title: Internal rectal prolapse: Definition, assessment and management in 2016.
abstract: Internal rectal prolapse (IRP) is a well-recognized pelvic floor disorder mainly seen during defecatory straining. The symptomatic expression of IRP is complex, encompassing fecal continence (56%) and/or evacuation disorders (85%). IRP cannot be characterized easily by clinical examination alone and the emergence of dynamic defecography (especially MRI) has allowed a better comprehension of its pathophysiology and led to the proposition of a severity score (Oxford score) that can guide management. Decision for surgical management should be multidisciplinary, discussed after a complete work-up, and only after medical treatment has failed. Information should be provided to the patient, outlining the goals of treatment, the potential complications and results. Stapled trans-anal rectal resection (STARR) has been considered as the gold standard for IRP treatment. However, inconsistent results (failure observed in up to 20% of cases, and fecal incontinence occurring in up to 25% of patients at one year) have led to a decrease in its indications. Laparoscopic ventral mesh rectopexy has substantial advantages in solving the functional problems due to IRP (efficacy on evacuation and resolution of continence symptoms in 65-92%, and 73-97% of patients, respectively) and is currently considered as the gold standard therapy for IRP once the decision to operate has been made.
authors.affiliation: Clinique de chirurgie digestive et endocrinienne, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Maternité, hôpital Mère-Enfant, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors.forename: L
authors.initials: L
authors.lastname: Cariou de Vergie
authors.affiliation: Clinique de chirurgie générale et digestive, 49000 Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Venara
authors.affiliation: Clinique de chirurgie digestive et endocrinienne, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Duchalais
authors.affiliation: Radiologie centrale, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Frampas
authors.affiliation: Clinique de chirurgie digestive et endocrinienne, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France. Electronic address: paulantoine.lehur@chu-nantes.fr.
authors.forename: P A
authors.initials: PA
authors.lastname: Lehur
mesh_terms: D003248:Constipation / Q000209:etiology; D019841:Defecography; D005242:Fecal Incontinence / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008279:Magnetic Resonance Imaging; D011788:Quality of Life; D012005:Rectal Prolapse / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D012720:Severity of Illness Index; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome
keywords: Constipation; Defecatory obstruction; Incontinence; Internal prolapse; Laparoscopic rectopexy; Management; Pelvic floor disorder; Rectum; Trans-anal rectal resection