Introduction
Surgery to correct a rectal prolapse is conducted under general anaesthetic either via the abdomen or the anus. In most cases, abdominal approaches for rectal prolapse are carried out using minimally invasive (laparoscopic) techniques. The most common procedure for rectal prolapse repair via the abdomen is called a laparoscopic ventral mesh rectopexy. The alternative anal approaches include a Delorme’s procedure or a perineal rectosigmoidectomy (Altemeier Procedure).
Procedures
A laparoscopic ventral rectopexy involves the insertion of a synthetic mesh between the front of the rectum and the back of the vagina which is then secured by stitches and fixated to the sacral bone as an anchor to prevent the rectum from prolapsing.
A Delorme’s Procedure is another method of repairing a rectal prolapse via the anus. It involves ‘stripping’ the lining of the prolapsed rectum, bunching the muscle layers of the bowel wall together, and reattaching the two cut ends of the rectal wall lining. This procedure may be carried out under a spinal anaesthetic instead of a general anaesthetic.
A perineal rectosigmoidectomy (Altemeier Procedure) involves the rectum being accessed via the anus. A section of the prolapsed rectum is removed, with the remaining section then reattached to the top of the anal canal. As with a Delorme’s Procedure, this procedure may also be carried out under a spinal anaesthetic instead of a general anaesthetic.
Patients generally need to stay in hospital after the procedure. This may be only overnight with a laparoscopic ventral rectopexy or a 3-5 day stay after a Delorme’s or Altemeier Procedure. In order to prevent straining and constipation after the procedure, laxatives should be used for 4-6 weeks after surgery.
Full recovery may take 6-7 weeks and you will be advised at what point you can take up exercise and normal activities again. Most patients are able to return to work 2-4 weeks after the procedure and start driving around 2 weeks afterwards. Sexual activity can normally be resumed around 4 weeks after the procedure. Heavy work and lifting should be avoided for at least 6 weeks.
Risks
The risks of prolapse surgery include:
- Recurrence.
- Incontinence.
- Constipation.
- Painful intercourse.
- Infection.
- Bleeding.
