Mesh rectopexy: The wells technique

Abstract

Rectal prolapse as a clinical entity is still relatively poorly characterised [1], with a comparatively poor understanding of its complex physiology and pathogenesis [2]-[5]. It is well recognised that as more than 120 different types of surgical procedures have been described (and championed) for its treatment, there is currently no definitive surgical operation that suits all cases and is associated with an acceptably low recurrence rate [6, 7]. In part, the operative approach is a measure of our understanding of the pathophysiology of the prolapse as well as an appreciation of the relative perioperative risk to patients many, of whom are elderly women. In the first instance, abdominal surgery aims to correct some of the attendant pathology, such as the deep peritoneal cul-de-sac, the enlarged levator hiatus and the attenuated rectal fixation. In the second instance, the decision is one between a perineal and an abdominal approach, which is somewhat dependent upon the extent of the prolapse, patient comorbidity and clinical presentation (associated constipation/incontinence). © 2008 Springer-Verlag Italia.