Suture Rectopexy and Ventral Mesh Rectopexy

Introduction

Full-thickness external rectal prolapse is herniation of the rectum through the anal orifice. More commonly seen in older women, rectal prolapse can occur in both genders and even at a young age. The underlying mechanism of rectal prolapse is poorly understood. However, a mid-to-low rectal intussusception is thought to be the initiating step. Chronic straining is also thought to be a precipitating factor.

The goals of surgical repair are to fix the prolapsed rectum with a durable repair to minimize recurrence while maintaining or improving continence and bowel function. More than 100 surgical procedures have been proposed for the surgical management of rectal prolapse, indicating that an optimal operation has not been defined. The majority of these encompass several concepts that can be undertaken via a transabdominal or transperineal approach. The choice depends on the surgeon’s experience and training, as well as his or her understanding of the anatomic defect, patient condition, and fitness for the operation. These options include the following:

• Narrowing the patulous anus

• Restoration of the pelvic floor

• Obliteration of the peritoneal pouch of Douglas

• Bowel resection by an abdominal or perineal approach

• Fixation and/or suspension of the rectum to the sacrum

• A combination of these modalities

This chapter focuses on suture and ventral mesh rectopexy, because they are two of the more commonly used procedures in management of full-thickness prolapse.