Rectopexy for rectal prolapse

Rectal prolapse is a condition in which the rectum is outside its normal location in the body, more often visible at the anal orifice. Rectal prolapse can be caused by a variety of factors, for example, maldevelopment of the pelvis in children, diarrhea which is accompanied by weight loss and loss of the rectal supporting pad of fat.

1. Rectal Prolapse: Causes, Types, and Surgical Management

In adults, it mainly develops from the hemorrhoids, infection from the Enterobius Vermicularis species, in women due to the labor process which weakness the supporting floor of the perineum or just normal atrophy of the perineum due to old age.

It can either involve the mucosa or the full thickness of the rectum which involves the rectal walls. Most of the mucosal involvement is managed conservatively while most of the full thickness requires surgery to treat the condition.

Most of the instances of rectal prolapse are often accompanied by incontinence.

Rectopexy can either be done using the abdominal or the perineal approaches in which each has an advantage over the other. The abdominal rectopexy has lower rates of recurrence but risks damage to the pelvic nerves resulting in erectile dysfunction in males. The perineal approach is much safer to males and older age groups but has a higher chance of recurrence.

2. Indications

The major indications for a rectopexy include the conditions which cause discomfort when the rectum is protruding outside. Chronic constipation which is a cause of rectal prolapse is also an indication for rectopexy because it not only alleviates the symptoms of constipation but also cures the proplase problem

3. How is the procedure done

Perineal approach
For example, the Delorme approach where the mucosa of the rectum is cut and the muscle layer of the rectum is folded onto itself. This procedure is ideal for short rectal prolapse.
Abdominal approach
In the abdominal approach, the rectum is pulled back up and reinforced on the sacrum using sutures. This will prevent the rectum from prolapsing again a mesh or a fling could also be used to reinforce the rectum high up the sacrum
A modern technique called the laparoscopic rectopexy is used. It is a minimally invasive that repairs the rectum through holes made in the abdomen and it also reinforces the surgical repair using a meshwork. It provides faster and safer healing process compared to other techniques.

4. Risks

There is a risk for erectile dysfunction if the pelvic nerves are damaged during the rectopexy operation especially if the abdominal approach is used to treat the rectal prolapse. It is therefore prudent to go through the perineal route when dealing with young men or the extremely old patients. There is also an increased risk of severe constipation in patients who have undergone the abdominal rectopexy.

5. How you prepare for the surgery

The patient should be assessed if they are fit for surgery
Blood profiles should be taken before the surgery.
The patient is then given prophylactic antibiotics before the surgery is done to prevent any infections.
The patient should discuss the drugs that they are currently using with the doctor before the procedure. Some of these medications interfere with the surgical process and could result in profuse bleeding, therefore ought to be tapered down.
An intravenous line is required to feed the required drugs into the body system of the patient. A water drip may or may not be employed.
Because of the nature of the surgery, the patient is required to have a temporary urinary catheter to deliver the formed urine from the urinary bladder to prevent the bladder from becoming overfull during the surgery.

6. Recovery after surgery

The patients can be discharged a day or two after the procedure is done. The patient is fully healed in about 8 weeks. The patient should be given anticoagulants and advised to take frequent walks to avert clot formation especially in the legs following the surgery because of prolonged immobility Taking of any pain medication as recommended by the doctor is important because the surgery is associated with some pain postoperatively. Avoid sexual intercourse until the wound is fully healed. Laxatives could be prescribed to avoid constipation thus the healing process is much more successful. The patient should prepare for assistance during the recovery period with the home/work chores to prevent straining post-surgery.

7. Outcomes after surgery

The abdominal rectopexy approach has much lower rates of recurrence as compared to the perineal one which tends to recur a little more frequent.

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