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There are over 300 different variations of surgical procedures described for rectal prolapse, and this area has seen rapid development. [3] However, there is no clear consensus regarding the best method. [6] Surgical treatment for rectal prolapse may be via the perineal or abdominal (transabdominal / peritoneal) approach.
Long term injury to the rectal mucosa and ischemic trauma are thought to be the main mechanisms. [5] In a report of 36 patients with SRUS, the underlying cause was internal prolapse (intussusception) in 20 patients, external rectal prolapse in 14 patients, and dyssynergic defecation (anismus) in 2 patients. [7]
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. [2] However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.
Patients may complain of bleeding, prolapse, personal discomfort and minor anal leakage. Where traditional non-surgical measures such as rest, suppositories and dietary advice fail to improve the condition, there is then a choice of further treatments. Opinion on the best management for patients varies considerably.
The procedure reduces constipation and fecal incontinence in patients with rectal prolapse or rectal intussusception, and has a low rate of complications and recurrence. [64] The procedure is able to correct multiple anatomical defects associated with vaginal and rectal prolapse, as well as improving function in terms of continence and defecation.
When operating a pelvic organ prolapse, introducing a mid-urethral sling during or after surgery seems to reduce stress urinary incontinence. [13] Transvaginal repair seems to be more effective than transanal repair in posterior wall prolapse, but adverse effects cannot be excluded. [ 14 ]
It is not clear in such situations if the enterocele caused or aggravated the rectal prolapse, or if the pouch of Douglas is merely pulled down by the rectal prolapse. It is thought that enterocele may initiate or aggravate a rectal intussusception (internal rectal prolapse). The hernia may descend into and impinge upon the rectal wall. [5]
After pelvic exenteration, many patients will have perineal hernia, often without symptoms, but only 3–10% will have perineal hernia requiring surgical repair. [4] Many problems can occur with the stoma. [1] Bowel obstruction may occur, or the anastomosis created by the surgery may leak. [1] The stoma may retract, or may prolapse. [1]