Rectal prolapse treatments

The aim of these procedures is to try and restore the prolapsed bowel back into the pelvis in its normal position or remove part of the redundant bowel. The treatment options will depend on your general health whether you still want to have a family, as well as your symptoms and the degree of rectal prolapse. The most appropriate treatment option for you will be discussed at the clinic at an individual basis.

Laparoscopic Ventral Mesh Rectopexy (VMR)

This is a minimally invasive procedure requiring a general anaesthetic. The operation takes place through small incisions on your abdomen, 0.5-1cm typical size, through which gas is inflated in order to create space and make internal organs easy to see. A tiny camera (laparoscope) is then inserted into the abdomen guiding the insertion of further specialised laparoscopic instruments which are used to perform the repair.

The rectum is then released from the back of the vagina in women and back of prostate in men. A synthetic or biological mesh is then stitched at the lower part of the rectum and the back of the vagina and the mesh is then fixed to the lower part of the backbone supporting the bowel and vagina. Any potential buldge of the rectum into the vagina (rectocele) is also corrected at the same time. The role of the mesh is to cause the body to form scar tissue and strengthen the repair giving it a more lasting effect.

Benefits of laparoscopic Ventral Mesh Rectopexy

The benefits of a laparoscopic procedure compared to an open procedure are:

• less discomfort following the procedure and return back to normal activities much faster.
• reduced risk of bleeding and wound infections,
• less scarring inside the abdomen with the subsequent risk of bowel obstruction,
• smaller abdominal scars offer a better cosmetic result.

Research suggests that the success rate of this procedure is 85% with 10% of patients not noticing any improvement in their symptoms.

Recovery

After the procedure you will wake up in a hospital room. Laparoscopic VMR is normally performed as a day case operation but sometimes patients may need to spend a night in hospital. You are typically expected to go home once you are eating and drinking, are able to manage the pain and walk unaided and have passed some urine. It normally takes about two weeks to fully recover from a laparoscopic VMR and return back to work but it varies from person to person and depends on their general health and the nature of their work. You should avoid any heavy object lifting, strenuous exercise or straining on the toilet for at least 6 weeks to reduce the risk of the prolapse coming back. You will be provided with pain killers and laxatives to keep your motions soft during this period.

Risks of the operation

A laparoscopic VMR is generally a safe procedure. Complications with this procedure which are common to all surgical procedures include infection, bleeding, blood clots, heart problems, pneumonia, urinary retention and anaesthetic risks. The main significant complication in relation to this type of surgery is the risk of mesh erosion into the rectum or vagina (1-3%) or slight worsening of your symptoms (5%), risk of the prolapse coming back and small risk of injury to the bowel. There is also a small risk of sexual or urinary dysfunction (1%), as the nerves controlling these functions are situated behind the vagina or prostate where the rectum is released and where the mesh is placed in order to cause some scarring.

Perineal rectosigmoidectomy (Altmeiers) procedure

This procedure involves removal of the prolapsed redundant bowel (rectosigmoid) through the back passage and joining the rest of the bowel together (anastomosis). The procedure can be performed under regional (spinal) or general anaesthesia and lasts approximately 60 to 90 min. This procedure is usually performed in patients with a significant degree of prolapse that may not be fit enough to undergo an operation through the tummy or because of patient preference. Prior to the procedure you will be given an enema an hour or so before your surgery to clear the lower part of your bowel.

Before the procedure

You will be given an enema an hour or so before your surgery in order to clear the lower part of your bowel.

Recovery

After the procedure you will wake up in a hospital room. After an Altmeier’s procedure you would be expected to spend approximately 3-5 nights in hospital. You are typically expected to go home once you are eating and drinking, are able to manage the pain and walk unaided and have passed some urine. It normally takes a few weeks to fully recover from this procedure but it varies from person to person and depends on their general health. You should avoid any heavy object lifting, strenuous exercise or straining on the toilet for at least 6 weeks to reduce the risk of the prolapse coming back. You will be provided with pain killers and laxatives to keep your motions soft during this period.

Risks of the operation

An Altmeier’s procedure is generally a safe procedure. Complications with this procedure which are common to all surgical procedures include infection, bleeding, blood clots, heart problems, pneumonia, urinary retention and anaesthetic risks. Complications in relation to this type of surgery include the risk of anastomotic leak, risk of slight worsening of your symptoms, risk of injury to the bowel and risk of the prolapse coming back. The risk of the prolapse coming back is low but slightly higher than the laparoscopic VMR procedure.

Delorme’s procedure

This procedure involves removal of the internal lining of the prolapsed redundant bowel through the back passage and placating the muscular layer of the bowel together. The procedure can be performed under regional (spinal) or general anaesthesia and lasts approximately 60 to 90 min. This procedure is usually performed in patients that are generally not very fit to undergo any of the other procedures, in young patients because of the minimal risks to sexual function and fertility or because of patient preference.

Before the procedure

You will be given an enema an hour or so before your surgery in order to clear the lower part of your bowel.

Recovery

After the procedure you will wake up in a hospital room. After a Delorme’s procedure you would be expected to spend approximately 3-5 nights in hospital. You are typically expected to go home once you are eating and drinking, are able to manage the pain and walk unaided and have passed some urine. It normally takes a few weeks to fully recover from this procedure but it varies from person to person and depends on their general health. You should avoid any heavy object lifting, strenuous exercise or straining on the toilet for at least 6 weeks to reduce the risk of the prolapse coming back. You will be provided with pain killers and laxatives to keep your motions soft during this period.

Risks of the operation

A Delorme’s procedure is the safest of the above procedures. Complications with this procedure which are common to all surgical procedures include infection, bleeding, blood clots, heart problems, pneumonia, urinary retention and anaesthetic risks. Complications in relation to this type of surgery include risk of slight worsening of your symptoms, risk of injury to the bowel and risk of the prolapse coming back. The risk of the prolapse coming back is 50 to 70% over 5 years.