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2016 ; 29
(3
): 271-6
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English Wikipedia
Optimizing Treatment for Rectal Prolapse
#MMPMID27582654
Hrabe J
; Gurland B
Clin Colon Rectal Surg
2016[Sep]; 29
(3
): 271-6
PMID27582654
show ga
Rectal prolapse is associated with debilitating symptoms and leads to both
functional impairment and anatomic distortion. Symptoms include rectal bulge,
mucous drainage, bleeding, incontinence, constipation, tenesmus, as well as
discomfort, pressure, and pain. The only cure is surgical. The optimal surgical
repair is not yet defined though laparoscopic rectopexy with mesh is emerging as
a more durable approach. The chosen approach should be individually tailored,
taking into account factors such as presence of pelvic floor defects and
coexistence of vaginal prolapse, severe constipation, surgical fitness, and
whether the patient has had a previous prolapse procedure. Consideration of a
multidisciplinary approach is critical in patients with concomitant vaginal
prolapse. Surgeons must weigh their familiarity with each approach and should
have in their armamentarium both perineal and abdominal approaches. Previous
barriers to abdominal procedures, such as age and comorbidities, are waning as
minimally invasive approaches have gained acceptance. Laparoscopic ventral
rectopexy is one such approach offering relatively low morbidity, low recurrence
rates, and good functional improvement. However, proficiency with this procedure
may require advanced training. Robotic rectopexy is another burgeoning approach
which facilitates suturing in the pelvis. Successful rectal prolapse surgeries
improve function and have low recurrence rates, though it is important to note
that correcting the prolapse does not assure functional improvement.