Rectal prolapse and sphincter operations

The surgical management of rectal prolapse and sphincter injuries is complex. These conditions are benign and generally not life-threatening; however they significantly impact on patients’ quality of life. A large number of operations have been described, but often without thorough follow-up or clearly defined outcomes. The challenge for the surgeon is to balance the patient’s symptom severity and quality of life against the risks of surgery, which include making the anal incontinence worse and recurrence of the prolapse.Neuromodulation with sacral nerve stimulation provides good symptom control in up to 75% of selected patients with anal incontinence irrespective of whether there is a sphincter defect or not. Full thickness rectal prolapse is traditionally treated with a perineal operation such as a Delorme’s procedure, but this is associated with a high recurrence rate. Laparoscopic ventral mesh rectopexy is increasingly used to treat rectal prolapse even in the elderly.