Treatment of Extensive Prolapse of the Rectum in Aged or Debilitated Patients

THE REPAIR of complete rectal prolapse in aged or debilitated patients requires the use of a surgical procedure which is followed by a high percentage of cure, a low mortality, and minimal morbidity. The large number of operations which have been suggested, tried, and often abandoned is indicative of the difficulties attending the management of rectal prolapse and of the frequency of unsatisfactory results. In general, the principles involved in the various operative procedures which have been advocated include the following: (1) resection of the protruding bowel; (2) reduction of the size of the anus and lower rectum; (3) plastic reconstruction or reinforcement of the perineal floor; (4) abdominal suspension, fixation, or both, of the prolapsed bowel, and (5) obliteration of the cul-de-sac. The studies of Moschcowitz,1Todd,2Graham,3and Orr4have shown that a large rectal prolapse is essentially a sliding hernia of the anterior