The evolution of laparoscopic surgery for rectal prolapse.

External rectal prolapse is defined as a full thickness extrusion of the rectum outside of the anus. In patients who are fit enough, it is usually treated with surgical intervention. The surgical focus has traditionally been on reduction of the prolapse, rather than improvement in function. Internal rectal prolapse is also well recognised, being a folding of the full thickness of the rectal wall that occurs on straining to defecate, but that does not protrude outside of the anus. It may present with either obstructed defecation or faecal incontinence.(1,2) In contrast to external prolapse surgery for internal rectal prolapse has enjoyed a poor reputation, in part due to the poor results of surgery in the late 1980s(3,4) but also because of the suggestion that internal prolapse is an incidental finding.(5) The introduction of surgical techniques that focus on functional outcomes in external prolapse surgery have led to a re-appraisal of the treatment of internal rectal prolapse.(6) This coupled with new evidence regarding the morphology of symptomatic internal prolapse has quashed the concept of internal prolapse as an untreatable and incidental phenomenon.(7,8) This article will outline the evolution of surgery for rectal prolapse, the use of laparoscopic ventral rectopexy in external prolapse and the evaluation and treatment of patient with internal rectal prolapse.