No

1. Laparoscopic management of Rectal
Prolapse
By: ibrahim isaac gaied
Teaching assistant of general surgery

2. ‘ Rectal prolapse is
not a disease per se
but a symptom of
pelvic floor damage ,

3. Historical view
Hippocrates (460 BC)
(A) Coptic mummy (400 BC)
(B) Picture of prolapse , van Buren 1881

4. Anatomy Of The Rectum
1
2
3

5. Puborectalis sling & Anorectal ring

8. Types Of Rectal Prolapse
Complete
Partial

9. Epidemiology and Risk factors:
Children under 3
years
Women are affected in
85%
Patients from 4th to 7th decades
General incidence: 2.5/100,000 median
age is 69y
Chronic Constipation
Female: wider pelvis , multiple
vaginal births
Straining at stool
Epidemiology Risk Factors

10. Differential diagnosis

11. Mucosal VS Complete Rectal Prolapse
DD.

13. Prolapsed piles VS Rectal Prolapse
DD.

14. Prolapsed piles VS Full Rectal Prolapse
DD.
Rectal
Prolapse Prolapsed
piles

15. Diagnosis:
DRE
Inspection
History(Score)
Colonoscopy
Transit time measures
Defecography (MRI_X-rays)
Basic Diagnostics
(Physical Examination)
Further Diagnostics
Proctoscopy
Anal Manometry
Endoanal U/S

17. Non-Operative Management
2.
3.
1
Treat
Constipation
* Fiber
Supplement
s
*Stool
Softeners.
2
Reduce
incarcerated rectal
prolapse
* Table
sugar.
* Cold
packs.
But>>>>Surgery is the only effective treatment

19. Surgical management

20. Rectal Prolapse: Strategy
Fit for surgery or not?
No or with difficulties
Yes
Perineal operation
Abdominal(laparoscopic)operation
Constipation : NO Constipation : Yes Prolapse < 5cm Prolapse > 5 cm
Mesh
Rectopexy
Resection
Rectopexy
Delorme’s procedure Altemeir procedure
&levatorplasty

21. Suture
Rectopexy
Ripstein
operation
Well’s op. D’Hoore op.
Post. Mesh Rectopexy Ventral Mesh rectopexy

22. Frykman-Goldberg (Resection
Rectopexy)
Suture rectopexy
The resected part
“Resection Rectopexy”
Abdominal Rectopexy and Rectosigmoidectomy

23. CHECKLIST
Resection Rectopexy

24. The advantages of abdominal op. compared to perineal
op.

26. Thank you