Management Guidelines for Full-thickness Rectal Prolapse

  • Andrew P. Zbar
  • Hung Nguyen


Given the profusion of surgical approaches in rectal prolapse, despite their history, there is currently no agreed-upon management strategy for this condition [1]. This situation, coupled with the unknown demographics of isolated full-thickness rectal prolapse or that combined with genital prolapse [2, 3], has been one of the stimulants for the ongoing PROSPER (PROlapse Surgery: PErineal or Rectopexy) trial being conducted in the UK. The trial, designed to recruit and randomise 1,000 patients, commenced in 2004 and separated short-term perioperative results and functional outcomes by comparing two main abdominal operations, abdominal rectopexy and resection rectopexy, with two principal perineal procedures, the Delorme mucosectomy and the Altemeier perineal rectosigmoidectomy. The prospective collection of this data will create the largest available randomised trial for surgical treatment of rectal prolapse in the adult. It will assess basic demography, risk factors, standardised defecatory function and quality of life.


Rectal Prolapse Internal Anal Sphincter Complete Rectal Prolapse Resection Rectopexy Abdominal Rectopexy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bachoo P, Brazelli M, Grant A (2000) Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 2:CD001758Google Scholar
  2. 2.
    Kriplani A, Banerjee N, Kriplani AK et al (1998) Uterovaginal prolapse associated with rectal prolapse. Aust N Z J Obstet Gynaecol 38:325–326PubMedCrossRefGoogle Scholar
  3. 3.
    Dekel A, Rabinerson D, Rafael ZB et al (2000) Concurrent genital and rectal prolapse: two pathologies — one joint operation. BJOG 107:125–129PubMedCrossRefGoogle Scholar
  4. 4.
    Gray R, Jan S, Hills RK et al (2003) PROSPER: Association of Coloproctology of Great Britain & Ireland randomized trial of rectal prolapse surgery. Colorectal Dis 5(Suppl 1):A 131Google Scholar
  5. 5.
    Jan S, Gross L, Senapati A et al (2005) Persistent benefits in bowel function and quality of life following rectal prolapse surgery — the ACPGBI PROSPER Trial. Colorectal Dis 7(Suppl 1):A 234Google Scholar
  6. 6.
    Zbar AP, Takashima S, Hasegawa T, Kitabayashi K (2002) Perineal rectosigmoidectomy (Altemeier’s procedure): a review of physiology, technique and outcome. Techn Coloproctol 6:109–116CrossRefGoogle Scholar
  7. 7.
    Carditello A, Milone A, Stilo F et al (2003) Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results. Chir Ital 55:687–692PubMedGoogle Scholar
  8. 8.
    Sailer M, Bonicke L, Petersen S (2007) Surgical options in the treatment of rectal prolapse: indications, techniques and results. Zentralb Chirurg 132:350–359CrossRefGoogle Scholar
  9. 9.
    Phillips RKS (2004) Rectal prolapse — update on the PROSPER trial. Royal Australasian College of Surgeons Annual Scientific Congress: CR 33Google Scholar
  10. 10.
    Brown AJ, Nicol L, Anderson JH et al (2005) Prospective study of the effect on colonic motility in patients with rectal prolapse. Br J Surg 92:1417–1422PubMedCrossRefGoogle Scholar
  11. 11.
    Singh SJ, Gibbons NJ, Vincent MV et al (2005) Use of pelvic ultrasound in the diagnosis of megarectum in children with constipation. J Pediatr Surg 40:1941–1945PubMedCrossRefGoogle Scholar
  12. 12.
    Keshtgar AS, Ward HC, Clayden GS, Sanei A (2004) Thickening of the internal anal sphincter in idiopathic constipation in children. Pediatr Surg Int 20:817–823PubMedCrossRefGoogle Scholar
  13. 13.
    Zbar AP (2005) The role of functional evaluation before anorectal surgery. Societa Italiana di Chirurgia ColoRettale 9:74–83Google Scholar
  14. 14.
    Glasgow SC, Birnbaum EH, Kodner IJ et al (2006) Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum 49:1052–1058PubMedCrossRefGoogle Scholar
  15. 15.
    Zbar AP, Aslam M, Gold DM et al (1998) Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation. Dis Colon Rectum 41:200–208PubMedCrossRefGoogle Scholar
  16. 16.
    Zbar AP, Aslam M, Hider A et al (1998) Comparison of vector volume manometry with conventional manometry in anorectal dysfunction. Techn Coloproctol 2:84–90Google Scholar
  17. 17.
    Kaur G, Gardiner A, Duthie GS (2002) Rectoanal reflex parameters in incontinence and constipation. Dis Colon Rectum 45:928–933PubMedCrossRefGoogle Scholar
  18. 18.
    Teleky B, Jech B, Karner-Hanusch J et al (2006) Straight and colonic J-pouch reconstruction after low anterior resection. Arch Chir Iugosl 53:109–112Google Scholar
  19. 19.
    Ho YH, Tan M, Seow-Choen F (1996) Prospective randomized controlled study of clinical function after low anterior resection: comparison of straight and colonic J pouch anastomosis. Br J Surg 83:978–980PubMedCrossRefGoogle Scholar
  20. 20.
    Johansen OB, Wexner SD, Daniel N et al (1993) Perineal rectosigmoidectomy in the elderly. Dis Colon Rectum 36:767–772PubMedCrossRefGoogle Scholar
  21. 21.
    Habr-Gama A, Jacob CE, Jorge JM et al (2006) Rectal procidentia treatment by perineal rectosigmoidectomy combined with levator ani repair. Hepatogastroenterology 53:213–217PubMedGoogle Scholar
  22. 22.
    Chun SW, Pikarsky AJ, You SY et al (2004) Perineal rectosigmoidectomy for rectal prolapse: role of levatorplasty. Techn Coloproctol 8:3–9CrossRefGoogle Scholar
  23. 23.
    Shah A, Parikh D, Jawaheer G, Gornall P (2005) Persistent rectal prolapse in children: sclerotherapy and surgical management. Pediatr Surg Int 21:270–273PubMedCrossRefGoogle Scholar
  24. 24.
    Sasaki Y, Iwai N, Kimura O, Hibi M (2004) The treatment of rectal prolapse in children with phenol in almond oil. Eur J Pediatr Surg 14:414–417PubMedCrossRefGoogle Scholar
  25. 25.
    Fahmy MA, Ezzelarab S (2004) Outcome of submucosal injection of different sclerosing materials for rectal prolapse in children. Pediatr Surg Int 20:353–356PubMedCrossRefGoogle Scholar
  26. 26.
    Antao B, Bradley V, Roberts JP, Shawis R (2005) Management of rectal prolapse in children. Dis Colon Rectum 48:1620–1625PubMedCrossRefGoogle Scholar
  27. 27.
    Lee JI, Vogel AM, Suchar AM et al (2006) Sequential linear stapling technique for perineal resection of intractable pediatric rectal prolapse. Am Surg 72:1212–1215PubMedGoogle Scholar
  28. 28.
    Detry RJ, Vanheuverzwijn R, Mahieu P, Kestens PJ (1984) The use of prosthetic materials in rectopexies. Int Surg 69:301–304PubMedGoogle Scholar
  29. 29.
    Gourgiotis S, Baratsis S (2007) Rectal prolapse. Int J Colorect Dis 22:231–243CrossRefGoogle Scholar
  30. 30.
    Loygue J, Nordlinger B, Malafosse M et al (1984) Rectopexy to the promontory for the treatment of rectal prolapse: report of 257 cases. Dis Colon Rectum 27:356–359PubMedCrossRefGoogle Scholar
  31. 31.
    Khanna AK, Misra MK, Kumar K (1996) Simplified sutured sacral rectopexy for complete rectal prolapse in adults. Eur J Surg 162:143–146PubMedGoogle Scholar
  32. 32.
    Cutait D (1959) Sacro-promontory fixation of the rectum for complete rectal prolapse. Proc R Soc Med 52(Suppl):105Google Scholar
  33. 33.
    Heah SM, Hartley J, Hurley J et al (2000) Laparoscopic suture rectopexy without resection is effective treatment for full-thickness rectal prolapse. Dis Colon Rectum 43:638–643PubMedCrossRefGoogle Scholar
  34. 34.
    Solomon MJ, Young CJ, Eyers AA, Roberts RA (2002) Randomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse. Br J Surg 89:35–39PubMedCrossRefGoogle Scholar
  35. 35.
    Purkayastha S, Tekkis P, Athanasiou T et al (2005) A comparison of open vs. laparoscopic abdominal rectopexy for full-thickness rectal prolapse: a metaanalysis. Dis Colon Rectum 48:1930–1934PubMedCrossRefGoogle Scholar
  36. 36.
    Speakman CT, Madden MV, Nicholls RJ, Kamm MA (1991) Lateral ligament division during rectopexy causes constipation but prevents recurrence: results of a prospective randomized study. Br J Surg 78:1431–1433PubMedCrossRefGoogle Scholar
  37. 37.
    Mollen RM, Kuijpers HC, van Hoek F (2000) Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function. Dis Colon Rectum 43:1283–1287PubMedCrossRefGoogle Scholar
  38. 38.
    Nelson R, Spitz J, Pearl RK, Abcarian H (2001) What role does full rectal mobilization alone play in the treatment of rectal prolapse? Techn Coloproctol 5:33–35CrossRefGoogle Scholar
  39. 39.
    Roberts PL, Schoetz DJ, Coller JA, Veidenheimer MC (1988) Ripstein procedure: Lahey Clinic experience 1963–1985. Arch Surg 123:554–557PubMedGoogle Scholar
  40. 40.
    Lukkonen P, Mikkonen U, Järvinen H (1992) Abdominal rectopexy with sigmoidectomy vs rectopexy alone for rectal prolapse: a prospective, randomised study. Int J Colorect Dis 7:219–222CrossRefGoogle Scholar
  41. 41.
    McKee RF, Lauder JC, Poon FW et al (1992) A prospective randomised study of abdominal rectopexy with and without sigmoidectomy in rectal prolapse. Surg Gynecol Obstet 174:145–148PubMedGoogle Scholar
  42. 42.
    Frykman HM, Goldberg SM (1969) The surgical management of rectal procidentia. Surg Gynecol Obstet 129:1225–1230PubMedGoogle Scholar
  43. 43.
    Stevenson AR, Stitz RW, Lumley JW (1998) Laparoscopic-assisted resection-rectopexy for rectal prolapse: early and medium follow-up. Dis Colon Rectum 41:46–54PubMedCrossRefGoogle Scholar
  44. 44.
    Carpelan-Holmström M, Kruna O, Scheinin T (2006) Laparoscopic rectal prolapse surgery combined with short hospital stay is safe in elderly and debilitated patients. Surg Endosc 20:1353–1359PubMedCrossRefGoogle Scholar
  45. 45.
    Boccasanta P, Venturi M, Barbieri S, Roviaro G (2006) Impact of new technologies on the clinical and functional outcome of Altemeier’s procedure: a randomized, controlled trial. Dis Colon Rectum 49:652–660PubMedCrossRefGoogle Scholar
  46. 46.
    Agachan F, Reissman P, Pfeifer J et al (1997) Comparison of three perineal procedures for the treatment of rectal prolapse. South Med J 90:925–932PubMedGoogle Scholar
  47. 47.
    Pascual Montero JA, Martinez Puente MC, Pascual I et al (2006) Complete rectal prolapse clinical and functional outcome with Delorme’s procedure. Rev Esp Enferm Dig 98:837–843PubMedCrossRefGoogle Scholar
  48. 48.
    Pescatori M, Interisano A, Stolfi VM, Zoffoli M (1998) Delorme’s operation and sphincteroplasty for rectal prolapse and faecal incontinence. Int J Colorect Dis 13:223–227CrossRefGoogle Scholar
  49. 49.
    Serventi A, Sallustio P, Lobascio P, Binda GA (2005) Role of levatorplasty in total rectal prolapse treatment using a perineal approach. II. Joint Meeting ECCP/EACP SICCR Congress. Bologna A:155–157Google Scholar
  50. 50.
    DiGiuro G, Ignatovic D, Brogger J, Bergamaschi R: Rectal Prolapse Recurrence Study Group (2006) How accurate are published recurrence rates after rectal prolapse surgery? A meta-analysis of individual patient data. Am J Surg 191:773–778PubMedCrossRefGoogle Scholar
  51. 51.
    Hool GR, Hull TL, Fazio VW (1997) Surgical treatment of recurrent complete rectal prolapse: a thirtyyear experience. Dis Colon Rectum 40:270–272PubMedCrossRefGoogle Scholar
  52. 52.
    Steele SR, Goetz LH, Minami S et al. (2006) Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum 49:440–445PubMedCrossRefGoogle Scholar
  53. 53.
    Raftopoulos Y, Senagore AG, DiGiuro G, Bergamaschi R: Rectal Prolapse Recurrence Study Group (2005) Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data. Dis Colon Rectum 48:1200–1206PubMedCrossRefGoogle Scholar
  54. 54.
    Fengler SA, Pearl RK, Prasad ML et al (1997) Management of recurrent rectal prolapse. Dis Colon Rectum 40:832–834PubMedCrossRefGoogle Scholar
  55. 55.
    Nicholls RJ (2005) Combined ECCP/EACP Meeting Bologna ItalyGoogle Scholar
  56. 56.
    Watts AM, Thompson MR (2000) Evaluation of Delorme’s procedure as a treatment for full-thickness rectal prolapse. Br J Surg 87:218–222PubMedCrossRefGoogle Scholar
  57. 57.
    Pikarsky AJ, Joo JS, Wexner SD et al (2000) Recurrent rectal prolapse: what is the next good option? Dis Colon Rectum 43:1273–1276PubMedCrossRefGoogle Scholar
  58. 58.
    Marceau C, Parc Y, Debroux E et al (2005) Complete rectal prolapse in young patients: psychiatric disease a risk factor of poor outcome. Colorectal Dis 7:360–365PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Andrew P. Zbar
    • 1
  • Hung Nguyen
    • 2
  1. 1.School of Clinical of Human Life SciencesUniversity of TasmaniaLauncestonAustralia
  2. 2.Department of SurgeryLaunceston General HospitalLauncestonAustralia

Personalised recommendations