A perineal approach (or trans-perineal) refers to surgical access to the rectum and sigmoid colon via an incision around the anus and perineum (the area between the genitals and the anus). Abdominal approach (trans-abdominal approach) involves the surgeon cutting into the abdomen and gaining surgical access to the pelvic cavity. Procedures for rectal prolapse may involve fixation of the bowel (rectopexy), or resection (a portion removed), or both. Trans-anal (endo-anal) procedures are also described where access to the internal rectum is gained through the anus itself. Abdominal procedures are associated with lower risk of postoperative recurrence of the prolapse, compared with perineal procedures (6.1% vs 16.3% in patients who are younger than 65 years of age at the time of surgery). Abdominal procedures
The abdominal approach carries a small risk of impotence in males (e.g. 1-2% in abdominal rectopexy). Abdominal operations may be open or laparoscopic (keyhole surgery).Laparoscopic procedures
Recovery time following laparoscopic surgery is shorter and less painful than following traditional abdominal surgery. Instead of opening the pelvic cavity with a wide incision (laparotomy), a laparoscope (a thin, lighted tube) and surgical instruments are inserted into the pelvic cavity via small incisions. Rectopexy and anterior resection have been performed laparoscopically with good results. Perineal procedures
The perineal approach generally results in less post-operative pain and complications, and a reduced length of hospital stay. These procedures generally carry a higher recurrence rate and poorer functional outcome. The perineal procedures include perineal rectosigmoidectomy and Delorme repair.
Stapled trans-anal rectal resection (STARR)
This operation aims to "remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler". In contrast to other methods, STARR does not correct the descent of the rectum, it removes the redundant tissue. The technique was developed from a similar stapling procedure for prolapsing hemorrhoids. Since, specialized circular staplers have been developed for use in external rectal prolapse and internal rectal intussusception.Complications, sometimes serious, have been reported following STARR,  but the procedure is now considered safe and effective. STARR is  contraindicated in patients with weak sphincters (fecal incontinence and urgency are a possible complication) and with anismus (paradoxical contraction of the pelvic floor during attempted defecation). The operation has been shown to improve rectal sensitivity and decrease rectal volume, the reason thought to create urgency. 90% of patients do not report urgency 12 months after the operation. The anal sphincter may also be stretched during the operation. STARR was compared with biofeedback and found to be more effective at reducing symptoms and improving quality of life. Mucosal prolapse
Rectal mucosal prolapse (mucosal prolapse, anal mucosal prolapse) is a sub-type of rectal prolapse, and refers to abnormal descent of the rectal mucosa through the anus.