Rectal prolapse is a full thickness protrusion of the rectum through the anal sphincters. The treatment is surgical repair; whether a perineal or a transabdominal repair is indicated depends mainly on the patient's medical condition (Figure 91-2). The laparoscopic technique consists of mobilization of the rectum in the presacral space to the levator ani and direct suture of the lateral rectal attachments to the presacral fascia. Because division of the lateral stalks decrease the recurrence rate but increase postoperative constipation, we perform a full posterior and anterior mobilization but only divide the upper half of the lateral stalks. Other fixation procedures which use mesh to fix the rectum to the presacral fascia have been advocated; however, we prefer to avoid using foreign material in the pelvis. The abdominal approach has lower recurrence rates with slightly higher morbidity compared with the perineal approach. Regarding the perineal techniques, in a previous report from our institution comparing Delorme procedure and perineal rectosigmoidectomy with and without leva-torplasty, the recurrence rate was statistically significantly different at 27.5%, 12.5% and 4%, respectively (Agachan et al, 1997).
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