THE MULTIPLICITY of operative procedures advocated for the treatment of complete rectal prolapse is indicative of the difficulties encountered in effecting relief of this condition. These procedures may be classified as suspensions, resections, and hernioplasties, or various combinations of these. If complete rectal prolapse is considered to be a hernia, hernioplasty directed toward repair of the musculofascial defects is the most logical approach to the problem. Our experience in treating 20 patients with complete rectal prolapse indicates that an abdominal-perineal plastic repair, as carried out in 6 of the patients, is an effective treatment.
Certain anatomical weaknesses are present when severe complete rectal prolapse occurs. The rectosigmoid colon is of unusual length. The rectosigmoid mesentery is long. The "rectal stalks" containing middle hemorrhoidal vessels are elongated. The external anal sphincter is dilated. The levatores ani are separated, the anterior and posterior rectal walls are mobile and the cul-de-sac is deep.