Rectal prolapse. Surgical techniques

The varied operative procedures available for the treatment of rectal prolapse can be confusing. Most of the maneuvers are relatively esoteric and can be performed successfully only by the few surgeons who have developed the specialized techniques. It is recommended, therefore, that the surgeon who is less experienced with rectal prolapse adopt one of the standard operations. A rectopexy or suspension procedure without resection can be performed safely with good results, low morbidity, and a low mortality rate. Anterior resection with or without sacral fixation, an operation familiar to most surgeons, also offers an excellent cure rate. The Thiersch-type approach should probably be reserved for those patients who cannot tolerate laparotomy. The material chosen should be one of the commercially available synthetic products; wire should not be used. The Silastic-impregnated Dacron prosthesis for this operation has some potential benefit, especially for the incontinent patient. Results of further studies are awaited.