Mesh Rectopexy (Ripstein, Orr-Loygue, Wells, and Frykman-Goldberg)

There is general agreement that surgical treatment is essential for complete rectal prolapse (CRP). Rectoanal intussusception (RAI), also known as internal prolapse, is often regarded as a medical condition; it can be found in healthy subjects [1] and the interpretation of radiological images remains controversial [2]. Therefore surgical treatment for symptomatic RAI is still a matter of debate, and bowel retraining (i.e., high-fiber diet, bulk laxatives, avoidance of straining and digitation, and pelvic floor exercises) must be considered as a first approach, leaving surgery as the last option for cases where conservative therapy fails. Fecal incontinence (FI) and obstructed defecation syndrome (ODS) make CRP and RAI very disabling conditions. FI is present in 30–80% of patients with CRP [3], and also in up to 44% [4] of those with RAI. ODS is often characterized by strenuous effort to expel stools, feeling of incomplete evacuation, rectal tenesmus and frequent visits to the toilet, digitation, and the use of enemas and/or suppositories [5]. Furthermore RAI and CRP are often associated with a more complex pelvic floor prolapse. Many patients who complain of a single pelvic compartment prolapse may be affected by prolapse of multiple pelvic compartments [6]. Multiple pelvic defects, variously associated with one another and to different degrees, can be present at the same time: rectocele and rectal occult mucosal or full-thickness prolapse are often associated with enterocele, and uterine, vaginal, and bladder prolapses [7].