Rectal prolapse surgery

Overview:

Rectal prolapse surgery is a procedure done for rectal prolapse. Rectal prolapse takes place when the rectum, the last portion of the large intestine drops into the anus. It occurs due to factors like age, pregnancy, illness, or injury. 

Rectal prolapse is not an emergency medical condition but can cause difficulties like immense pressure, or bulge in the anus if not treated. It is also known as rectopexy. In rectal prolapse surgery, the rectum is placed back to its original position. 

Indications:

Rectal prolapse surgery is commonly seen in older individuals and females. Children also can develop a prolapse after having chronic infections, but it is not common for them to have surgery as the rectum heals and comes back to its position. Surgery is generally indicated in adults with

• Leaky stools from the anus, 
• bowel movements are obstructed, or 
• when an inability to hold the bowel movements occurs. 

Types of Rectal prolapse surgery:

Rectal prolapse surgery can be conducted through the abdomen or the perineum. Perineum is the part between the anus and the genitals. It can be done by conventional methods or advanced techniques like laparoscopy and robotic surgery. Rectal prolapse surgeries can be carried out along with other prolapses like vaginal or pelvic organ prolapse. 

Some of the abdominal procedures are: 

• Abdominal rectal prolapse surgery is done by making cuts in the abdomen and pulling the rectum back to attach it to the back wall of the pelvis called the sacrum. Sometimes it is tightly sutured there, or a mesh sling is placed. Scarring occurs with healing that keeps the rectum in position. Occasionally, a part of the colon or large intestine is also removed, which is called bowel resection surgery to heal the constipation. 
• Laparoscopic surgery is done by making minor cuts in the abdomen and insert a narrow tube with a camera called the laparoscope to visualize the prolapse. The rectum is pulled back to its place and secured using special instruments along with the bowel resection surgery.
• Robotic surgery is an advanced surgery where prolapse is corrected by using a surgical robot along with bowel resection and mesh sling placement. 

Some of the perineal procedures are:

Perineal rectal prolapse surgery is also known as perineal proctosigmoidectomy. The surgery is done through the perineum. Cuts are made on the skin in the perineum. Using this procedure, rectal prolapse surgery is done in many ways. They are: 

• Altemeier surgery: This surgery pulls a part of the prolapsed rectum and scrotum. The scrotum is the last part of the large intestine. A part of the prolapsed rectum is removed by performing proctocolectomy. The remaining parts are secured to the large intestine. Pelvic floor muscles are also approximated tightly together. This is called levatorplasty. This surgery is preferred in those individuals where open or laparoscopic procedures cannot be performed. 
• Delorme’s surgery: This surgery is preferred for small rectal prolapses where the muscular layer of the rectum is removed and sutured back to the anal canal to shorten the rectal prolapse. 

Before the procedure:

Before undergoing a prolapse surgery, an individual should talk to the healthcare provider about the necessity and the type of surgery. They should get a surgical profile done, including blood tests, urine tests, as well as an Electrocardiogram (ECG), along with the physical examination and imaging tests for the abdomen. This helps healthcare professionals (HCPs) to understand the functioning of other organs, gives information about the current general health status, and helps them to identify any factors that may interfere with healing like diabetes or any infections. 

Certain medications like blood thinners, over-the-counter, and herbal medications have to be stopped. New medications may be prescribed to clean out the bowels like laxatives. An antiseptic soap will be prescribed for skin infections. Only clear fluids have to be taken before the surgery. Rectal prolapse surgery is done in a hospital and one has to stay in the hospital. 

During the procedure:

The surgery is done in an operating room under general or spinal anesthesia. The type of surgery will be selected based on:

• Age – Older people recover from minimally invasive procedures
• Prolapse size- perineal approaches are best for small-sized prolapses. 
• Systemic health- medical conditions like obesity, diabetes, and cardiac conditions can delay recovery if abdominal procedures are done. 

Based on these factors one can have an abdominal or the perineal procedure. 

After the procedure:

An individual is taken to a recovery room and observed till the vitals are stabilized. Medications are prescribed for pain and to ward off infections. Clear fluids are given followed by solids. One can be discharged after proper bowel movements are initiated like the ability to have solids, passing on gas, and poop. Stool softeners and a fiber-rich diet may be prescribed for a few days after surgery. One can start their normal activities after 4-6 weeks of surgery. Physiotherapy exercises to use the pelvic floor muscles properly are advised. 

The effectiveness:

Rectal prolapse surgery improves the symptoms of fecal incontinence and constipation after the surgery. However, some individuals may develop worsening constipation after the procedure. 

Side effects, risks, and complications:

Pain, bleeding at the site of the surgery, bowel obstruction, and infection are some of the side effects of the procedure. Complications include damage to the adjacent organs, sexual dysfunction in males due to damage to the pelvic organs, recurrence of the prolapse, a new opening called fistula, and worsened constipation are some of the complications. 

Conclusion:

Rectal prolapse surgery is a procedure done to relieve the symptoms of prolapse in individuals whose rectum slides into the anus. It can reduce the symptoms, give relief, and improve the patient's quality of life. 

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