This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Current diagnostic tools and treatment modalities for rectal prolapse
Mustafa Oruc, Timucin Erol
Mustafa Oruc, Timucin Erol, Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
Author contributions: Oruc M designed the report, drafted the manuscript, and reviewed the literature; Erol T designed the report, drafted the manuscript, supervised manuscript writing, and provided surgical examples.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Timucin Erol, MD, Associate Professor, Department of General Surgery, Hacettepe University School of Medicine, Sıhhiye, Ankara 06100, Turkey. firstname.lastname@example.org
Received: January 31, 2023 Peer-review started: January 31, 2023 First decision: March 14, 2023 Revised: March 31, 2023 Accepted: April 25, 2023 Article in press: April 25, 2023 Published online: June 6, 2023
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.
Core Tip: Patients with rectal prolapse should be subjected to detailed history taking, thorough physical examinations, and assessments with appropriate scoring systems before deciding to proceed with surgical intervention. The aim of surgery is an anatomical correction to obtain optimal functional outcomes. Magnetic resonance defecography is beneficial for understanding both functional and anatomical pathologies. To date, robotic and laparoscopic ventral mesh rectopexies are the most commonly performed surgeries and achieve better functional and anatomical outcomes than other surgical alternatives.