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 Printable version |
Surgical treatment of complete rectal prolapse |
Hépato-Gastro. Volume 15, Number 6, 441-8, Novembre-Décembre 2008, Mini-revue
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 Résumé
Article gratuit
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Author(s) : Jean-Luc Faucheron, Irene Morra, David Voirin, Walter Moreno |
Summary : For complete rectal prolapse to occur, several conditions have to be met: hyperlax and vertical rectum, long and mobile sigmoid colon, hypotonic anal sphincter, weak pelvic floor and deep Douglas pouch. It may be constitutional or acquired, in particular after intense and prolonged episods of abdominal straining. Disease progression is marked by repeated episods of rectal prolapse, pain, fecal incontinence, rectal ulcer, bleeding and finally strangulation and necrosis. Surgical intervention is thus recommended. There are two transperineal procedures: Delorme operation involves separation of the mucosa from the sphincter and the muscularis propria with plication of the muscularis propria above the pelvic floor and final suturing of the mucosa. Altemeier operation involves excision of the prolapse and mesorectum, achieving a full-thickness excision of the rectum, followed by coloanal anastomosis. The major set back of these perineal procedures is a 30% rate of early relapse. Abdominal procedures have been favored since the advent of laparoscopic surgery: they involve Douglas pouch resection and moderate rectum mobilization with posterior mesh rectopexy. Absence of resection means that incisions are small and associated with a lack of significant parietal or intraperitoneal morbidity. Pain is minimal, hospital stay is short and relapse rate is below 5%. |
Keywords : rectal prolapsus, rectum, Douglas pouch |
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