This document discusses rectal prolapse, including partial (mucosal) and complete (full-thickness) prolapse. It describes the types, causes, diagnosis and treatment options for each. For partial prolapse in infants and children, treatment includes digital repositioning, injections or surgery like Thiersch's operation. In adults, options are injections, excision or ligature. Complete prolapse involves all rectal wall layers and has abdominal or perineal surgical treatments like mesh rectopexy, resection rectopexy or Delorme's operation to reposition or remove the prolapsed tissue.

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Introduction
Rectal prolapse was known to mankind as early as 1500
B.C.
Types
Partial(Mucosal) prolapse
Complete(full-thickness) prolapse

3. Partial Prolapse
Mucosa and submucosa of rectum protrude outside anus
for approximately 1-4cms
Composed of double layer of mucous membrane
Occurs at the extremes of life
Children: 1-3 yrs
Elderly
Prolapsed mucous membrane is pink while prolapsed
haemorrhoids are plum coloured and pedunculated

4. Partial prolapse-Aetiopathology
Infants
Direct downward course of rectum due to absence of sacral curve
Diminished support of anal mucosa due to poor resting anal tone
Children
After an attack of diarrhoea
Severe whooping cough
Loss of weight resulting in reduced fat in ischiorectal fossae

5. Partial prolapse-Aetiopathology
Adults
Associated with 3rd
degree haemorrhoids
Torn perineum in females
Straining from urethral obstruction in males
Atony of anal sphincter in old age
After an operation for fistula in ano

6. Partial prolapse in infants

7. Differential diagnosis from
intussusception

8. Treatment
In infants and children
Digital reposition and treating malnutrition
Submucous injections of phenol in almond oil
Thiersch’s operation
In adults
Submucous injections
Excision of prolapsed mucosa: Goodsall’s ligature
Endoluminal stapling

9. Thiersch’s operation

10. Goodsall’s ligature

11. Complete prolapse(procidentia)
Less common compared to partial prolapse
The protrusion is more than 4 cm in length
Involves all layers of the rectal wall
The mucosa is often arranged in a series of circular folds
Lax anal sphincter
Women are 6 times more affected and may be associated
with prolapse of uterus
Faecal incontinence

12. Complete rectal prolapse

13. Complete rectal prolapse

14. Complete rectal prolapse

15. Complete rectal prolapse

16. Complete rectal prolapse
Treatment
Abdominal approach
 Preferred in most cases as it has lower recurrence rates
 Open or laparoscopic
Perineal approach
 Preferred in elderly and debilitated patients

17. Abdominal procedures
Mesh rectopexy
Rectum is mobilised completely
Non absorbable mesh (prolene) is fixed to presacral fascia
Mesh is partially wrapped around the rectum held up in
tension and fixed by stitches
Suture rectopexy
Resection rectopexy
Combination of anterior resection and mesh rectopexy
A good option for patients with significant constipation
Anterior resection

18. Mesh rectopexy

19. Abdominal rectopexy

20. Perineal procedures
Anal encirclement(Thiersch’s operation)
Delorme’s mucosal sleeve resection
Rectal mucosa is excised circmferentially from dentate line
to the apex of prolapse
The denuded prolapsed muscle is then pleated with a suture
The transected edges of the mucosa is sutured together
Perineal rectosigmoidectomy

21. Delorme’s operation

22. Delorme’s operation

23. Laparoscopic mesh rectopexy

24. Thank you