LAUSR

significant improvement) of symptoms in about 70% of patients [3–5]. The functional results of LVR challenged the widely accepted view of the role of internal prolapse in ODS and introduced a reappraisal of the role of surgery not only in fecal incontinence, but also in ODS. However, patients who could benefit from LVR for ODS must be more carefully selected. Despite appropriate workup and failed conservative treatment, about one in three patients will not benefit from the surgery [6]. Therefore, the research of the Oxford Group on LVR is a first step toward a better selection of patients who should undergo surgery. In this study, patients with high-grade intussusception and concomitant enterocoele had a significantly better functional outcome than patients with a horizontal rectal axis (drawer phenomenon). In our own experience, patients with significant perineal descent and a denervated pelvic floor do not respond to LVR. LVR cannot correct pelvic floor descent and therefore the dissipation of the force vector to void the rectum persists. LVR has gained widespread acceptance in total rectal prolapse repair: it restores anatomy and improves function (continence, constipation) in most patients. However, LVR is not a solution for any patient with ODS and internal prolapse. More studies are needed to explore and validate which patient benefits from ‘functional’ surgery.