Laparoscopic repair of rectal prolapse: surgical technique.

Technical features of laparoscopic rectopexy include complete rectal mobilization without division of the lateral stalks to avoid parasympathetic denervation and postoperative problems with defecation. Suture rectopexy is equally effective as posterior mesh rectopexy in preventing recurrences and eliminates the use of foreign material which is sometimes associated with intense fibrosis, sepsis and increased constipation. According to two randomised studies constipation seems to be less after resection rectopexy than suture or posterior mesh rectopexy alone perhaps by eliminating possible kinking at the rectosigmoid region by falling of the redundant sigmoid colon in the pouch of Douglas. Randomized studies are, however, needed to validate the need for colonic resection and to determine its optimal extent in patients who suffer from rectal prolapse, constipation and slow transit.