Rectal prolapse can have a significant impact on your life. It occurs when part, or all, of the rectum slips out of its normal position, sometimes protruding through the anus. While it may start gradually, it often worsens over time, leading to discomfort, difficulties with bowel control, and embarrassment that can interfere with everyday life.
Surgery is the main treatment when symptoms become persistent or severe. However, there isn’t just one way to repair a prolapse. In fact, surgeons have been debating the best approach for years.
Here, we’ll explore the surgical options available and how to choose the right approach for you.
Understanding your surgical options
There are two broad categories of surgery for rectal prolapse: abdominal procedures and perineal procedures.
Abdominal repairs are usually performed under general anaesthetic and involve lifting the rectum back into place and securing it with mesh or sutures. Usually, this is done with keyhole surgery, which tends to offer quicker recovery and less postoperative pain. This approach is often used in younger, fitter patients who can safely tolerate general anaesthesia.
Perineal repairs, on the other hand, are performed through the area around the anus. These procedures are less invasive overall and can usually be done with a spinal or local anaesthetic. This can be a more suitable option for older patients or those with other medical conditions that make abdominal surgery riskier.
Both methods aim to achieve the same goal, correcting the prolapse and improving bowel function. However, according to a recent trial, their outcomes can differ slightly.
What the PROSPER trial found
The PROSPER trial compared different surgical approaches in almost 300 patients across the UK. It followed patients for several years, giving insight not just into the immediate outcomes, but also how well each technique held up over time.
The results showed that both abdominal and perineal approaches were effective at resolving symptoms and improving quality of life. However, there were some differences worth noting. Patients who had an abdominal repair, particularly laparoscopic rectopexy, tended to have a lower risk of prolapse recurrence in the long term. They were also less likely to need further surgery later.
On the other hand, perineal surgery was associated with shorter hospital stays and fewer immediate postoperative complications, especially in older or frailer patients.
Choosing the right approach for you
There’s no one-size-fits-all answer when it comes to rectal prolapse surgery. What the PROSPER trial reinforces is that both abdominal and perineal techniques are valid and effective. The choice between them should be made collaboratively between patient and surgeon, with a full understanding of the pros and cons.
At the Warwick Bowel and Hernia Clinic, we take the time to understand each patient’s individual needs. Whether you’re fit and active and looking for a durable, low-recurrence option, or you’re seeking a minimally invasive approach with a faster recovery; there is a surgical route that can help restore bowel function and improve your quality of life.
Living with rectal prolapse can feel isolating, but help is available. Book a consultation with Mr Michael Stellakis today to determine which surgical option is right for you.
