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Rectal prolapse repair

Rectal prolapse repair is surgery to fix a rectal prolapse \, in which the last part of the colon (called the rectum) sticks out through the anus.

Rectal prolapse may be partial, involving only the mucosa . Or it may be complete, involving the entire wall of the rectum. It can occur in children, but is much more common in older people.

Surgery is needed to correct rectal prolapse in adults and some children. Most surgical procedures for rectal prolapse are done under general anesthesia. For older or sicker patients, epidural or spinal anesthesia may be used.

There are three basic types of surgery to repair rectal prolapse. Your surgeon will decide which one is best for you.

For healthy adults, an abdominal procedure has the best chance of success. While you are under general anesthesia, the doctor makes a surgical cut in the abdomen and removes a portion of the colon. The rectum may be attached (sutured) to the surrounding tissue.

Sometimes a soft piece of mesh is wrapped around the rectum to help it stay in place. This procedure can also be done with laparoscopic surgery (also known as "keyhole" or "telescopic" surgery).

For older adults or those with other medical problems, an approach from below (perineal approach) might be less risky. However, with the perineal procedure, the condition will be more likely to come back (recur).

While you are under general, epidural, or spinal anesthesia, the prolapsing rectum or colon can be treated from the pelvic floor (perineum). The doctor will remove a portion of the colon, suture the rectum to the surrounding tissues, or both.

Very frail or sick patients may need a small procedure to reinforce the sphincter muscles. This technique encircles the muscles with a band of soft mesh or a silicone tube. This approach provides only temporary improvement and is rarely used.

Why the Procedure is Performed

For children, rectal prolapse does not always require surgery. However, children whose rectal prolapse does not improve over time may need surgery. Infant prolapse often disappears without treatment.

Surgery to repair rectal prolapse is advised for most adults.

Risks

Risks for any anesthesia include the following:

  • Breathing problems, pneumonia
  • Heart problems
  • Reactions to medications

Risks for any surgery include the following:

  • Bleeding
  • Infection

Other risks include:

  • Constipation is very common, although most patients have constipation before the surgery.
  • Incontinence that is present before the surgery often improves. However, in a small number of patients, incontinence can get worse.
  • Prolapse can return after either abdominal or perineal surgery.

Before the Procedure

During the 2 weeks before your surgery:

  • Two weeks before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), and naprosyn (Aleve, Naproxen).
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop. Ask your doctor for help.
  • Always let your doctor know if you have been sick before your surgery. This includes a cold, flu, herpes flare-up, or any other illness.
  • Eat high-fiber foods and drink 6 - 8 glasses of water every day.

The day before your surgery:

  • Eat a light breakfast and lunch.
  • You may be told to drink only clear liquids such as broth, clear juice, and water after noon.
  • Do NOT drink anything after midnight, including water. Sometimes you will not be able to drink anything for up to 12 hours after surgery.
  • Your doctor or nurse may ask you to use enemas or laxatives to clear out your intestines. They will give you instructions.

On the day of your surgery:

  • Take any medications that your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

How long you stay in the hospital depends on the procedure. The average stay for open abdominal procedures is 5 - 8 days. You will go home sooner if you had laparoscopic surgery. The average stay for perineal surgery is 2 - 3 days. You should make a complete recovery in 4 - 6 weeks.

Outlook (Prognosis)

The surgery is usually effective in repairing the prolapse. The long-term outlook is good. Constipation and incontinence can be problems for some patients.

References

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and Rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 50.

Updated: 5/17/2010

Shabir Bhimji, MD, PhD, Specializing in Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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