Rectal Prolapse

What is the difference between procidentia and rectal mucosal prolapse?

Procidentia is a complete, full-thickness, rectal prolapse.

Procidentia can be differentiated by its circumferential, concentric folding pattern. Mucosal prolapse manifests with deep grooves with a radial pattern.

What patient population typically presents with rectal prolapse?

Older women

What studies may be useful in evaluation of rectal prolapse and disorders in defecation?

Colonic transit studies
Anorectal manometry
Pudendal nerve latency studies
Electromyography
Cinedefecography

What studies should be performed prior to operative intervention?

Colonoscopy or air-contrast barium enema

The colon should be assessed for neoplasms and diverticular disease.

What are the two primary surgical approaches to manage rectal prolapse?

1. Abdominal
2. Perineal

The abdominal approaches have lower recurrence rates, while perineal approaches have lower operative morbidity. There are also laparoscopic modifications that can potentially decrease surgical stress on the patient.

What procedures utilize the abdominal approach?

1. Rectopexy (suture or prosthetic)
2. Rectopexy with resection of redundant sigmoid

What procedures utilize the perineal approach?

1. The Delorme procedure
2. The Altemeier procedure
3. The Tiersch procedure

What is the Moschowitz repair?

Transabdominal reduction of a perineal hernia with closure of the cul-de-sac

What is the Ripstein repair?

A transabdominal rectopexy using an anterior mesh sling

What is the Wells repair?

A transabdominal rectopexy using a posterior mesh suspension

What is the Delorme procedure?

A transperineal mucosectomy

This is commonly performed for mucosal prolapse and is essentially a mucosal sleeve resection with plication of the muscularis.

What is the Altemeier procedure?

A transperineal rectosigmoidectomy

This involves eversion of redundant rectum with a full-thickness resection and anastomosis.

What is the Tiersch procedure?

An anal encirclement procedure that was originally described using a silver wire to encircle the external sphincter within the ischiorectal space, creating an outlet obstruction.

This is considered a palliative procedure, and has been done under local anesthesia using subcutaneously placed polypropylene mesh.

Late...SG

Sources:
Schwartz' Principles of Surgery, 8th ed.
Mastery of Surgery, 5th ed.