Current diagnostic tools and treatment modalities for rectal prolapse

Abstract

Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.

Clinical efficacy of ultrasound doppler-guided hemorrhoidal artery ligation combined with procedure for prolapse and hemorrhoids in treatment of severe hemorrhoids

“…DG-HAL, which ligates hemorrhoidal arteries, offers limited benefit in the fixation of anal cushions and is generally employed for patients with hemorrhoids characterized by severe bleeding. [23][24][25][26] Our study aimed to evaluate the clinical efficacy of combining DG-HAL with PPH versus PPH alone for the treatment of severe hemorrhoids. The results demonstrated no significant difference in the duration of surgery and intraoperative bleeding between the 2 groups (P > .05), but revealed a notably shorter healing time and hospital stay for the combined group (P < .05).…”

“…DG-HAL, which ligates hemorrhoidal arteries, offers limited benefit in the fixation of anal cushions and is generally employed for patients with hemorrhoids characterized by severe bleeding. [23–26]…”

Outcomes of Laparoscopic Suture Rectopexy Versus Laparoscopic Mesh Rectopexy: A Systematic Review and Meta-Analysis

“…The prevalence of complete rectal prolapse in the general population is 0.5% [ 5 ]. However, a 2.5% annual incidence of rectal prolapse is reported in patients ≥50 years, who often present with tenesmus, pain, rectal bleeding, incomplete evacuation, incontinence, and constipation [ 5 ]. Of note, the rates of constipation and fecal incontinence in such patients are 25-50% and 50-75%, respectively [ 5 ].…”

“…However, a 2.5% annual incidence of rectal prolapse is reported in patients ≥50 years, who often present with tenesmus, pain, rectal bleeding, incomplete evacuation, incontinence, and constipation [ 5 ]. Of note, the rates of constipation and fecal incontinence in such patients are 25-50% and 50-75%, respectively [ 5 ]. The progression of rectal prolapse is further aggravated by several potential factors, including pelvic floor weakness, insufficient recto-sacral fixation, redundant sigmoid colon, and a deep Douglas pouch [ 6 ].…”

“…Additionally, the straining chain, constipation, and outlet obstruction are initiated by external sphincter tonus elevation in patients with rectal prolapse [ 7 ]. The optimization of surgical approaches for rectal prolapse depends on a range of factors including differential diagnosis, patient presentation, and the incidence of clinical complications including fecal incontinence, diarrhea, constipation, mucus discharge, incomplete bowel evacuation, and abdominal discomfort [ 5 ]. The preoperative scoring systems, such as the Wexner Constipation Score, Rome IV Criteria, Altomare Obstructed Defecation Syndrome (ODS) Score, Pescatori Incontinence Score, Fecal Incontinence Severity Index (FISI), and St. Mark's Incontinence Score (SMIS) facilitate the assessment of rectal prolapse complications [ 8 - 10 ].…”