Management of rectal prolapse: The role of laparoscopic approaches

Rectal prolapse has a profound effect on quality of life and has been associated with a multitude of surgical treatment options since its original description. It is defined as a full-thickness protrusion of the rectal wall through the anal sphincter. Clinical management is confounded by the fact that whereas 75% of patients with rectal prolapse experience problems with anal incontinence, 25-50% will have significant constipation [1]-[4]. Symptoms of anal incontinence may be due to acquired changes in bowel motility or a reduction in resting anal pressure as a result of continual activation of rectoanal inhibition-7]. Constipation in patients with rectal prolapse may be a consequence of slow colonic transit or an increase in external anal sphincter contractions 4, 8. These symptoms have a significant influence on the choice of operative approach in the treatment of rectal prolapse. However, due to the variable results of operative approaches, it is unclear whether optimal treatment can be selected based on preoperative physiologic testing.