Laparoscopic Repair Rectal Prolapse
What is a rectal prolapse
Rectal prolapse is a condition in which the rectum looses its internal support and falls in on itself/turns itself inside out. In the earliest phases of this condition the rectum does not stick out of the body, but as it worsens it may protrude. Symptoms include leakage of mucus/stool/urgency/discomfort and eventually prolapse. The condition is more common in women.
Why does it occur?
It may follow a lifelong habit of straining at stool or as a delayed result of stresses involved in childbirth. It also seems to be part of the aging process. Treatment depends on several factors:
What is a laparoscopic rectopexy?
Laparoscopic ventral rectopexy is an operation in which stitches are used to secure the rectum, vagina and womb in their proper positions.
You will be given medicine to clear your bowels. Under a general anaesthetic a small incision is made in the bellybutton to allow insertion of the laparoscope. Two further incisions are made in the lower right hand side of the abdomen. The right hand side of the rectum is mobilised down to the top of the vagina. The rectovaginal septum is then mobilised right down to the pelvic floor/perineum. The front of the rectum and the back wall of the vagina (and womb if present) is then supported by a piece of mesh which is sutured to the front of the rectum/back of the vagina. This mesh is then attached to the front of the sacrum/lower spine. The pelvic peritoneum is then closed over the mesh. Occasionally a drain is placed in the pelvis to stop a haematoma collecting. The small incisions are then closed and infiltrated with a local anaesthetic. You will be allowed to eat and drink once you have recovered from the anaesthetic. The urinary catheter will be removed the following morning and you will then be encouraged to mobilise. Walking helps speed up the recovery.
Most patients normally go home on either the second or third postoperative day. As some, patients continue to have some problems going to the toilet and need a period of retraining we send you home with some Glycerine suppositories, a small Microlax enema and a supply of senna tablets. If you feel uncomfortable, take two senna tablets just before you go to bed and after your breakfast, pop in two suppositories. If they don’t work try the small enema.
What are the benefits?
1) Three tiny scars instead of one large abdominal scar.
2) Early introduction of diet within 24 hrs.
3) A very short hospital stay (2-3 days).
4) Reduced postoperative pain and fewer complications.
5) Shorter recovery time and quicker return to daily activities.
6) No risk of an incisional hernia.
7) As the rectum is not mobilised from the sacrum, its nerve supply is left intact so making constipation and evacuatory dysfunction less likely than a more conventional operation.
How safe is laparoscopic rectopexy?
If performed by experts in this field, the operation is as safe if not safer than 'open' surgery.
Rectal prolapse is frequently associated with - rectocele, vaginal vault prolapse and urinary stress incontinence. Operations to correct these can be carried out at the same time.
How successful is treatment?
Success depends upon a number of factors, including the status of the patient’s anal sphincter muscle prior to surgery, whether the prolapse is internal or external, the overall condition of the patient and the surgical operation used. Constipation and straining must be avoided. As general rule some 90% of patients are completely relieved of symptoms. Occasionally women develop a worsening of their stress incontinence following correction of their rectal and vaginal prolapse. This can usually be corrected by further surgery – Tension Vaginal Tape.
Bristol Laparoscopic Associates have been performing this novel surgery since 1998 and have the largest UK experience of laparoscopic prolapse surgery.