Advertisement

Treatment of Internal Rectal Prolapse by Rectopexy

  • Hugh M. Paterson
  • David C. C. Bartolo

Abstract

Internal rectal prolapse (IRP), also known as rectoanal intussusception, occult rectal prolapse or incomplete rectal prolapse, may be described as a full-thickness circumferential infolding arising from the midrectum during straining at defecation and which does not extend beyond the anal canal. However, a consensus clinical definition is lacking, and this makes interpretation of the surgical literature confusing. Most reports are single-unit studies with small numbers accrued over relatively long time periods. A number of procedures have been performed using inconsistent patient selection criteria, and there are no randomised trials. Many authors emphasise conservative therapy as the first line of management in most patients, but we feel that there are good indications for surgery in certain patients: the key is in careful patient selection. What follows is an account of the published results of surgery for IRP, concluding with our own approach to patient selection and operative technique.

Keywords

Rectal Prolapse Internal Anal Sphincter Obstructive Defecation Syndrome Rectal Intussusception Solitary Rectal Ulcer Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Shorvon PJ, McHugh S, Diamant NE et al (1989) Defecography in normal volunteers: results and implications. Gut 30(12):1737–1749PubMedCrossRefGoogle Scholar
  2. 2.
    Metcalf AM, Loening-Baucke V (1988) Anorectal function and defecation dynamics in patients with rectal prolapse. Am J Surg 155(2):206–210PubMedCrossRefGoogle Scholar
  3. 3.
    Berman IR, Manning DH, Dudley-Wright K (1985) Anatomic specificity in the diagnosis and treatment of internal rectal prolapse. Dis Colon Rectum 28(11):816–826PubMedCrossRefGoogle Scholar
  4. 4.
    Fleshman JW, Kodner IJ, Fry RD (1989) Internal intussusception of the rectum: a changing perspective. Neth J Surg 41(6):145–148PubMedGoogle Scholar
  5. 5.
    Mellgren A, Schultz I, Johansson C, Dolk A (1997) Internal rectal intussusception seldom develops into total rectal prolapse. Dis Colon Rectum 40(7):817–820PubMedCrossRefGoogle Scholar
  6. 6.
    Choi JS, Hwang YH, Salum MR et al (2001) Outcome and management of patients with large rectoanal intussusception. Am J Gastroenterol 96(3):740–744PubMedCrossRefGoogle Scholar
  7. 7.
    Bartram CI, Turnbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 13(1):72–80PubMedCrossRefGoogle Scholar
  8. 8.
    Dvorkin LS, Gladman MA, Epstein J et al (2005) Rectal intussusception in symptomatic patients is different from that in asymptomatic volunteers. Br J Surg 92(7):866–672PubMedCrossRefGoogle Scholar
  9. 9.
    Tsiaoussis J, Chrysos E, Athanasakis E et al (2005) Rectoanal intussusception: presentation of the disorder and late results of resection rectopexy. Dis Colon Rectum 48(4):838–844PubMedCrossRefGoogle Scholar
  10. 10.
    Sarles JC, Arnaud A, Joly A, Sielezneff I (1991) La procidence interne du rectum. Possibilites therapeutiques, a propos de 47 patients. Gastroenterol Clin Biol 15:124–129Google Scholar
  11. 11.
    Hoffman MJ, Kodner IJ, Fry RD (1984) Internal intussusception of the rectum. Diagnosis and surgical management. Dis Colon Rectum 27(7):435–441PubMedCrossRefGoogle Scholar
  12. 12.
    Ihre T, Seligson U (1975) Intussusception of the rectum-internal procidentia: treatment and results in 90 patients. Dis Colon Rectum 18(5):391–396PubMedCrossRefGoogle Scholar
  13. 13.
    Dvorkin LS, Hetzer F, Scott SM et al (2004) Open-magnet MR defaecography compared with evacuation proctography in the diagnosis and management of patients with rectal intussusception. Colorectal Dis 6(1):45–53PubMedCrossRefGoogle Scholar
  14. 14.
    Christiansen J, Zhu BW, Rasmussen OO, Sorensen M (1992) Internal rectal intussusception: results of surgical repair. Dis Colon Rectum 35(11):1026–1028; discussion 1028–1029PubMedCrossRefGoogle Scholar
  15. 15.
    Pescatori M, Spyrou M, Pulvirenti d’Urso A (2006) A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis 8(9):785–789PubMedCrossRefGoogle Scholar
  16. 16.
    Farouk R, Duthie GS, Bartolo DC, MacGregor AB (1992) Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram. Br J Surg 79(5):439–440PubMedCrossRefGoogle Scholar
  17. 17.
    Duthie GS, Bartolo DC (1992) Abdominal rectopexy for rectal prolapse: a comparison of techniques. Br J Surg 79(2):107–113PubMedCrossRefGoogle Scholar
  18. 18.
    Schultz I, Mellgren A, Dolk A et al (1996) Continence is improved after the Ripstein rectopexy. Different mechanisms in rectal prolapse and rectal intussusception? Dis Colon Rectum 39(3):300–306PubMedCrossRefGoogle Scholar
  19. 19.
    Dvorkin LS, Gladman MA, Scott SM et al (2005) Rectal intussusception: a study of rectal biomechanics and visceroperception. Am J Gastroenterol 100(7):1578–1585PubMedCrossRefGoogle Scholar
  20. 20.
    Marshall M, Halligan S, Fotheringham T et al (2002) Predictive value of internal anal sphincter thickness for diagnosis of rectal intussusception in patients with solitary rectal ulcer syndrome. Br J Surg 89(10): 1281–1285PubMedCrossRefGoogle Scholar
  21. 21.
    Mellgren A, Bremmer S, Johansson C et al (1994) Defecography. Results of investigations in 2,816 patients. Dis Colon Rectum 37(11):1133–1141PubMedCrossRefGoogle Scholar
  22. 22.
    Dippolito A, Esser S, Reed J 3rd (2005) Anterior modification of Delorme procedure provides equivalent results to Delorme procedure in treatment of rectal outlet obstruction. Curr Surg 62(6):609–612PubMedCrossRefGoogle Scholar
  23. 23.
    Liberman H, Hughes C, Dippolito A (2000) Evaluation and outcome of the delorme procedure in the treatment of rectal outlet obstruction. Dis Colon Rectum 43(2):188–192PubMedCrossRefGoogle Scholar
  24. 24.
    Sielezneff I, Malouf A, Cesari J et al (1999) Selection criteria for internal rectal prolapse repair by Delorme’s transrectal excision. Dis Colon Rectum 42(3):367–373PubMedCrossRefGoogle Scholar
  25. 25.
    Berman IR, Harris MS, Rabeler MB (1990) Delorme’s transrectal excision for internal rectal prolapse. Patient selection, technique, and three-year follow-up. Dis Colon Rectum 33(7):573–780PubMedCrossRefGoogle Scholar
  26. 26.
    Christiansen J, Hesselfeldt P, Sorensen M (1995) Treatment of internal rectal intussusception in patients with chronic constipation. Scand J Gastroenterol 30(5):470–472PubMedCrossRefGoogle Scholar
  27. 27.
    Schultz I, Mellgren A, Dolk A et al (2000) Long-term results and functional outcome after Ripstein rectopexy. Dis Colon Rectum 43(1):35–43PubMedCrossRefGoogle Scholar
  28. 28.
    Brown AJ, Anderson JH, McKee RF, Finlay IG (2004) Surgery for occult rectal prolapse. Colorectal Dis 6(3):176–179PubMedCrossRefGoogle Scholar
  29. 29.
    McCue JL, Thomson JP (1990) Rectopexy for internal rectal intussusception. Br J Surg 77(6):632–634PubMedCrossRefGoogle Scholar
  30. 30.
    Scaglia M, Delaini GG, Ribero F et al (1993) Occult rectal prolapse: functional results after rectopexy. Chir Ital 45(1–6):183–188PubMedGoogle Scholar
  31. 31.
    Gemsenjager E (1996) [Internal rectal prolapse: therapy outcome and current status]. Schweiz Med Wochenschr 126(33):1377–1384PubMedGoogle Scholar
  32. 32.
    von Papen M, Ashari LH, Lumley JW et al (2007) Functional results of laparoscopic resection rectopexy for symptomatic rectal intussusception. Dis Colon Rectum 50(1):50–55CrossRefGoogle Scholar
  33. 33.
    Briel JW, Schouten WR, Boerma MO (1997) Longterm results of suture rectopexy in patients with fecal incontinence associated with incomplete rectal prolapse. Dis Colon Rectum 40(10):1228–1232PubMedCrossRefGoogle Scholar
  34. 34.
    van Tets WF, Kuijpers JH (1995) Internal rectal intussusception-fact or fancy? Dis Colon Rectum 38(10):1080–1083PubMedCrossRefGoogle Scholar
  35. 35.
    Boccasanta P, Venturi M, Salamina G et al (2004) New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis 19(4):359–369PubMedCrossRefGoogle Scholar
  36. 36.
    Boccasanta P, Venturi M, Stuto A et al (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47(8):1285–1296; discussion 1296–1297PubMedCrossRefGoogle Scholar
  37. 37.
    Arroyo A, Perez-Vicente F, Serrano P et al (2007) Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome. J Am Coll Surg 204(1):56–63PubMedCrossRefGoogle Scholar
  38. 38.
    Ommer A, Albrecht K, Wenger F, Walz MK (2006) Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome. Langenbecks Arch Surg 391:32–37PubMedCrossRefGoogle Scholar
  39. 39.
    Pechlivanides G, Tsiaoussis J, Athanasakis E et al (2007) Stapled transanal rectal resection (Starr) to reverse the anatomic disorders of pelvic floor dyssynergia. World J Surg 31(6):1329–1335PubMedCrossRefGoogle Scholar
  40. 40.
    Dodi G, Pietroletti R, Milito G et al (2003) Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol 7(3):148–153PubMedCrossRefGoogle Scholar
  41. 41.
    Bassi R, Rademacher J, Savoia A (2006) Rectovaginal fistula after STARR procedure complicated by haematoma of the posterior vaginal wall: report of a case. Tech Coloproctol 10(4):361–363PubMedCrossRefGoogle Scholar
  42. 42.
    Jayne DG, Finan PJ (2005) Stapled transanal rectal resection for obstructed defaecation and evidence-based practice. Br J Surg 92(7):793–794PubMedCrossRefGoogle Scholar
  43. 43.
    Corman ML, Carriero A, Hager T et al (2006) Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis 8(2):98–101PubMedCrossRefGoogle Scholar
  44. 44.
    Dench JE, Scott SM, Lunniss PJ et al (2006) Multimedia article: external pelvic rectal suspension (the express procedure) for internal rectal prolapse, with or without concomitant rectocele repair: a video demonstration. Dis Colon Rectum 49(12):1922–1926PubMedCrossRefGoogle Scholar
  45. 45.
    Williams NS, Dvorkin LS, Giordano P et al (2005) External Pelvic Rectal Suspension (Express procedure) for rectal intussusception, with and without rectocele repair. Br J Surg 92(5):598–604PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Hugh M. Paterson
    • 1
  • David C. C. Bartolo
    • 2
  1. 1.Department of Colorectal SurgeryWestern General HospitalEdinburghUK
  2. 2.Western General HospitalEdinburghUK

Personalised recommendations