Rectal Prolapse Repair (Perineal vs Abdominal Laparoscopic/Robotic)

Procedure Snapshot

• Indication: Full-thickness rectal prolapse causing incontinence or bleeding.
• Expected duration: ___
• Special instruments: Laparoscope or perineal set, mesh (optional).

Step Workflow — Abdominal (Laparoscopic/Robotic)

1. Trendelenburg; mobilize sigmoid & rectum posteriorly to pelvic floor.
2. Preserve hypogastric nerves.
3. Rectopexy: fix anterior or posterior rectum to sacrum (non-mesh or mesh).
4. Optional sigmoid resection if redundant colon.

Step Workflow — Perineal (Delorme or Altemeier)

1. Delorme: mucosectomy + plication of muscular layer.
2. Altemeier: perineal rectosigmoidectomy with coloanal anastomosis.

Key Pimp Questions

• Q: Recurrence higher with which approach?
  A: Perineal (~20–30%) > Abdominal (~5–10%) (PMID 31560152).
• Q: When prefer perineal? Elderly or frail patients.

Critical Anatomy

• Landmarks: Levator ani, sacral promontory, rectum, sigmoid colon.
• Danger zones: Hypogastric nerves, presacral veins.

Informed Consent Highlights

• Recurrence __, bleeding __, constipation __, incontinence __.

Post-op Considerations

• Bowel regimen and stool softeners. Avoid straining.

References

• Chassin’s, Rectal section. Clinical Scenarios, Colorectal.
• Madiba 2019 (PMID 31560152).