Best approaches to rectal prolapse

Abstract: Rectal prolapse is a bothersome and debilitating condition with both functional and anatomical underpinnings. The prevalence of rectal prolapse rises in both elderly women and in younger women with functional bowel disorders, a history of chronic straining, and a history of psychiatric disorders. Commonly reported symptoms include fecal incontinence (FI), constipation, rectal urgency, pain, and symptoms of obstructed defecation, and concomitant pelvic organ prolapse is common. There are hundreds of techniques described to repair rectal prolapse, and no single procedure has been definitively proven to be superior. Perineal procedures are advocated for frail and higher risk patients and age is not an absolute contraindication for surgery when quality of life is impacted. Abdominal rectopexy prolapse repairs are considered more durable than perineal operations, and minimally invasive options make this the preferred approach for many. However, there is no consensus or standardization on the extent of dissection, the use and type of mesh, and how to manage patients at high risk for recurrence or with recurrent prolapse. Overall, the morbidity and mortality rate is low, with approximately 10% of patients experience postoperative complications. In general, patients experience improvement in symptoms, function, and quality of life after rectal prolapse repair, highlighting the importance of offering surgical management promptly when rectal prolapse is diagnosed. This review covers the clinical presentation and work up for patients with rectal prolapse and the operative management with a focus on rectopexy procedures.