Surgery For Rectal Prolapse

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Rectal prolapse is an uncommon condition defined as complete protrusion of the entire thickness of the rectal wall through the anus. It is seen far more commonly in women than in men and generally after the age of 40 (15). Pathologic defects noted are a diastasis of the levator ani muscles, an abnormally deep cul de sac, an elongated sigmoid colon, and loss of the rectal fixation to the sacrum. Prolapse can secondarily result in incontinence caused by a patulous anus. Numerous procedures have been described for correction of rectal prolapse, including both abdominal and perineal approaches. Neither approach requires specialized facilities and the choice of approach is generally determined by patient risk factors. One of the most common abdominal operations employed is the Ripstein procedure. It is indicated for the repair of complete rectal prolapse in a patient considered being an acceptable risk for abdominal surgery. Contraindications include an excessively redundant sigmoid colon in a patient with high risk for postoperative mortality and morbidity from an abdominal procedure.

Ripstein Operation
Fig. 3. Ripstein procedure for rectal prolapse. A 5-cm band of synthetic plastic mesh is then sutured to the sacrum with nonabsorbable sutures. The rectum is then pulled out of the pelvis, and the mesh is sutured to the rectum in a fully encircling.

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