Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.116575
Revised: December 13, 2025
Accepted: January 15, 2026
Published online: March 27, 2026
Processing time: 133 Days and 13.3 Hours
Obstructed defecation syndrome (ODS) frequently results from an internal rectal prolapse, which disrupts the rectal axis and impairs evacuation. Resectional transanal operations can remove redundant tissue, but fail to restore structural support, whereas abdominal mesh rectopexy involves prosthetic materials and has a higher operative burden. The sutured rectal lift (SuReL) was developed as a reconstructive, non-resective, and mesh-free transanal technique to restore rectal suspension while preserving continence in patients with ODS secondary to internal prolapse.
To describe the rationale, indications, and step-by-step operative technique of SuReL for Oxford grade II-III internal rectal prolapse causing obstructed defe
SuReL was performed using the Sylarum® transanal access device. The rectal wall was addressed sequentially in six circumferential sectors (11, 1, 9, 3, 7, and 5 o’clock). In each sector, a triphasic suture sequence with a barbed 0/0 monofilament (Filbloc®) was placed: (1) A mucosa-submucosa pass; (2) A deeper pass including the muscularis layer at the same level; and (3) A third pass 3 mm caudally, forming a semiloop for suspension. Cranial plications advanced distally to the upper limit of the prolapse. A deep circumferential reinforcement layer with a 2/0 Assuplus® monofilament consolidated the lift.
The procedure standardizes the reconstructive phase through sector-based rotation, allowing symmetric traction and full-thickness suspension without resection. Operative pearls consist of maintaining uniform exposure, ensuring precise semiloop depth for tension control, and verifying lumen patency with saline irrigation. Key technical advantages include the absence of stapling devices or prosthetic materials, minimal bleeding, a short operative time, and preservation of mucosal sensitivity. Postoperative recovery is typically rapid with early mobilization and minimal discomfort.
SuReL represents a technically reproducible and standardized approach for the treatment of internal rectal prolapse. This preclinical study demonstrated feasibility and mechanical consistency using anatomical simulators, while the clinical efficacy and physiological benefits remain to be validated in prospective trials.
Core Tip: Obstructed defecation syndrome due to internal rectal prolapse requires options beyond resection or mesh rectopexy. Sutured rectal lift is a physiological, mesh-free, sphincter-preserving transanal suspension. This basic study details the anatomic rationale, step-by-step standardization, and bench validation of suture-based lift to restore the rectal axis and compliance. By focusing on Oxford grade II–III prolapse and excluding multicompartmental descent, we provide reproducible technical guidance and implementation pearls that are distinct from the clinical outcomes reported elsewhere. The aim was to enable safe adoption, inform the study design, and avoid data overlap with prior clinical series.