Definition :
Procedure for the correction of rectal prolapse
Introduction :
Rectal prolapse is a fairly uncommon procedure. As a result, there is a paucity of data regarding the treatment of this condition. Given the wide range of proposed surgical procedures to correct this (each proposing equal efficacy) it is extremely difficult to recommend one procedure above all other. Treatments are based on correcting the proposed causative mechanisms:
- Abnormally deep pouch of Douglas
- Pelvic floor dysfunction
- Pudendal nerve neuropathy
- Poor fixation of rectum
Indication For Procedure:
Full thickness protrusion of the rectum through the anus. In patients with constipation, consider performing a sigmoid resection as well
Contraindications:
Unfit patient
Untreated causative factor (obstructive urinary pathology, colonic tumours/polyps)
Pre-Operative Investigations :
- Clinical diagnosis
- Prior colonoscopy to exclude other colonic pathology
- Defaecogram (if available)
- Antibiotic prophylaxis
- DVT prophylaxis for at risk patients
Length of stay (LOS): 3-5 days
Level of Care: General ward
Advantages :
Reduced postoperative pain, Improved cosmesis, Reduced hospital stay
Disadvantages :
Prolonged operating time, Increased equipment costs
Technical Recommendations :
There is at present no consensus as to which surgical corrective procedure is superior (viz. suture vs mesh rectopexy).There is no agreement on which approach is better (viz. laparotomy, laparoscopy or perineal). There is no agreement on how extensively to mobilize the rectum (division or preservation of lateral ligaments).
At present, there is only evidence available suggesting that laparoscopic rectopexy can be performed safely and effectively, but as yet there is no data recommending which
patients would best benefit from the laparoscopic approach.