The Surgical Management of Rectal Prolapse

Rectal prolapse is a debilitating condition predominant in the elderly female population. Etiological factors include age, multiparity, and anorexia. The diagnosis is clinical but a full assessment of pelvic floor function and the exclusion of organic disease are essential prior to operative intervention. As concomitant urogynecological disorders are present in a third of patients, discussion in a pelvic floor multidisciplinary team forum is mandated. Surgical correction can be performed using a perineal or an abdominal approach. The heterogeneity of trial design in the current literature makes direct comparison of the techniques difficult. Perineal approaches are generally preferred in high-risk, elderly patients as they can often be performed under regional anesthesia. The evidence surrounding the technical aspects of abdominal rectopexy, such as the need to perform a colectomy or the decision to preserve/divide the lateral ligaments, is examined in this review. In abdominal surgery, the use of minimally invasive laparoscopic techniques and enhanced recovery protocols are recommended.