Robotic ventral mesh rectopexy for rectal prolapse: a few years until this becomes the gold standard

Excerpt

Several procedures have been described to treat rectal prolapse. The aims of the surgical treatment are to correct the anatomical abnormality, to cure the accompanying symptoms such as incontinence, mucus discharge, bleeding, constipation, and pain, with the lowest rate of complications as possible, an acceptable rate of recurrence, at the lowest possible cost. These goals can be best achieved by ventral rectopexy to the promontory, so that this procedure has become one of the most strongly advocated surgical treatments for patients with full-thickness rectal prolapse and deep enterocele [1]. Surgical treatment of intussusception or isolated rectocele (meaning without enterocele or sigmoidocele on defecography) associated with outlet obstructive defecation is still debated, first depending on which is the primum movens of the symptoms: long-term dyschesia with hard stools leading to intussusception or rectocele should not be an indication for surgery, as “correction” of the anatomy will not cure the functional disorder of obstructed defecation and lead to recurrence due to repeated, prolonged, intense defecatory thrust [2]. Moreover, we know from the literature that some radiologic features, particularly those of internal rectal prolapse (or intussusception) and rectocele, can be present in a third of normal individuals. Specific symptoms have to be present and secondary to the image of “true” prolapse, in order for the condition to be considered pathological. Therefore, some papers from the literature must be interpreted with caution, keeping in mind the proportion of patients with either external rectal prolapse or intussusception, tools that were used to affirm the diagnosis, surgical technique that were used, and postoperative technical and functional results that were observed. …