This operation is performed via a laparoscope (keyhole) abdominal surgery.

 

 

Why is laparoscopic ventral rectopexy performed?

 

This procedure may be recommended for patients with external or internal rectal prolapse or “intussusception” when the bowel prolapses internally within the rectum, there may also be more general pelvic organ and pelvic floor prolapse.

 

Patients commonly have a sensation of blockage of the bowel, difficulty in passing a motion, prolonged visits to the toilet and a frequent need to apply pressure with a finger or hand on the perineum (the area between the anus and genitals). Internal rectal prolapse can cause faecal incontinence and laparoscopic ventral rectopexy may help these patients.

 

 

What tests are necessary before the operation?

 

Initial consultation involves assessment of your symptoms and examination. Other tests may include colonoscopy, studies of the anal sphincter to look at its structure and function (anorectal physiology and ultrasound) and X-ray studies that look at how well your large bowel works and how well-supported your pelvic organs are during the process of emptying your bowels.

 

 

What does the operation involve?

 

 

The operation is performed under a general anaesthetic via a laparoscope and takes approximately 1.5 to 2.5 hours.

 

 

The operation approach is down the front of the rectum, away from the nerves supplying the bowel and genitalia.

 

 

Absorbable surgical mesh is placed between the anterior wall of the rectum and (the bladder and prostate in men) and posterior wall of the vagina in women, (called sacralcolporectopexy). It is attached to ligaments on the sacral promontory, either sutured or titanium tacks (MRI safe).

 

 

The mesh helps to prevent an actual or future vaginal prolapse. It also corrects a rectocele (bulge in the wall of the rectum pushing onto the vagina) and enterocele (small bowel dropping into the pelvis between vagina and rectum).  

 

This operation may also include a bowel resection (removal of section of large bowel) this is done if the bowel is adversely affected by diverticular disease or if a condition known as redundant colon has been diagnosed.

 

 

What are the risks?

 

There are small risks associated with any abdominal operation. Pre-operative assessments of heart and lung conditions are made as well as any co-existing medical conditions. During the hospital admission patients wear stockings and are given a regular small injection to prevent thrombosis (blood clots).

 

Bleeding is rare in this type of surgery but if significant a blood transfusion may be necessary.

 

Wound infections can occur in any form of bowel surgery, open or laparoscopic. Wound infections rarely cause serious problems but may require treatment with antibiotics.

 

For patients with pre-existing problems with bowel function, symptoms may persist after surgery due to either anal sphincter deficiency or due to the negative effects of long-term constipation on colon motility.

 

Complications from the surgical mesh used to support the bowel are rare; the mesh used is disolving/absorable and integrates well with the native tissue. Rarely adverse symptoms may require surgical removal of part of the mesh.  

  

What is the recovery like after surgery?

 

Patients usually stay in hospital for 3-5 days after surgery.

 

Patients have a urinary catheter and intravenous fluids.

 

Your Anaesthetist will have discussed pain control with you before your operation.

 

The catheter and IV will be removed when you are comfortable and drinking and eating adequately.

 

• Patients will be discharged on a weaning course of laxatives most commonly used is Macrogol (brand names include Movicol, Osmolax) and may need to take this for up to six weeks. It is important to avoid constipation or straining with bowel motions. The laxative should be stopped if bowel motions become too loose and frequent.

 

• It is normal to tire easily in the first few weeks of recovery and for pelvic discomfort / heaviness to be more pronounced towards end of the day, frequent short walks around your home initially can assist your recovery along with rest periods.

 

• Low impact exercise is recommended e.g. walking and swimming as far as your comfort level allows, avoid lifting anything heavier than 3-5 kg for up to 6 weeks after surgery, avoid running, jogging and heavy exercise. Driving is usually possible from about 2 weeks post surgery when quite comfortable.

 

• Introduce fibre diet slowly post-op, start with soluble fibre, avoid spicy and acidic foods for 4-6 weeks and drink adequate fluids (about 1.5-2 litres a day)

 

• Please report if there are any signs of heavy bleeding/clots post-operatively this is unlikely but there maybe small amounts of bright blood seen with bowel motions. Sexual intercourse may be possible from about 4 – 6 weeks post surgery when comfortable.

 

•  Simple analgesia can help improve comfort level and assist mobility i.e. regular paracetamol a stronger analgesia may be dispensed on discharge to take if required.