Therapie des Rektumprolapses

Complete rectal prolapse is a full-thickness intussusception of the rectum through the anal canal. Diagnosis is ascertained by clinical presentation and leads to surgical treatment. Treatment of rectal prolapse can be categorized into perineal and abdominal procedures. Today, abdominal access is usually performed laparoscopically. The most common perineal surgical procedures are the Delorme operation (sutured plication of the muscle after mucosal resection), rectosigmoidectomy (Altemeier), and perineal rectopexy. For abdominal techniques, there is the option of combining rectopexy with a resection of the redundant or diverticula bearing colon sigmoideum. Perineal procedures are characterized by reduced narcosis risk – thus they appear ideal for elderly patients with high comorbidity. Although there is a lack of well-conducted randomized trials that compare perineal and abdominal procedures, abdominal treatment seems to be superior in the aspect of recurrence. An abdominal approach should be the first treatment option for suitable patients.