Abstract
Selection of the best surgical procedure for the treatment of complete rectal prolapse is difficult amid the many different techniques for which excellent results are reported. A critical review is given. It is concluded that any surgical procedure with rectal mobilization and fixation as a standard maneuver will lead to a recurrence rate of 2% to 4%. Advocacy of additional maneuvers to make the procedure easier is acceptable if it does not lead to a higher complication rate. But to obtain a better result its benefit has to be proven, either by a large prospective double-blind study, or by tests from the colorectal laboratory. New surgical techniques for rectal prolapse should therefore be based, not only on a low recurrence and complication rate, but also on tests that evaluate the effect of the procedure on fecal continence.
Résumé
Choisir le meilleur procédé chirurgical pour traiter le prolapsus total du rectum est d'autant plus difficile qu'il existe de nombreuses méthodes thérapeutiques, toutes vantées dans la litérature pour être la meilleure. Une revue critique des ces procédés est faite. On conclue que toute méthode comportant une mobilisation et une fixation du rectum est suivie de récidive dans 2 à 4% des cas. Recommander des gestes supplémentaires pour faciliter la technique n'est acceptable que si le taux des complications n'augmente pas. Pour prouver que les résultats sont meilleurs, cependant, il faudrait soit réaliser une grande étude prosective à double insu, soit faire des comparaisons par des tests de laboratoire de physiologie colorectale. Des techniques nouvelles de chirurgie du prolapsus rectal devraient être basées non pas sur le taux de récidive ou de complication, mais aussi sur le résultats des tests qui démontrent son efficacité sur la continence fécale.
Resumen
Seleccionar el mejor procedimiento quirúrgico para el tratamiento del prolapso rectal completo es difícil, frente a las numerosas y diversas técnicas, cada una de las cuales reclama excelentes resultados. Se presenta una revisión crítica y se plantea la conclusión de que cualquier procedimiento quirúrgico que implique la movilización y fijación como maniobra estándar, da lugar a una tasa de recurrencia de 2–4%. Es aceptable preconizar maniobras adicionales para una más fácil realización del procedimiento mientras no resulten en incremento de la tasa de complicaciones. Para reclamar un mejor resultado, es necesario comprobar el beneficio mediante un estudio prospectivo y doble ciego mayor o por medio de pruebas funcionales en la laboratorio colorrectal. Las nuevas técnicas quirúrgicas para el tratamiento del prolapso rectal deben fundamentarse no sólo en bajas tasas de recurrencia y de complicaciones, sino también en pruebas funcionales que valoren objetivamente el efecto del procedimiento sobre la continencia fecal.
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Kuijpers, H.C. Treatment of complete rectal prolapse: To narrow, to wrap, to suspend, to fix, to encircle, to plicate or to resect?. World J. Surg. 16, 826–830 (1992). https://doi.org/10.1007/BF02066977
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DOI: https://doi.org/10.1007/BF02066977