Complete Rectal Prolapse: Etiopathogenesis, Diagnosis and Treatment

Dear Colleagues,

External rectal prolapse, rectal procidentia, or “complete” rectal prolapse (CRP), can be defined as a circumferential, full-thickness intussusception of the rectal wall which protrudes outside the anal canal. It occurs at the extremes of age with an incidence of approximately 2.5 per 100,000 inhabitants and a clear predominance among elderly women.

The precise aetiology of rectal prolapse is not completely understood, but it seems to be multifactorial and includes weakness of the pelvic floor, chronic constipation, multiple pregnancies, previous pelvic surgery, and a deep pouch of Douglas.

The most common symptom is protrusion of rectum following defecation, together with mucous discharge, and rectal bleeding. Constipation, faecal incontinence, and obstructive defecation syndrome (ODS) are also frequently seen.

The diagnosis is often clinical and anoperineal examination, including proctoscopy, is mandatory. More recently, endoanal ultrasound, MRI, anorectal manometry, defecography, and neurophysiological testing are also being utilized to assess the severity of the disease.

Surgical treatments are divided into abdominal and perineal approach, but minimally invasive procedures (laparoscopic or robotic approaches) are found to be safe and effective when performed by experienced surgeons. However, the available evidence does not allow us to draw definitive conclusions about the best treatment for CRP.

Furthermore, despite anatomical correction, patients frequently complain of persisting pelvic floor symptoms and recurrences. For this reason, the management of CRP is challenging for all coloproctologists specializing in anatomo-functional disorders of the pelvic floor.

The aim of this Special Issue is to provide a series of state-of-the-art manuscripts, including both original contributions and review articles, in order to reach a complete understanding of the etiopathogenesis, diagnosis, and treatment of CRP.

Dr. Gaetano Gallo
Dr. Ugo Grossi
Dr. Atsushi Sakuraba
Guest Editors

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