Treatment of Rectal Prolapse

Publication Date: November 1, 2017

Recommendations

Evaluation of Rectal Prolapse

The initial evaluation of a patient with rectal prolapse should include a complete history and physical examination with focus on the prolapse, on anal sphincter structure and function, and on concomitant symptoms and underlying conditions. (1C)
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Additional testing, such as a fluoroscopy or MRI defecography, colonoscopy, barium enema, and urodynamics, may be used selectively to refine the diagnosis and identify other important coexisting pathology. (1B)
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Anal physiologic testing may be considered to assess and treat coexisting functional disorders associated with rectal prolapse, such as constipation or fecal incontinence. (2C)
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Nonoperative Management

Rectal prolapse cannot be corrected nonoperatively, although some of the symptoms associated with this condition, such as fecal incontinence, pain, and constipation, can be palliated medically. (2C)
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Operations for Rectal Prolapse

Abdominal Procedures for Rectal Prolapse

In patients with acceptable risk, the procedure of choice for the treatment of rectal prolapse should typically incorporate transabdominal rectal fixation. (2B)
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There is insufficient evidence to argue that posterior rectal prolapse repairs, such as suture rectopexy or resection with suture rectopexy, are better or worse than anterior rectal prolapse repairs, such as ventral mesh rectopexy. (1C)
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Posterior Rectal Dissection Techniques to Repair Rectal Prolapse

Posterior rectal mobilization without a rectopexy (with or without a concomitant anterior resection) is associated with higher recurrence rates and complications and is typically not recommended.

(1B)
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Posterior Suture Rectopexy With and Without Sigmoid Resection

Rectopexy is a key component in the abdominal approach to rectal prolapse. (1A)
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Sigmoid resection may be added to posterior suture rectopexy in patients with prolapse and preoperative constipation. (1B)
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Division of the lateral stalks during posterior rectal dissection may worsen postoperative constipation but is associated with decreased recurrence rates. (2B)
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Posterior Mesh Rectopexy

Posterior mobilization of rectum with mesh fixation of the anterior rectal wall to the sacral promontory may be used for treatment of rectal prolapse but is associated with higher morbidity. (1C)
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A modified Wells procedure using a variety of foreign materials for posterior fixation of the rectum may be used for treatment of rectal prolapse. (2B)
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Anterior Rectal Dissection Techniques to Repair Rectal Prolapse

Ventral Rectopexy
Ventral mesh rectopexy offers an alternative approach to the repair of rectal prolapse with acceptable short- and long-term complication rates. (1C)
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Additional Abdominal Surgery Considerations

A minimally invasive approach to rectal prolapse by experienced surgeons is associated with improved morbidity and comparable recurrences compared with open surgery and should be considered when technically feasible. (1B)
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Perineal Operations for Rectal Prolapse

Patients with a short segment of full-thickness rectal prolapse can be treated with mucosal sleeve resection. (1C)
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Rectal prolapse may be treated with a perineal rectosigmoidectomy. (1C)
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Recommendation Grading

Disclaimer

Overview

Title

Treatment of Rectal Prolapse

Authoring Organization

Publication Month/Year

November 1, 2017

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D012005 - Rectal Prolapse, D011391 - Prolapse

Keywords

colorectal, Rectal Prolapse, Rectopexy

Source Citation

Bordeianou, Liliana M.D., M.P.H.; Paquette, Ian M.D.; Johnson, Eric M.D.; Holubar, Stefan D. M.D.; Gaertner, Wolfgang M.D.; Feingold, Daniel L. M.D.; Steele, Scott R. M.D. Clinical Practice Guidelines for the Treatment of Rectal Prolapse, Diseases of the Colon & Rectum: November 2017 - Volume 60 - Issue 11 - p 1121-1131 doi: 10.1097/DCR.0000000000000889
 

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
104
Literature Search Start Date
October 1, 2011
Literature Search End Date
December 1, 2016