%, with several studies reporting a 0% recurrence rate. Morbidity rates range from 4-23%. Because the redundant colon is also resected, constipation improves in 60-80% of patients, and continence improves in 35-60%.

Delorme mucosal sleeve resection

Recurrence rates range from 5-26%, with a variable morbidity that is usually related to the patient's underlying comorbidities. Fecal incontinence and constipation improve in about 50% of patients.

Altemeier perineal rectosigmoidectomy

Recurrence rates vary from 0-50%, with an average of approximately 10%. Continence is improved, especially if a levator plication is added to the procedure. (As previously mentioned, however, a study by Altomare et al indicated that restoration of continence with this procedure can be unpredictable.)2

Future and Controversies

Which repair constitutes the best treatment is the main controversy in surgery for rectal prolapse.3 All of the procedures have their proponents, and there is no right answer.

A laparoscopic approach to rectal prolapse repair has become increasingly popular and has intensified the controversy because it has decreased the morbidity of the abdominal approach to rectal prolapse in appropriate candidates. Long-term results of the laparoscopic approach are still being studied.4,5

The second controversy revolves around the cause(s) of rectal prolapse.

 


More on Rectal Prolapse

Overview: Rectal Prolapse
Workup: Rectal Prolapse
Treatment: Rectal Prolapse
Follow-up: Rectal Prolapse
Multimedia: Rectal Prolapse
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Wijffels NA, Collinson R, Cunningham C, et al. What is the natural history of internal rectal prolapse?. Colorectal Dis. Apr 13 2009;[Medline].

  2. Altomare DF, Binda G, Ganio E, et al. Long-term outcome of Altemeier's procedure for rectal prolapse. Dis Colon Rectum. Apr 2009;52(4):698-703. [Medline].

  3. Elmalik K, Dagash H, Shawis RN. Abdominal posterior rectopexy with an omental pedicle for intractable rectal prolapse: a modified technique. Pediatr Surg Int. Jun 25 2009;[Medline].

  4. de Hoog DE, Heemskerk J, Nieman FH, et al. Recurrence and functional results after open versus conventional laparoscopic versus robot-assisted laparoscopic rectopexy for rectal prolapse: a case-control study. Int J Colorectal Dis. Jul 9 2009;[Medline].

  5. Sajid M, Siddiqui M, Baig M. Open versus laparoscopic repair of full thickness rectal prolapse: a re-meta-analysis. Colorectal Dis. Apr 13 2009;[Medline].

  6. Blatchford GJ, Perry RE, Thorson AG. Rectopexy without resection for rectal prolapse. Am J Surg. Dec 1989;158(6):574-6. [Medline].

  7. Boulos PB, Stryker SJ, Nicholls RJ. The long-term results of polyvinyl alcohol (Ivalon) sponge for rectal prolapse in young patients. Br J Surg. Mar 1984;71(3):213-4. [Medline].

  8. Cirocco WC, Brown AC. Anterior resection for the treatment of rectal prolapse: a 20-year experience. Am Surg. Apr 1993;59(4):265-9. [Medline].

  9. Johansen OB, Wexner SD, Daniel N. Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum. Aug 1993;36(8):767-72. [Medline].

  10. Loygue J, Nordlinger B, Cunci O. Rectopexy to the promontory for the treatment of rectal prolapse. Report of 257 cases. Dis Colon Rectum. Jun 1984;27(6):356-9. [Medline].

  11. Luukkonen P, Mikkonen U, Jarvinen H. Abdominal rectopexy with sigmoidectomy vs. rectopexy alone for rectal prolapse: a prospective, randomized study. Int J Colorectal Dis. Dec 1992;7(4):219-22. [Medline].

  12. Madoff RD, Williams JG, Wong WD. Long-term functional results of colon resection and rectopexy for overt rectal prolapse. Am J Gastroenterol. Jan 1992;87(1):101-4. [Medline].

  13. McKee RF, Lauder JC, Poon FW. A prospective randomized study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obstet. Feb 1992;174(2):145-8. [Medline].

  14. Schlinkert RT, Beart RW Jr, Wolff BG. Anterior resection for complete rectal prolapse. Dis Colon Rectum. Jun 1985;28(6):409-12. [Medline].

  15. Schultz I, Mellgren A, Dolk A, et al. Continence is improved after the Ripstein rectopexy. Different mechanizms in rectal prolapse and rectal intussusception?. Dis Colon Rectum. Mar 1996;39(3):300-6. [Medline].

  16. Senapati A, Nicholls RJ, Thomson JP. Results of Delorme''s procedure for rectal prolapse. Dis Colon Rectum. May 1994;37(5):456-60. [Medline].

  17. Watts JD, Rothenberger DA, Buls JG. The management of procidentia. 30 years'' experience. Dis Colon Rectum. Feb 1985;28(2):96-102. [Medline].

  18. Williams JG, Rothenberger DA, Madoff RD. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum. Sep 1992;35(9):830-4. [Medline].

  19. Yoshioka K, Heyen F, Keighley MR. Functional results after posterior abdominal rectopexy for rectal prolapse. Dis Colon Rectum. Oct 1989;32(10):835-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

Related eMedicine topics:
Constipation
Hemorrhoids [Emergency Medicine]
Hemorrhoids [General Surgery]
Intussusception [Pediatrics: General Medicine]
Intussusception, Child
Intussusception, Surgical Treatment
Rectal Prolapse [Emergency Medicine]
Rectal Prolapse [Pediatrics: General Medicine]
Rectal Prolapse, Surgical Treatment

Clinical guidelines:
ASGE guideline: guideline on the use of endoscopy in the management of constipation. American Society for Gastrointestinal Endoscopy - Medical Specialty Society.  2005 Aug.  3 pages.  NGC:004485

Clinical trial:
Clinical Study for the Evaluation of the Efficiency of a Device for the Diagnosis of an Internal Rectal Prolapse, a Pelvic Floor Ptosis and for the Determination of an Internal Hernia Into the Douglas Pouch

[ CLOSE WINDOW ]

Keywords

rectal prolapse, procidentia, full-thickness rectal prolapse, mucosal prolapse, internal prolapse, internal intussusception, pelvic floor descent, constipation, rectal ulcers, hemorrhoids, hemorrhoidal disease, cystocele, fecal incontinence, defecogram, anal rectal manometry, proctosigmoidoscopy, Marlex rectopexy, Ripstein procedure, suture rectopexy, resection rectopexy, Frykman Goldberg procedure, anal encirclement, Thiersch wire, Delorme mucosal sleeve resection, Altemeier perineal rectosigmoidectomy, hemorrhoidectomy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Lisa S Poritz, MD, Assistant Professor, Department of Surgery, Section of Colon and Rectal Surgery, Milton S Hershey Medical Center, Pennsylvania State University
Lisa S Poritz, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

Medical Editor

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: RFA Medical None Director; MRC Biotec None Director

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.