Rectal prolapse: information and rectal prolapse specialists

Rectal prolapse, also known as rectal prolapse, is a protrusion of the rectum downwards towards the anal canal or through the anal canal. Many different techniques are available for rectal prolapse surgery. Several scientific studies have confirmed the effectiveness and safety of laparoscopic resection rectopexy. Here you will find further information as well as selected rectal prolapse specialists and centers.

What is rectal prolapse?

The rectum, also known as the rectum, is part of the rectum. It leads from the colon to the anal canal and thus to the anus.

Rectal prolapse is also known as rectal prolapse. It is characterized by the telescopic protrusion of the rectum downwards towards the anal canal.

Overview of the sections of the bowel © FGWDesign | AdobeStock

Different degrees of severity can be distinguished:

• the incipient, partial rectal prolapse (grade I),
• internal recumprolapse, which, like grade I, cannot be recognized from the outside (grade II) and
• complete prolapse that protrudes outwards (grade III).

The latter often occurs during the pushing process during bowel movements.

Women are affected in over 90% of cases, with the frequency of the disease increasing with age.

The symptoms associated with rectal prolapse are varied:

• Itching,
• mucus secretion,
• foreign body sensation,
• impression of incomplete bowel evacuation after a bowel movement,
• disturbance of continence and
• chronic constipation

can, individually or in combination, considerably restrict the quality of life of those affected.

Numerous anatomical changes are associated with rectal prolapse. Ultimately, it is not clear what are accompanying symptoms and what are causal changes.

Among other things, there is

• a sagging of the pelvic floor,
• a stretching of the sphincter muscles,
• a loosening of the connective tissue suspension of the rectum and
• a relative lengthening of the upper sections of the colon.

Various surgical techniques for rectal prolapse

Over the last few decades, more than 100 variations of surgical procedures have been performed for the treatment of rectal prolapse.

The different surgical techniques can be divided into the following main categories:

1. Surgery starting from the pelvic floor / anus (perineal surgery) or surgery through the abdomen (abdominal surgery)
2. Open, conventional surgery or keyhole surgery (laparoscopic / minimally invasive)
3. Operations with or without fixation of the rectum (with / without pexy)
4. Operations with or without removal of the excess colon (resecting / non-resecting operations)

Due to the current study situation, it has not yet been possible to establish a general guideline for the choice of procedure.

Nevertheless, it can be stated that operations starting from the pelvic floor / anus are somewhat gentler. They are also associated with slightly lower complication rates. However, in comparison with operations through the abdominal cavity, the symptoms are not treated as effectively in the long term.

We therefore recommend perineal surgery for

• Patients of a very advanced age and
• Patients with significant secondary diseases that represent a high risk for a more extensive operation.

However, minimally invasive surgery is increasingly taking the aspect of gentle surgery into account.

Centers with a focus on minimally invasive surgery can therefore offer laparoscopic resection rectopexy to the majority of patients. This involves using a minimally invasive technique through the abdominal cavity

• the excess bowel is removed,
• the continuity of the bowel is restored with the help of a stapler,
• the pelvic floor is lifted and
• the rectum is fixed in its original position using a suture.

Other surgical procedures involve fixation with plastic mesh. However, this involves additional risks and does not favor the functional results.

Possible complications and risks of laparoscopic resection rectopexy

Every operation generally involves risks, such as wound healing disorders and others. In addition, the (very rare) leakage of the intestinal suture (anastomotic insufficiency) should be mentioned in particular. This can result in the complication of peritonitis.

Patients can get up again on the day of the operation © rocketclips | AdobeStock

Before and after the operation

The operation is performed under general anesthesia. It takes between 90 and 150 minutes.

Patients can and should get up on the day of the operation and can leave the clinic after five to six days.

A significant improvement in a previously existing bowel evacuation disorder usually occurs very quickly and in around 70% of cases. However, pre-existing incontinence usually only improves over the course of the following months. (Biofeedback)

The success rate for incontinence is also around 70 %.

Conclusion on laparoscopic resection rectopexy

Several scientific studies support the effectiveness and safety of laparoscopic resection rectopexy.