Surgery for Complete Rectal Prolapse in Adults - A Historical Perspective and How to Select an Appropriate Procedure -

概要

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Many surgical procedures are available for rectal prolapse, but it is still unknown which procedure is the best. Therefore, the procedure is decided depending on the conditions and request of patients as well as the experience and preference of surgeons. According to the best available evidence, abdominal rectopexy is recommended if patients are fit enough, and the laparoscopic approach is superior to open surgery if techniques are good enough. For rectopexy, lateral ligaments might as well be preserved, and a mesh does not need to be utilized. Sigmoidectomy may be added in patients with preoperative constipation, but it is not necessary in those without. Patients who are not candidates for rectopexy may be treated with perineal approaches including Delorme, Altemeier and Gant-Miwa (-Thiersch).<BR>However, such strategy is based on the policy that the lowest recurrence rate has the highest priority. We must remember that rectal prolapse is a benign condition and its “recurrence” does not necessarily mean the end of the world. Based on this concept, perineal approaches can be chosen even if patients are fit enough. In order to substantiate these statements, this paper conducts a historical review of surgery for rectal prolapse, and discusses how to select an appropriate procedure.