Surgical therapy for rectal prolapse: Advantages and limits of proctopexy using an abdominal route

In the surgical treatment of prolapse proctopexies using an abdominal route and synthetic mesh appear to represent the most effective type of surgery. Various techniques can be used, all with similar results: in particular, it is worth emphasising the low operating risk even in elderly patients, the small number of recurrences, and the improved continence reported in many cases. The authors discuss whether the mobilisation of the rectum as far as the levators ani, a stage which precedes the plasty, should be circumferential or limited to the posterior wall in order to avoid nerve lesions. Although specific complications are limited in overall terms (in particular the risk of sepsis), the occurrence of a considerable numer of alterations of the alvus, ranging from persistent stipsis to real occlusion, are worth noting in the postoperative period. These may be explained by the formation of a convoluted sigmoid loop and damage to nerve fibres in the autonomous system. Alternative operations such as simple presacral proctopexy associated with sigmoid resection or surgery using a perineal route (e.g. Delorme's technique) are therefore used and should not only be reserved for those patients in generally poor conditions. Moreover, these techniques are often not simple and a much higher number of recurrences are reported compared to abdominal proctopexy.