Full-thickness rectal prolapse occurs when the rectum invaginates into the anal canal and beyond the anal sphincters. The only definitive treatment for rectal prolapse is surgery. Here, Dr. Brooke Gurland at Stanford University Medical Center presents an Altemeier proctosigmoidectomy on an 80-year-old female with full-thickness rectal prolapse. The redundant rectum is delivered and then excised through a transanal approach, and the proximal colon is sutured to the distal end of the rectum.
This patient is a 38-year-old female who presented with fecal incontinence, constipation, and stress urinary incontinence. She was found to have stage II posterior vaginal wall prolapse. She desired definitive surgical management of her prolapse and opted for posterior vaginal repair. Although stress urinary incontinence was demonstrated on urodynamic testing, the decision was made not to proceed with concurrent midurethral sling given her history of pelvic floor dyssynergia and intermittent urinary retention. Here, Dr. Berkowitz and Dr. Hudson at MGH present and demonstrate a site-specific posterior colporrhaphy and perineorrhaphy.
This is the case of an 87-year-old female who presented with a history of constipation and bothersome rectal prolapse that required manual rectal prolapse reduction. She had minimal constipation and minimal incontinence, and anorectal manometry revealed low rectal pressures. On exam, she was found to have full-thickness rectal prolapse and stage II posterior vaginal wall pelvic organ prolapse. Gynecological POP-Q exam showed mostly posterior prolapse and some apical prolapse, and urodynamic testing was negative. Defacography revealed an enterocele. Here, Dr. Bordeianou and Dr. Von Bargen at MGH discuss the decision-making process when treating rectal prolapse and perform a laparoscopic suture rectopexy with culdoplasty, vaginal wall repair, and perineorrhaphy with levator plication.