What are the guideline sources, guidelines and references for Rectal prolapse ?
Guideline sources The following summarized guidelines for the evaluation and management of rectal prolapse are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES/AAST 2021), the American College of Radiology (ACR 2021), and the American Society of Colon and Rectal Surgeons (ASCRS 2017). 1 2 3 Guidelines 1. Diagnostic investigations Clinical history and pysical examination: elicit a complete history and perform a physical examination, focusing on signs and symptoms of rectal prolapse, on anal sphincter structure and function, and underlying conditions. A Laboratory testing: Consider obtaining the following laboratory tests in patients with suspected complicated rectal prolapse: CBC serum creatinine inflammatory markers (such as CRP, procalcitonin, and lactates). C Anal physiologic testing: consider obtaining anal physiologic testing to assess and treat coexisting functional disorders associated with rectal prolapse, such as constipation or fecal incontinence. C Diagnostic imaging: https://web.pathway.md/diseases/recwOPVSgMG5J5fRE 1/3 6/24/23, 2:56 PM Rectal prolapse Pathway Diagnostic imaging: As per WSES 2021 guidelines: Consider obtaining urgent contrast-enhanced abdomino-pelvic CT, whenever available and without delaying appropriate treatment, in hemodynamically stable patients with irreducible or strangulated rectal prolapse to detect possible associated complications and to assess the presence of colorectal cancer. C Avoid delaying appropriate and timely management in order to obtain imaging in hemodynamically unstable patients with irreducible or strangulated rectal prolapse. D As per ACR 2021 guidelines, consider obtaining fluoroscopic cystocolpoproctography or magnetic resonance defecography as the initial imaging in patients with vaginal protrusion or bulge or clinically suspected pelvic organ prolapse, if imaging is deemed necessary after clinical evaluation. C 2. Medical management Conservative management: As per WSES 2021 guidelines, consider attempting conservative measures and gentle manual reduction under mild sedation or anesthesia in patients with incarcerated rectal prolapse without signs of ischemia or perforation. C As per ASCRS 2017 guidelines: Consider offering medical therapy to relieve symptoms associated with rectal prolapse, such as fecal incontinence, pain, and constipation. C Recognize that rectal prolapse cannot be corrected nonoperatively. B Antibiotics: consider administering empiric antibiotics in patients with strangulated rectal prolapse, because of the risk of intestinal bacterial translocation. Decide on the appropriate regimen based on the clinical condition of the patient, the individual risk for multidrug-resistant organisms, and the local resistance epidemiology. C 3. Surgical interventions Timing for surgery: avoid delaying surgery in order to attempt a conservative management in hemodynamically unstable patients with complicated rectal prolapse. D Show 2 more Choice of surgical approach: As per WSES 2021 guidelines, consider deciding between abdominal and perineal approaches in patients with complicated rectal prolapse and no signs of peritonitis or hemodynamic instability based on the specific patient's characteristics and on surgeon's skills and expertise. C Show 4 more As per ASCRS 2017 guidelines, perform a procedure incorporating transabdominal rectal fixation as the procedure of choice for the treatment of patients with rectal prolapse with https://web.pathway.md/diseases/recwOPVSgMG5J5fRE 2/3 6/24/23, 2:56 PM Rectal prolapse Pathway acceptable risk. B Show 2 more Abdominal approaches (posterior dissection): avoid performing posterior rectal mobilization without a rectopexy (with or without a concomitant anterior resection) because of the higher rates of recurrence and complications. D Abdominal approaches (posterior rectopexy): perform rectopexy as the key component in the abdominal approach for the treatment of patients rectal prolapse. A Show 2 more Abdominal approaches (posterior mesh rectopexy): Consider performing posterior mobilization of rectum with mesh fixation of the anterior rectal wall to the sacral promontory for the treatment of patients with rectal prolapse, recognizing that this procedure is associated with higher morbidity. B Consider performing modified Wells procedure using a variety of foreign materials for posterior fixation of the rectum. C Abdominal approaches (ventral rectopexy): consider performing ventral mesh rectopexy as an alternative approach to the repair of rectal prolapse with acceptable short- and long-term complication rates. B Perineal approaches (mucosal sleeve resection): consider performing mucosal sleeve resection in patients with a short segment of full-thickness rectal prolapse. B Perineal approaches (perineal rectosigmoidectomy): consider performing perineal rectosigmoidectomy for the treatment of patients with rectal prolapse. B References 1. Antonio Tarasconi, Gennaro Perrone, Justin Davies et al. Anorectal emergencies: WSES AAST guidelines. World J Emerg Surg. 2021 Sep 16;16 1 48. Open 2. Bordeianou L, Paquette I, Johnson E et al. Clinical Practice Guidelines for the Treatment of Rectal Prolapse. Dis Colon Rectum. 2017 Nov;60 11 1121 1131. Open 3. Expert Panel on GYN and OB Imaging: Gaurav Khatri, MD, Priyadarshani R. Bhosale et al. American College of Radiology ACR Appropriateness Criteria Pelvic Floor Dysfunction in Females. ACR. 2021. Open 4. Varma M, Rafferty J, Buie WD et al. Practice parameters for the management of rectal prolapse. Dis Colon Rectum. 2011 Nov;54 11 1339 46. Open 5. Arnold Wald, Adil E Bharucha, Berkeley Limketkai et al. ACG Clinical Guidelines: Management of Benign Anorectal Disorders. Am J Gastroenterol. 2021 Oct 1;116 10 1987 2008. Open https://web.pathway.md/diseases/recwOPVSgMG5J5fRE 3/3