Perineal Approaches to the Treatment of Rectal Prolapse

Rectal prolapse is a disabling and socially isolating surgical disease that frequently strikes elderly individuals with multiple risk factors for surgical intervention. Numerous operations have been designed to correct prolapse. In choosing an approach, the surgeon must balance the medical condition of his patient against the likelihood of an effective and durable repair. Operations for rectal prolapse are divided into abdominal and perineal approaches, with the former being traditionally perceived as more morbid but more enduring, and the latter as less invasive but more prone to recurrence. These perceptions are based on observational studies and there continues to be a lack of randomized data comparing the 2 approaches in terms of morbidity, efficacy, and functional outcome. Furthermore, as new surgical tools and techniques-such as bioprosthetic materials and minimally invasive surgery-are employed, the optimal surgery for rectal prolapse remains a matter for debate.