Surgical Management of Rectal Prolapse
Summary
Rectal prolapse, the full-thickness protrusion of the rectal wall through the anal canal, presents a significant challenge in colorectal surgery. Management strategies fall broadly into abdominal and perineal approaches. Abdominal techniques, notably ventral mesh rectopexy, aim to restore normal anatomy by securing the rectum to the sacrum, often using synthetic or biologic meshes. Laparoscopic and robotic assistance have expanded the minimally invasive repertoire, offering enhanced visualisation and reduced recovery times. Perineal operations, such as rectosigmoidectomy, are preferred in frail or elderly patients owing to lower operative stress, albeit with a slightly higher recurrence risk. Patient selection hinges on physiological fitness, anatomical defect, symptom profile and prior interventions. Contemporary research emphasises comparative outcomes—functional improvement, recurrence rates and mesh-related morbidity—as well as cost-effectiveness. An evidence-based algorithm now guides surgeons in balancing durable repair against operative risk, tailoring interventions to individual needs while maintaining quality of life and continence.
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Surgical Management of Rectal Prolapse publication trend
The graph below shows the total number of articles in surgical management of rectal prolapse across all publications each year (not limited to Nature Index journals).
Technical terms
Rectal prolapse: Full-thickness eversion of the rectum through the anal canal.
Ventral mesh rectopexy (VMR): Abdominal fixation of the anterior rectal wall to the sacrum using mesh to correct prolapse.
Suture rectopexy: Abdominal reattachment of the rectum to the sacrum without use of mesh.
Perineal rectosigmoidectomy: Removal of redundant rectosigmoid colon via a perineal approach to treat prolapse.
Intussusception: Telescoping of one part of the rectal wall into an adjacent segment, often associated with internal prolapse.
References
- Mesh-related complications and recurrence after ventral mesh rectopexy with synthetic versus biologic mesh: a systematic review and meta-analysis. Techniques in Coloproctology (2021).
- Suture rectopexy versus ventral mesh rectopexy for complete full-thickness rectal prolapse and intussusception: systematic review and meta-analysis. BJS Open (2021).
- Perineal rectosigmoidectomy for rectal prolapse—the preferred procedure for the unfit elderly patient? 10 years experience from a UK tertiary centre. Techniques in Coloproctology (2019).
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