Rectal prolapse: which operation for the best function?

Clinical Case

The pathogenesis of rectal prolapse is ill-understood . So far the curative treatment of rectal prolapse is exclusively surgical , but there is no consensus on the best surgical procedure . Surgery may be abdominal or perineal , with most abdominal procedures being rectopexies from the rectum to the sacrum with or without a colon resection. The most widely used perineal operations are Delorme’s procedure and Altemeier’s procedure. Despite the interest of the surgical community in adopting a standard approach to rectal prolapse, trials such as the PROSPER Trial have failed to demonstrate differences between the three operations. Soren Laurberg, Professor of Surgery at Aarhus University Hospital in Denmark, explains the current evidence on rectal prolapse treatment and the functional outcomes associated with each procedure. He highlights the lack of differences in the trials performed to date between the abdominal and perineal approaches and even between different types of rectopexy in the abdominal approach (ventral mesh rectopexy vs. posterior sutured rectopexy).