Laparoscopic Rectopexy: Basic Surgical Steps

What is rectal prolapse?

Patients with a rectal prolapse have a protrusion (prolapse) of the rectum through the anus. They may also experience symptoms such as a change in bowel habits, rectal bleeding, mucus drainage, anorectal pain, or fecal incontinence. A rectal prolapse is thought to occur due to a loss or weakness of the normal support structures for the rectum.

What is laparoscopic rectopexy?

Laparoscopic rectopexy is one of the surgeries used to repair a rectal prolapse. In this surgery, the rectum is restored to its normal position in the pelvis, so that it no longer prolapses (protrudes) through the anus. Usually, stitches are used to secure the rectum, often along with mesh.

Fig 1: normal intestinal anatomy

The term "laparoscopic" refers to surgery performed through very small "keyhole" incisions in the abdomen. A laparoscope--a small, telescope-like instrument containing a camera--is placed through an incision near the bellybutton in order to see the inside of the abdomen. The surgery is done using instruments placed via these small incisions.

What happens during the surgery?

There are two main steps to this surgery.

Step 1: Positioning the laparoscope

Once you are under anesthesia, the surgeon will make a small cut (about 1/2 inch) near the bellybutton. A laparoscope will be inserted into the abdomen through this incision. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.

Once the laparoscope is in place, the surgeon usually makes several more "keyhole" incisions in the abdomen (figure 2). The number and position of these incisions depends on the build of the patient, the preference of surgeon and various other factors. Surgical instruments will then be placed through these incisions to complete the surgery.

Fig 2: Laparoscopic surgery is performed through several small incisions in the abdomen

Step 2: Repositioning the rectum

Your surgeon will begin the surgery by locating the sigmoid colon and rectum. Next, the rectum will be freed from its surrounding structures and gently lifted into its proper position inside the pelvis. Stitches will be placed around the rectum to secure it in place. Mesh may be used along with the sutures. In some cases, your surgeon may remove a portion of your sigmoid colon. He or she will discuss with you before the surgery whether this is a possibility. Finally, the pelvis will be rinsed out and the incisions will be stitched closed.

Recovering at home

Your surgeon will give you specific instructions for your post-operative recovery. In general, you will be encouraged to increase your activity level steadily once you are home. Walking is great exercise and will help your general recovery by strengthening your muscles, keeping your blood circulating to prevent blood clots, and helping your lungs to remain clear. You will be sent home on a soft diet, which means you can eat almost everything except raw fruits and vegetables. You should continue this diet until your post-surgical check-up. If you become constipated while at home or if you have any other concerns, please contact your doctor.



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