Introduction: Surgical management of external rectal prolapse (ERP) remains a challenge with the breadth of choices available and varies on the international, national, regional and locoregional level. Significant innovation has led to new techniques to manage ERP including changes to both abdominal and perineal approaches.
Evidence acquisition: A systematic, English-language search of major databases was conducted from 2006-2016. From 636 papers two reviewers identified 24 studies which compared two or more surgical techniques in adult patients with rectal prolapse and reported on complications, quality of life or recurrence. The Newcastle-Ottawa Scale (NOS) was used to score quality in non-randomized control trials (RCT) and the Cochrane Collaboration tool was use for RCTs.
Evidence synthesis: Abdominal and perianal surgeries both result in the resolution of symptoms and an improvement of quality of life for most patients. Short-term outcomes generally favored laparoscopy. Rectopexy with or without resection confers balances a low risk of recurrence with a similar complication rate to perineal surgery. The quality of included studies was general poor and most was at significant risk of bias.
Conclusions: Most studies are of low quality and surgical management should be individualized to balance risk of the operation and the potential benefit to quality of life. Laparoscopy and modern anesthesia has made the abdominal approach more attractive even for elderly patients.