Background
The complete rectal prolapse (RP) or procidentia is sliding down of the full thickness of the upper part of the rectum through the anus. It has been known since the Egyptian and Greek times. It is proposed that RP starts as an intussusception of the rectal wall and occurs at the extremes of age. The etiology of RP has not been fully understood till now. Many factors are thought to be the cause, such as increase intra-abdominal pressure, weak anal sphincter, and malnutrition. Other causes include polyps, rectal inflammation, and chronic constipation. In children, straight sacrum and decrease in the angulation between rectum and anus is regarded to be the cause. Rectal prolapse frequently associates with pelvic floor disorders, rectocele and/or enterocele; a condition known as "pelvic floor dysfunction". If it's not evident; it can be provoked by straining. Rectal prolapse is associated with physical and psychological impacts on the affected patient. The prolapsed part secretes mucus and may results in mucosal ulceration and polyps. It may be associated with incontinence, constipation, or incomplete evacuation with defecation.
The Rectal prolapse is diagnosed entirely clinically and the treatment is primarily surgical. The aim is to repair the prolapse with improvement of any associated bowel disorder. More than 100 different techniques have been tried till now. They are either perineal or abdominal approaches. All have a common aim, which is mobilization and fixation of the affected rectum. None of these operations could be regarded ideal for all the patients. Although abdominal approaches have less recurrence rate but significantly associate with higher rate of infection and complications, compared to transperineal approaches. This makes abdominal approaches preferable in medically fit patients. The transperineal approaches is usually reserved for those patients who cannot tolerate the former procedure.
Our objective in this paper is to present a novel procedure, which is a perineal approach in treating full-thickness rectal prolapse for all the age-groups. It can be performed as a day-case procedure, regardless of the presence or absence of co morbidities, with fewer complications.