Steven D. Wexner, MD, FACS, FRCS, FRCS (Ed)
Chairman, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, Professor, Ohio State University, Columbus, OH, Clinical Professor of Surgery, University of South Florida, Tampa, FL

Susan M. Cera, MD
Physician, Department of Colorectal Surgery, Physician Regional Medical Center, Naples, FL, Faculty, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL

Abstract
Rectal prolapse is an intussusception of the rectum, which may be categorized as occult (internal), mucosal, or complete. Factors associated with the development of rectal prolapse include constipation; female gender; postmenopausal status; and previous anorectal surgical procedures. Initial evaluation is described as critical as most initially mistake rectal prolapse for hemorrhoids. Various surgical management techniques are available, as there is no one optimal surgical approach. The choice of operation is thus dependent on the patient's age; sex; level of operative risk; associated pelvic floor defects; degree of incontinence; history of constipation; and the surgeon's experience. Perineal procedures include a mucosal sleeve resection (Delorme procedures) and a perineal rectosigmoidectomy. The steps of the operative technique are provided for each perineal procedure, as is information on postoperative care, troubleshooting, and complications. Abdominal procedures include open rectopexy (resection rectopexy); laparoscopic rectopexy (laparoscopic resection rectopexy and laparoscopic suture or mesh rectopexy), and mesh and sponge repairs (the Ripstein procedures and the Ivalon Sponge repairs [the Wells procedure]). The steps of the operative technique are provided for each abdominal procedure, as is information on postoperative care, troubleshooting, and complications. Figures show mucosal versus complete rectal prolapse; rectal prolapse versus hemorrhoids; mucosal sleeve resection; perineal rectosigmoidectomy; open resection rectopexy; laparoscopic resection rectopexy; laparoscopic suture or mesh rectopexy; laparoscopic mesh rectopexy; the Ripstein procedure; and the Ivalon sponge repair (Wells procedure). Tables show the anatomic abnormalities associated with rectal prolapse; symptoms of rectal prolapse; differences between rectal prolapse and hemorrhoids; and operations performed to treat rectal prolapse. This chapter contains 46 references.