Surgical approaches for complete rectal prolapse

Table 1 Summary of surgery for complete rectal prolapse

Surgical types	Surgical methods	Indications for surgery	Advantages	Disadvantages	Outcomes	Complications
Transabdominal rectal suture fixation	Transabdominal rectal suture fixation	Suitable for patients with complete rectal prolapse, no major comorbidities	Simple, effective in preventing prolapse recurrence	Higher complication rate, more invasive than other techniques	High success rate, effective in preventing recurrence. Recurrence rate 23.33%	Infection, bleeding, bowel injury, prolonged recovery
Transabdominal rectal patch fixation surgery	Ventral mesh rectopexy	Indicated for patients with rectal prolapse and multiple pelvic organs prolapse	Reduced recurrence rate, good outcomes in most cases	Risk of mesh-related complications, longer recovery time	Effective for complex cases, low recurrence. Recurrence rate 4%	Mesh infection, bowel injury, bowel obstruction, recurrence
	Wells rectopexy	Indicated for patients with extensive prolapse and poor pelvic support	Good for severe prolapse, restores rectal function	High complication risk, more invasive	Effective in severe prolapse cases, high recurrence rate. Recurrence rate 6% to 12%	Infection, bleeding, bowel injury, mesh-related complications
	Ripstein rectopexy	Suitable for patients with extensive anterior rectal prolapse	Effective for anterior prolapse, durable results	Longer operation, higher complication rate	High success rate, especially for anterior prolapse. Recurrence rate 2% to 5%	Bowel injury, recurrence, constipation, prolonged recovery
Transperineal rectal fixation	Mikulicz’s procedure	Recommended for elderly or high-risk patients	Minimal surgical trauma, quick recovery	Risk of prolapse recurrence, lower long-term success	Effective in short-term, high recurrence rate	Bleeding, infection, recurrence, incontinence
	Delorme’s procedure	Suitable for elderly, frail patients with non-complex prolapse	Minimally invasive, good for elderly patients	High recurrence rate, requires careful technique	High short-term success rate, but risk of recurrence	Rectal injury, bleeding, infection, incontinence, anastomotic stenosis and dehiscence
	Altemeie’s procedure	Ideal for patients with significant rectal prolapse and bowel dysfunction	Reduces prolapse, restores function	Risk of complications, more invasive compared to other perineal approaches	Effective in long-term management, reduces recurrence. Recurrence rate 0% to 29%	Infection, bowel injury, anastomotic leak, incontinence
	PSPR procedure	Suitable for patients with moderate prolapse who are poor surgical candidates	Minimally invasive, quicker recovery, low complication rate	Higher risk of recurrence compared to abdominal procedures	Effective in treating prolapse with good short-term results. Recurrence rate 12%	Staple line breakdown, recurrence, bleeding
	Thiersch’s operation	Best for patients with recurrent prolapse who are poor surgical candidates	Simple, low-risk procedure	Higher recurrence rate, limited applicability	High recurrence rate, not as effective for complex prolapse cases	Subcutaneous infection, anal stenosis

PSPR: Perineal stapled prolapse resection.