Rektumprolaps

Abstract

Surgical treatment of rectal prolapse aims to correct morphology and restore function. Many techniques are available, but none can be considered a gold standard. Abdominal approaches differ with regard to abdominal access, extent of rectal mobilisation, technique of rectal pexy, and concomitant sigmoid resection. Local (perineal/transanal) procedures plicate or resect the rectum. The choice of operative approach is based on the patient's condition and expected outcome of the procedure, e.g. recurrence rate, morbidity, and function. Abdominal operations are favored in fit patients, while local procedures are considered for the elderly and frail. This review compares differences in the most common techniques, focussing on recurrence, morbidity, and functional outcome.

Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse

“…Much like our data, many studies reported satisfactory rates of improvement of constipation with 82% [26], 62% [27], and 69% [24] after LRR. Equally, incontinence can be effectively improved by the procedure as shown by the current study as well as by others [9,13]. Improvement rates for both continence and constipation after Delorme's procedure only rarely exceed 50%, regardless of age [9,13].…”

“…Improvement rates for both continence and constipation after Delorme's procedure only rarely exceed 50%, regardless of age [9,13]. Outcome for improvement of incontinence is generally slightly better in other perineal operations such as Altemeier's procedure, whereas improvement of constipation is almost never significant [9,13].…”

“…Women are affected predominantly, and the incidence of this pathology is age dependent. Above 65 years of age, the incidence is around 10/1,000 [9]. Given the presently documented aging of Western societies, one can assume that the incidence of rectal prolapse will rise accordingly.…”

“…In addition, improvement rates for both incontinence and constipation are higher in patients who received abdominal rather than perineal surgery [13]. It has, therefore, been generally accepted that perineal procedures should be undertaken in elderly patients as they benefit from less invasive operations and may not experience recurrent prolapse [9].…”

“…In general, perineal approaches can be distinguished from abdominal approaches. The outcomes of these distinct techniques have been widely evaluated [9,11,12]. By nature, perineal procedures are less invasive than abdominal approaches, but with up to 44%, they entail higher rates of recurrent prolapse in comparison to abdominal approaches (0-12%) [13].…”