Rehn-Delorme transanal mucosal resection

Inspection and digital rectal examination reveal a gaping anus and significantly reduced sphincter tone. After slow manual stretching of the sphincter, insert the Parks retractor. Withdraw the prolapsed rectum before the anus with Allis clamps. Even after removing the Parks retractor, the prolapse does not spontaneously reduce, but remains a few centimeters outside the anus. This confirms the diagnosis of a rectal prolapse grade III.

Expose the dentate line with a Lone Star retractor. Next, mark as a circle and incise the rectal mucosa 1-2 cm proximal to the dentate line with the monopolar needle electrode.

After injection of physiological saline or Ringer solution, start the dissection anteriorly from the mucosa down to the muscularis propria. Then, step by step, after each injection and repeated hemostasis (sometimes monopolar, sometimes bipolar), dissect the mucosa off the muscle layer in circular fashion.

Tip: Use a highly diluted blue solution for injection (add a few drops of toluidine blue to the NaCl/Ringer solution!). The mucosa takes up the stain well and can be better delineated against the muscularis.

Step by step, slowly continue proximally the dissection technique presented in the previous step. This will expose the rectal wall quite well. The resulting mucosal tube should be at least 10 cm long.