Rectal prolapse is a condition in which the rectum (the last section of the large intestine) protrudes through the anus. This condition can cause significant discomfort and affect a person's quality of life. It is more common in older adults, particularly women, but can also occur in younger individuals and men. Symptoms of rectal prolapse include a noticeable bulge, incontinence, pain, and bleeding. When conservative treatments fail to provide relief, surgery becomes necessary to correct the prolapse and restore normal bowel function.
Rectal prolapse surgery, also known as rectopexy, is a procedure aimed at repairing the rectum's protrusion. The surgery repositions and secures the rectum back into its normal anatomical place. Various surgical techniques are available, and the choice depends on factors such as the patient's health, the severity of the prolapse, and the surgeon's expertise.
There are two primary approaches to rectal prolapse surgery: abdominal and perineal.
1. Abdominal Approach
Robotic/Laparoscopic Rectopexy: This minimally invasive procedure involves small incisions in the abdomen. A scope is inserted to provide a clear view of the internal organs. The surgeon uses specialized instruments to lift and secure the rectum to the sacrum (the bony structure at the base of the spine) using sutures or mesh.
Robotic/Laparoscopic rectopexy offers several benefits compared to traditional open surgery for treating rectal prolapse:
Open Abdominal Rectopexy: This approach involves a larger incision in the abdomen. While it is more invasive than robotic/laparoscopic surgery, it can be necessary for patients with extensive prolapse or other complicating factors. The rectum is similarly secured to the sacrum.
Perineal Rectosigmoidectomy (Altemeier Procedure): This procedure is typically reserved for older or high-risk patients. It involves the removal of the prolapsed section of the rectum through an incision made around the anus. The remaining rectum is then reattached to the last part of the large intestine. This method is beneficial for patients who may not tolerate abdominal surgery.
Delorme Procedure: This technique involves folding and securing the rectal walls to shorten and stabilize the rectum. It is less invasive than the Altemeier Procedure and is also performed through the anus.
Surgery is usually recommended for patients experiencing chronic, symptomatic rectal prolapse, incontinence or severe constipation, inability to manage symptoms with conservative treatments such as dietary changes, pelvic floor exercises, or biofeedback therapy and recurrent infections or ulcers in the prolapsed rectum.
You will undergo a thorough medical evaluation to determine your overall health and suitability for surgery. This includes blood tests, imaging studies, and possibly colonoscopy. You may be instructed to follow a clear liquid diet and take laxatives or enemas to cleanse the bowel before surgery. Certain medications, such as blood thinners, may need to be adjusted or temporarily discontinued. The surgery will be performed under general anesthesia through small incisions followed by closing the ports with sutures or staples, and sterile dressings are applied.
You will stay in the hospital for a few days to ensure there are no complications. Pain medications will be provided to manage discomfort. You’ll start taking liquids in few hours of surgery followed by soft then gradual progression to normal diet. You’ll be encouraged to move around to promote healing but should avoid strenuous activities.
Regular follow-up visits shall be scheduled to monitor recovery and address any concerns.
As with any surgery, rectal prolapse surgery carries potential risks, including infection, bleeding, recurrence of prolapse, damage to surrounding organs and incontinence or constipation. With proper care and follow-up, most patients experience a substantial improvement in their quality of life.
