Management of recurrent external rectal prolapse. A single center experience

External rectal prolapse (ERP) is a complete protrusion of the rectal wall through the anal canal. The precise prevalence of recurrent (R)- ERP is still unknown although some studies have reported 20–30 % after primary surgery. The aim of this study was to assess the anatomic and functional outcomes of R-ERP surgical treatment proposing a decision-making algorithm for this rare and challenging disease. This is a case series report. Of the 141 patients treated for external rectal prolapsed between January 2014 and December 2020, 19 (3M-16F) developed a recurrence. Anatomical recurrence was assessed and classified as complete or partial and mucosal or full-thickness. Functional outcomes were assessed using Wexner scores for constipation and incontinence. The global satisfaction rate was evaluated using a 5-point scale. The patients were stratified according to the first line surgery: 5(26 %) Delorme (Group A), 6(32 %) Altemeier (Group B), and 8(42 %) robotic ventral rectopexy (Group C). Five patients had a previous proctologic and pelvic floor surgery; Functional disorders were: 8 (42 %) fecal incontinence and 4(21 %) ODS. The overall recurrence rate was 21.4 %. The overall functional outcomes showed a significant improvement in the Wexner incontinence score (median value 8.7 vs 3.1) and constipation score (10.4 vs 4.6). 78.6 % patients declared to be satisfied. The treatment of choice for R-ERP needs to be tailored according to personal surgical competence considering the first-line ERP surgery,prolapse characteristics, and patients' comorbidities.