Surgery is currently the only cure for rectal prolapse. Standardized preoperative evaluation and appropriate selection of surgical methods are crucial to the outcome of rectal prolapse surgery. With the development of a series of clinical studies in China and abroad, transabdominal surgery (such as ventral mesh fixation) and transperineal (anal) surgery (such as Altemeier surgery) have been widely recognized. Precise preoperative assessment of rectal prolapse and appropriate selection of surgical approaches has important clinical value in reducing postoperative recurrence rates and surgical-related complications. However, the current rectal prolapse assessment system needs to be improved, and the choice of surgical procedures remains controversal. To guide the diagnosis and surgical treatment of patients with rectal prolapse in China, nationwide specialists of colorectal and pelvic floor surgery have been organized by the of Chinese Medical Doctor Association Anorectal Branch, the Pelvic Floor Surgery Committee, and Clinical Guidelines Committee. Experts have conducted rounds of discussions on the core content of standardized diagnosis and surgical treatment for rectal prolapse, and jointly formulated the "Chinese expert consensus on the diagnosis and surgical treatment of rectal prolapse (2022)". We hope that this consensus will provide useful resources for the colorectal and pelvic floor surgeons, and promote the standardization of diagnosis and surgical treatment for the rectal prolapse in China.
Humans ; Rectal Prolapse/complications* ; Consensus ; East Asian People ; Treatment Outcome ; Colorectal Neoplasms/complications* ; Surgical Mesh/adverse effects*

Anal Canal/surgery* ; Anorectal Malformations ; Constriction ; Fecal Incontinence ; Humans ; Rectal Prolapse

PURPOSE: The laparoscopic rectopexy has become increasingly popular with verified stability, surgical route selection should be tailored to individual patient characteristics rather than operative risk. The perineal approach is useful in young male patients who need to preserve fertility. This study aimed to compare the characteristics of men and women who underwent Delorme-Thiersch procedures and analyze the postoperative outcomes of the perineal approach by sex. METHODS: We retrospectively reviewed the medical records of 293 patients who underwent Delorme-Thiersch operations in Seoul Song Do Colorectal Hospital between January 2011 and September 2017. Patient clinical characteristics and postoperative complications were analyzed by sex. We analyzed surgical outcomes with preoperative and 3-month postoperative incontinence questionnaires, constipation levels, and anal manometry. RESULTS: In this study, men with rectal prolapse were younger than women with the same condition. American Society of Anesthesiologists physical status classifications were higher in women and women had more L-spine X-ray and pudendal nerve terminal motor latency test abnormalities. Anorectal manometry pressures were higher in men. Men also had longer operation times and hospital stays and more postoperative complications (8 T ring infections, 6 patients with bleeding, 3 with strictures, 2 with severe pain, and 2 with rectal perforations). The recurrence rate was higher among women. CONCLUSION: Men with rectal prolapse were younger, healthier, and had relatively better anorectal function than women. The Delorme-Thiersch operation in men promoted lower recurrence rates and was advantageous in preserving the fertility of young patients, but the incidence of complications was also higher in men. Adequate counseling and preparation for the possibility of complications are needed.
Classification ; Constipation ; Constriction, Pathologic ; Counseling ; Female ; Fertility ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Male ; Manometry ; Medical Records ; Music ; Postoperative Complications ; Pudendal Nerve ; Rectal Prolapse ; Recurrence ; Retrospective Studies ; Seoul

PURPOSE: Despite the plethora of surgical options, there is no consensus regarding the best treatment for rectal prolapse. This study is aimed at evaluating our experience with its treatment and outcomes.METHODS: We retrospectively reviewed rectal prolapse patients' characteristics, clinical presentation, surgical procedure, average length of hospital stay, morbidity, mortality, and recurrence over a 10 year period at our institution.RESULTS: A total of 46 patients underwent rectal prolapse repair at our institution over a 10 year period. Of the 39 patients with primary rectal prolapse, 18 patients had an abdominal procedure, while 21 patients underwent a perineal approach. Operative duration was significantly longer in abdominal procedures, of which 16 cases were performed laparoscopically. Length of hospital stay and recurrence were not statistically significant between the 2 groups. In patients with recurrent rectal prolapse, more than 80% of the initial surgeries were done using the perineal approach. An abdominal approach was utilized in the management of 75% of recurrences.CONCLUSION: An abdominal repair may be preferable in the treatment of recurrent rectal prolapse. Minimally invasive techniques may be feasible and can provide a safe alternative to perineal procedures in elderly patients.
Aged ; Consensus ; Humans ; Length of Stay ; Mortality ; Prolapse ; Rectal Diseases ; Rectal Prolapse ; Rectum ; Recurrence ; Retrospective Studies

With the life span of the general population increased, rectal prolapse in elderly patients became a major concern in terms of the decision of the treatment modalities and quality of life of patients. Most elderly patients with rectal prolapse in the past received a perineal approach with the fear of general anesthetic complications rather than the abdominal approach. However, improvement in perioperative care in anesthesiology and minimally invasive surgery, the trend of surgical management of rectal prolapse is rapidly changing. Minimally invasive surgery including the laparoscopic and robotic surgeries showed comparable short-term outcomes even in elderly patients. Recently published guidelines also recommended a laparoscopic abdominal approach for the management of rectal prolapse.
Aged ; Anesthesiology ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Perioperative Care ; Quality of Life ; Rectal Prolapse

OBJECTIVE: To explore the application value of rectal prolapse constipation balloon in single auxiliary defecation. METHODS: Forty-one patients with moderate or severe rectocele were treated with a rectocele constipation balloon through the vagina. The defecography and VAS scores were compared before and after implantation. RESULTS: There was a significant difference between the anorectal angle, rectocele, and VAS scores before and after intervention in defecography (<0.01). CONCLUSIONS A single assisted defecation of the rectocelicular constipation balloon is feasible.
Constipation ; diagnosis ; Defecation ; Defecography ; instrumentation ; Female ; Humans ; Rectal Prolapse ; Rectocele

Chronic constipation is a polysymptomatic heterogeneous disorder with the incidence rising in many countries, and becomes a common disease affecting the quality of life and financial burden. In China surgical guideline, the primary constipation is divided into 3 types: slow transit constipation, outlet obstructive constipation, mixed constipation. The Rome IIII( criteria is usually referred to diagnosis, considering with clinical features and patient complaints. Through detail interrogation, physical examination and various detections, the secondary causes should be excluded, and etiological treatment is worth to try. Surgery is generally recommended as the second-line therapy, and finally only few patients require operation. There are still several controversies over the choice of surgical procedures and the mode of anastomosis in patients with slow transit constipation. Common surgical procedures include total colectomy with ileorectal anastomosis (TAC-IRA), subtotal colectomy with ileosigmoid anastomosis, ileorectal anastomosis or cecal-rectal anastomosis. Now laparoscopic operations have been widely applied to these patients, and have achieved good efficacy, and the application of robots is also under exploration. With the outlet obstructive constipation complicated pathogeny, the mechanisms currently involved include paradoxical puborectalis contraction, increased perineal descent, rectal intussusception, rectocele and rectal prolapse. In recent years, aiming at the above mechanisms, variety of surgical methods has been explored, including bilateral partial resection of puborectalis (PDPR) for paradoxical puborectalis contraction, rectal mucosa longitudinal plication plus sclerosing agent injection, procedure for prolapse and hemorrhoids (PPH), rectal mucosal resection and muscle plication procedure (Delorme), stapled transanal rectal resection (STARR) and laparoscopic ventral mesh rectopexy (LVR) etc for rectal prolapse. However, there is still no long-term large sample study to prove the advantages and disadvantages of these operations, so operative procedure should be chosen according to the actual situation of the patient. With the integration of the pathogenesis and the diversification of the treatment methods, the constipation still needs the precise treatment combined with multidisciplinary support in the future.
Anastomosis, Surgical ; China ; Constipation ; surgery ; Female ; Humans ; Male ; Quality of Life ; Rectal Prolapse ; surgery ; Rectocele ; Rectum ; Treatment Outcome

PURPOSE: Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients. METHODS: Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients’ satisfaction scores (0–10), and the occurrence of constipation. RESULTS: No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation. CONCLUSION: LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.
Constipation ; Fascia ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Male ; Manometry ; Methods ; Patient Satisfaction ; Polypropylenes ; Postoperative Complications ; Rectal Prolapse* ; Recurrence ; Retrospective Studies ; Sepsis ; Sutures

Magnetic resonance imaging is the optimal modality for pelvic imaging. It is based on T2-weighted magnetic resonance (MR) sequences allowing uterine and vaginal cavity assessment as well as rectal evaluation. Anatomical depiction of these structures may benefit from distension, and conditions either developing inside the lumen of cavities or coming from the outside may then be better delineated and localized. The need for distension, either rectal or vaginal, and the way to conduct it are matters of debate, depending on indication for which the MR examination is being conducted. In this review, we discuss advantages and potential drawbacks of this technique, based on literature and our experience, in the evaluation of various gynecological and rectal diseases.
Magnetic Resonance Imaging* ; Pelvic Organ Prolapse ; Rectal Diseases

Anorectal disorders are common and present with overlapping symptoms. They include several disorders with both structural and functional dysfunction(s). Because symptoms alone are poor predictors of the underlying pathophysiology, a diagnosis should only be made after evaluating symptoms and physiologic and structural abnormalities. A detailed history, a thorough physical and digital rectal examination and a systematic evaluation with high resolution and/or high definition three-dimensional (3D) anorectal manometry, 3D anal ultrasonography, magnetic resonance defecography and neurophysiology tests are essential to correctly identify these conditions. These physiological and imaging tests play a key role in facilitating a precise diagnosis and in providing a better understanding of the pathophysiology and functional anatomy. In turn, this leads to better and more comprehensive management using medical, behavioral and surgical approaches. For example, patients presenting with difficult defecation may demonstrate dyssynergic defecation and will benefit from biofeedback therapy before considering surgical treatment of coexisting anomalies such as rectoceles or intussusception. Similarly, patients with significant rectal prolapse and pelvic floor dysfunction or patients with complex enteroceles and pelvic organ prolapse may benefit from combined behavioral and surgical approaches, including an open, laparoscopic, transabdominal or transanal, and/or robotic-assisted surgery. Here, we provide an update on the pathophysiology, diagnosis, and management of selected common anorectal disorders.
Biofeedback, Psychology ; Constipation ; Defecation ; Defecography ; Diagnosis ; Digital Rectal Examination ; Humans ; Intussusception ; Manometry ; Neurophysiology ; Pelvic Floor ; Pelvic Organ Prolapse ; Rectal Diseases ; Rectal Prolapse ; Rectocele ; Ultrasonography