Rectal Prolapse Surgery

Rectal prolapse is a protrusion of the bowel into the anal canal, or external.

There are many ways to treat this condition. Different techniques used depend on the extent of prolapse, the  condition of the patient, and surgeon preference.

Procedures can be performed abdominally, where the approach is through the abdominal cavity, or perineal, that is through the rectum.

The aim of abdominal surgery is to pull the rectum back up into the abdomen and secure it inside.  This can be done by an open technique, or laparoscopically. A suture or mesh is used to secure the rectum, and this is done on the front part of the rectal wall (an anterior or ventral rectopexy) or back part  of the rectal wall (posterior rectopexy).

When done perineally, the rectum is either tightened, or the excess tissue excised.

The abdominal approach to prolpase has a lower prolapse recurrence rate.

The use of laparoscopic surgery has helped decreased hospital stay and increased the speed of recovery.

Laparoscopic Ventral Colporectopexy

This procedure can be done for full rectal prolapse, a mixture of rectal and vaginal prolapse, internal rectal prolapse and rectocoeles (prolapse of the vagina into the rectum).

This involves superficial dissection beside the rectum, carried down in the plane between the rectum and vagina,  all the way down to the pelvic floor. To hold the rectum and vagina up a mesh is sutured to the lower rectum and vaginal wall, then stapled or sutured to the lower part of the sacrum.

A fleet enema may be given before the operation to empty the rectum

You may have a catheter in your bladder and or drain in over night.

After the operation you can eat and drink. Stool softeners may be commenced, so as to avoid constipation and straining.

With laparoscopic surgery the hospital stay is usually short (1-2days), although other medical or health issues may prolong the stay.

You will generally be discharged with simple analgesia and stool softeners. You should not strain or do heavy lifting for 6 weeks to allow for healing, but you can resume normal duties as soon as you feel comfortable.

Laparoscopic Rectopexy

This procedure involves dissection behind the rectum, and then pulling it up and securing it to the back of the sacrum. There are different ways to secure it, either using suture, or a mesh. No bowel is removed.

Before the operation to empty the rectum you may be given an enema, but generally no other bowel prep is required

You may wake up from  the operation with a catheter and drain, which usually are left for a short period only.

After the operation you will usually be allowed to eat and drink. Laxative are often started  soon after, so as to prevent constipation and straining.

Following laparoscopic surgery the hospital stay is generally short, being discharged on day 1 or 2, however, other medical conditions or health issues may prolong the stay.

On discharge you will be given simple analgesia and stool softeners (or a script to purchase the

Perineal Procedures For Rectal Prolapse

Delormes procedure involves dissecting the lining off the prolapsed rectum and then plicating (gathering) the muscle wall with strong stitches. The extra lining is then removed and the full layer closed over.

This procedure is associated with minimal pain in the post operative period. It is associated with minimal risks, and is often performed in patients who are frail and would benefit from a more simple operation. It may also be the first choice for simple internal prolapses.

The operative risks are very low, however the  recurrence rate is higher than if the repair is done abdominally.

Altmeirs procedure is an operation where the full layers of prolapsing rectum is removed. The dissection is carried out as far as possible, the bowel is divided, then joined up in the anal canal. This is usually not very painful. Because there is a join in the bowel there is a low chance of a leak, and this can sometimes a major complication. The recurrence rate is lower than that of Delormes procedure.

For these procedures  fleet enema may be given before the operation to empty the rectum

You may have a catheter in your bladder  in over night. This will usually be removed the next morning.

After the operation you can eat and drink. Stool softeners may be commenced, so as to avoid constipation and straining.

You will generally be discharged with simple analgesia and stool softeners. You should not strain or do heavy lifting for 6 weeks to allow for healing, but you can resume normal duties as soon as you feel comfortable.