Comparative Study Between Ventral Mesh Rectopexy And levatorplasty in Management of Rectal prolapse

Author(s): Mohamed A.B. Alatrash, Ali A. Shafik, Aya M. Alamrawy, Amr K. Ebrahim, Mohamed Y. Elbarmelgi, Osama R. Mohamed, Mohamed Tamer

Rectal prolapse is when the layers of the rectum protrude through the anal canal. It can happen to both men and women of any age, but it is more common in women who have given birth and are in their seventies or eighties. While rectal prolapse doesn't pose a life-threatening risk, it can greatly affect a patient's quality of life. Symptoms can range from loss of bowel control and urgency to constipation and difficulty passing stool. There are numerous surgical techniques available, with no clear consensus on the best approach. Each technique carries a risk of recurring prolapse. The choice of the most suitable surgical repair for a patient depends on various factors, such as overall health, bowel function, bothersome symptoms, and the presence of another pelvic organ prolapse [1].

The female pelvis can be divided into three main sections: the front, middle, and back. The posterior compartment specifically includes the rectovaginal space and rectum. Traditionally, rectal prolapse has been viewed as a problem limited to the posterior compartment, and surgeons focused on repairing only that area. However, there is a growing recommendation for a multidisciplinary approach that considers all compartments of the pelvis. Research has demonstrated that a structural defect in one pelvic compartment often coexists with symptoms or issues in other compartments. For instance, a patient with rectal prolapse might also experience urinary incontinence or vaginal bulging. This concurrent condition, known as pelvic organ prolapse (POP), can involve prolapse of the bladder, uterus, or intestines. The likelihood of this correlation increases with age, higher body mass index (BMI), and prior hysterectomy [1].

Neglecting to acknowledge this association when planning treatment may lead to the worsening of symptoms in another pelvic compartment after isolated repair. This is particularly significant because patients with POP have a higher risk of earlier recurrence after rectopexy alone, as well as a greater number of reoperations for rectal prolapse and repair of other compartments. Taking a multidisciplinary approach can provide a more comprehensive surgical plan and potentially avoid the need for multiple sequential surgeries [1].