الفهرس 
ANATOMY OF THE RECTUM,Only 14 pages are availabe for public view
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Abstract
Controversies regarding the management of rectal prolapse continue to stimulate interest in the study of its etiology, pathophysiology, and functional aspects, as well as methods of its surgical treatment. A number of diametrically opposed conditions were accepted as all predisposing to prolapse; constipation and diarrhea, a sedentary life styles and excessively vigorous exercise, and an external sphincter that was too strong and one that was too weak (Madoff& Mellgrin, 1990).
Similarly, despite large sophisticated physiologic investigations, the exact causes of prolapse associated incontinence and constipation are uncertain (Agachan et al., 1996).
In terms of therapy, our century has seen the establishment of broad outlines of appropriate surgical care for full thickness rectal prolapse still numerous treatment issues await resolution. What is the optimal operation for healthy patient and what is optimal for frail or elderly patient? Which of the perineal or abdominal operation is the better? What is the role of laparoscopy? How continence is best restored? How constipation is best alleviated or avoided postoperatively? These are, but a few, of the many unresolved issues in rectal prolapse surgery (Kim et al., 1999).
The motion that rectal prolapse results from circumferential intussusceptions of the rectum had led to the development of operations requiring rectal mobilization with a variety of techniques for its fixation to the pelvis (Madden et al., 1992).
Debate has raged for two generations over optimal technique for rectal suspension. Ripstein’s anterior sling has frequently been criticized because it causes obstructed defecation. Because of concern over anterior sling obstruction, many surgeons favor posterior sling described by Wells in 1959 (Gordon et al., 1978).
Other suspension options are lateral sacro-rectal strips (Orr, 1947), and direct suture rectopexy (Cutait, 1959). Much discussion has also centered on the choice of suspending material from none at all (Schlnkert et al., 1985) to sutures alone (Cutait, 1959) permanent prosthetics e.g. Malex, Teflon, prolene, ivalon (Morgan et al, 1972) and absorbable prosthetics (polyghycolic acid) (Arndt et, al, 1980).
Duhie and Bartolo in 1992, reported superior physiologic and functional results in patients treated by rectopexy without foreign material. Despite the sincere and sometimes emotional advocacy of one or another of those suspension techniques, the simple fact is that most modern studies using any one of them have in common excellent recurrence rate , fewer than 10% (Khanna et al., 1996).
Technical factors beyond the type of suspension, used are increasingly being studied for their effect on function after abdominal rectopexy. When Frykman and Goldberg described resection rectopexy in 1969, the original rationale for resection was to suspend the left colon from the splenic flexure to prevent recurrence. It has since become apparent from the comparable recurrence rates reported in rectopexy studies with or without resection that recurrence is not an adequate rationale for resection, (Madoff et al., 1992).