What are the treatment options for rectal prolapse?

From the Guidelines

Rectal prolapse requires prompt medical attention, and the most effective treatment is surgical correction, with the choice of approach depending on the patient's age, overall health, and severity of prolapse, as suggested by the most recent study 1. The main surgical approaches include abdominal procedures (rectopexy, where the rectum is secured to the sacrum) or perineal procedures (like Delorme's operation or Altemeier procedure).

• For patients with complicated rectal prolapse and signs of shock or gangrene/perforation of prolapsed bowel, immediate surgical treatment is recommended 1.
• For patients with complicated rectal prolapse and bleeding, acute bowel obstruction, or failure of non-operative management, urgent surgical treatment is suggested 1.
• In patients with incarcerated rectal prolapse without signs of ischemia or perforation, conservative measures and gentle manual reduction under mild sedation or anesthesia can be attempted 1.
• The decision between abdominal and perineal procedures should be based on the specific patient’s characteristics and on surgeon’s skills and expertise 1. Some key points to consider when treating rectal prolapse include:
• The importance of prompt medical attention to avoid complications like incarceration, strangulation, or ulceration of the rectal tissue.
• The need for individualized treatment plans based on the patient's age, overall health, and severity of prolapse.
• The role of non-operative management in reducing edema and facilitating manual reduction of the prolapse, although surgery should not be delayed if non-operative management fails 1.

From the Research

Surgical Options for Rectal Prolapse

• Rectal prolapse can be treated with various surgical options, including abdominal and perineal approaches, minimally invasive and open techniques, and different procedures such as posterior versus ventral rectopexy +/- sigmoidectomy 2
• The choice of surgical approach and technique depends on the patient's symptoms, bowel habits, anatomy, and pre-operative expectations 2
• The Delorme procedure, which involves mucosal stripping and muscle plication of the rectal prolapse, is a useful operation for complicated rectal prolapse in the elderly 3
• Laparoscopic ventral mesh rectopexy (LVMR) and Delorme's operation are two surgical options for complete rectal prolapse, with similar clinical and functional outcomes 4

Comparison of Surgical Techniques

• A prospective randomized study compared LVMR and Delorme's operation for complete rectal prolapse, finding no significant difference in recurrence rate or postoperative improvement of symptoms between the two groups 4
• A retrospective study compared the Delorme technique and rectopexy, finding similar recurrence rates and lower morbidity with the Delorme technique 5
• The Delorme technique is considered a safe procedure with results similar to rectopexy, and may be more often indicated due to its lower morbidity 5

Diagnosis and Evaluation

• The diagnosis of rectal prolapse is made based on physical examination, although several other modalities such as colonoscopy, anoscopy, anal manometry, and defecography may be used to provide additional information about the patient's condition 2, 6
• Medical management of rectal prolapse can be effective in some cases, but surgical correction is the mainstay of management 6