ASCRS Ch60 - Rectal Prolapse

Sixtieth chapter of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (Murphy M, Vogler SA), part of "Part V: Pelvic Floor Disorders." Book pages 1019–1033, PDF pages 1006–1020. Offset confirmed +13 (not +12 — see ASCRS Ch59 - Treatment of Difficult-Obstructive Defecation for the discovery of this jump at the Ch59/Ch60 boundary) via the copyright-line cross-check on this chapter's own first and last pages. A further check at the Ch60/Ch61 boundary found another +1 jump, to +14: Ch61 ("Fecal Incontinence: Evaluation and Treatment," PDF page 1021) has a copyright line reading book page 1035, not 1034 — the same "chapter starts on an odd/recto book page, forcing a blank page dropped from the PDF" pattern identified at the Ch59/Ch60 boundary. Chapter 61 onward uses offset +14.

Summary

Covers full-thickness rectal prolapse comprehensively: pathophysiology (mid-rectal intussusception theory, connective tissue disorders, multicompartment pelvic organ prolapse as a contributing factor), the distinction between rectal mucosal prolapse / internal rectal intussusception / overt prolapse, and the Oxford rectal prolapse grading system (grades I–IV internal, V overt). Evaluation covers history/exam, patient questionnaires (the 2019 Pelvic Floor Disorders Consortium's IMPACT instrument), anorectal physiology testing caveats specific to prolapse (low pressures from repeated stretching, paradoxical EMG activity mimicking dyssynergia), and imaging (fluoroscopic defecography vs. dynamic MRI defecography, with a meta-analysis showing dMRD is less sensitive).

Treatment is organized into perineal procedures (anal encirclement/Thiersch, Delorme, Altemeier) and abdominal procedures (suture rectopexy/Cutait, suture rectopexy with sigmoid resection/Frykman- Goldberg, posterior mesh rectopexy/Wells, Ripstein anterior sling rectopexy, and ventral mesh rectopexy/D'Hoore), each with detailed recurrence, complication, and mortality data drawn from named studies (Hidaka et al.'s RCT of suture rectopexy vs. VMR; Evans et al.'s 2,203-patient VMR mesh- erosion series; Tejedor et al.'s suture-type erosion comparison; Fang et al.'s NSQIP mortality analysis; Bjerke and Mynster's Danish national registry review; Rondelli et al.'s robotic-vs- laparoscopic VMR meta-analysis; Gurland et al.'s recurrent-prolapse VMR outcomes; Hotouras et al.'s systematic review of recurrence management). Incarcerated rectal prolapse management and a substantial "choosing an approach / recurrent rectal prolapse" decision-making section round out the chapter. A dedicated Solitary Rectal Ulcer Syndrome (SRUS) section covers colitis cystica profunda (CCP) as a related/overlapping disorder, updated ulcer/polyp prevalence figures, argon plasma coagulation as a treatment modality, and — most importantly — a mechanism-based treatment split (pelvic-floor-weakness-driven SRUS treated surgically via rectopexy vs. straining/dyssynergia-driven SRUS treated with pelvic floor physical therapy, not surgery).

Wiki impact

• Substantially rewrote: Rectal Prolapse Repair (near-total rewrite — corrected a conflation of the historically distinct Wells posterior-mesh and Ripstein anterior-sling procedures, added suture rectopexy and Frykman-Goldberg resection rectopexy as their own abdominal options, added the Thiersch anal-encirclement perineal option, and massively expanded ventral mesh rectopexy with D'Hoore technique/mesh-and-suture-type outcome data/robotic-vs-laparoscopic comparison, plus a new approach-selection and recurrent-prolapse section).
• Substantially expanded: Rectal Prolapse (Procidentia) (Oxford grading table, mucosal-prolapse/ internal-intussusception/overt-prolapse distinction, patient questionnaires, prolapse-specific physiology-testing and imaging detail) and Solitary Rectal Ulcer Syndrome (SRUS) (CCP, updated prevalence figures, argon plasma coagulation, the weakness-vs-straining treatment split).
• Updated: Obstructed Defecation Syndrome (ODS)'s internal-prolapse and overt-prolapse sections, which had explicitly deferred detail to this chapter.

Open items / gaps

• No single study compares all abdominal techniques (suture rectopexy, resection rectopexy, posterior mesh, Ripstein, VMR) head-to-head — only pairwise comparisons exist.
• No standardized algorithm for approach selection in male patients or in females without multicompartment pelvic organ prolapse — flagged by the chapter itself as an evidence gap, not just a wiki gap.