Understanding Rectopexy: A Procedure for Rectal Prolapse

Introduction and Terminology

Rectopexy is a surgical procedure used in the treatment of rectal prolapse, a condition where the rectum—the last part of the large intestine—descends out of its usual position. In the USA, the procedure has seen growing acceptance as an effective solution, with an estimated 30,000 surgeries performed annually. As you embark on understanding this procedure, several terms are important to familiarize with:

• Rectum: The final segment of the large intestine that stores feces before it’s expelled from the body.
• Prolapse: A condition where organs fall down or slip out of place; in this context, it refers to the rectum descending out of its usual position.
• Rectopexy: A surgical procedure used to secure the rectum in its correct position.

Indications for Rectopexy

Rectopexy is generally indicated for individuals suffering from complete or partial rectal prolapse. The main symptom of rectal prolapse is the sensation of a bulge or the appearance of reddish-colored mass protruding from the anus. Other associated symptoms that could warrant Rectopexy include:

• Persistent or recurring rectal bleeding.
• Fecal incontinence, the inability to control bowel movements, leading to leakage.
• Chronic constipation or straining during bowel movements.
• Anal pain, discomfort, or irritation.
• Feeling of incomplete evacuation after a bowel movement.

It is important to note that these symptoms can also be associated with other medical conditions. Therefore, proper diagnosis by a healthcare provider is crucial to determine if Rectopexy is the most suitable treatment option.

Pre-Op Preparation

Preparing for Rectopexy involves several steps designed to ensure the procedure is safe and effective. These typically include:

• Fasting: Avoid eating or drinking anything for a few hours before the surgery.
• Adjustments to medications: Certain medications may need to be temporarily stopped or adjusted; discuss this with your healthcare provider.
• Pre-op labs or imaging: Tests may be ordered to assess your general health before surgery.
• Pre-clearance authorization: Necessary to verify that your insurance will cover the procedure.
• Arranging transportation: As this is a surgical procedure, you’ll need someone to drive you home after surgery.

Please note that these are general guidelines. Your doctor will provide you with more specific instructions based on your individual circumstances. Our telemedicine primary care practice is well equipped to offer pre-operative clearances, order pre-op labs and imaging, and provide a personalized preparation plan for your surgery.

Procedure Technique for Rectopexy

Rectopexy is a surgical procedure to repair rectal prolapse, an uncomfortable condition where the rectum descends from its usual position. This section will explain the step-by-step process of the procedure, simplifying the medical terms for better understanding.

Before we start, it’s worth noting that there are several types of rectopexy procedures, including open rectopexy, laparoscopic rectopexy, and robotic-assisted laparoscopic rectopexy. Your surgeon will choose the most appropriate technique based on your specific condition and overall health. However, the basic steps remain similar.

1. Anesthesia

The procedure begins with the administration of general anesthesia. This means you’ll be asleep and won’t feel pain during the surgery.

2. Positioning

After anesthesia, you will be carefully positioned on the operating table, usually lying on your side or back. The surgical team then preps the surgical area with antiseptic solutions to minimize infection risk.

3. Incision and Access

In open rectopexy, the surgeon makes a single large incision in the lower abdomen. In contrast, laparoscopic and robotic-assisted rectopexy involve several smaller incisions through which the surgeon inserts special surgical instruments and a camera for visualization.

4. Rectal Mobilization

The surgeon carefully frees the rectum from the surrounding tissues. This step is called rectal mobilization and aims to fully expose the prolapsed section of the rectum.

5. Rectopexy (Rectal Fixation)

The rectum is then lifted and secured back to its original position in the pelvis. This is typically done using stitches or surgical mesh. The exact method can vary based on the specific procedure being used.

6. Confirmation and Closure

Once the rectum is securely in place, the surgeon will check to ensure it is correctly positioned and secured. After this, the surgical instruments are removed, and the incisions are closed with stitches.

7. Recovery

After the procedure, you’ll be moved to a recovery room where the medical staff will closely monitor your vital signs as you wake from anesthesia. While we’ll discuss postoperative care in the next section, it’s important to note that full recovery typically takes a few weeks.

Please remember, this is a generalized overview of the rectopexy procedure, and the specific steps may vary based on your personal circumstances and the surgical technique chosen by your surgeon. Therefore, it’s essential to discuss the details of the procedure with your healthcare provider to understand exactly what to expect during your rectopexy surgery.

Duration of Rectopexy

Typically, a rectopexy procedure lasts between one to three hours. The exact duration can vary based on the specific surgical technique used and the individual patient’s condition.

Post-Op Recovery from Rectopexy

After a rectopexy, you will likely stay in the hospital for 2 to 3 days before discharge. The first follow-up appointment usually takes place within 2 weeks after the surgery, followed by routine check-ups as recommended by your surgeon. Rehabilitation or physical therapy isn’t commonly needed after rectopexy, but lifestyle changes such as dietary adjustments and a regular exercise routine can be beneficial for overall colorectal health. You may need to take 1 to 2 weeks off work, depending on the nature of your job. Full recovery from a rectopexy procedure can take up to six weeks. Remember, our primary care practice is here for you, offering extended weekday and weekend hours for services such as providing work or school notes.

Effectiveness of Rectopexy

Rectopexy is considered an effective treatment for rectal prolapse, with success rates reported as high as 80 to 90 percent in several studies. The procedure effectively addresses both the prolapse and associated symptoms such as incontinence and constipation.

Factors contributing to the success of rectopexy include patient’s overall health, the presence of other bowel diseases, and the extent of the prolapse. Laparoscopic and robotic-assisted rectopexy procedures, being minimally invasive, often yield better outcomes with shorter hospital stays and faster recovery times.

However, like any surgical procedure, the effectiveness of rectopexy can be influenced by a number of factors. Smoking, obesity, and poor overall health can increase the risk of complications and potentially impact the success of the procedure. In addition, patients with severe constipation or other underlying bowel conditions may experience less symptom relief.

After surgery, continuing healthy lifestyle practices, like maintaining a balanced diet, staying hydrated, and exercising regularly, can help sustain the benefits of rectopexy and minimize the chances of recurrence.

Remember that while these statistics provide a general overview, the specific outcomes can vary based on individual circumstances. It’s always a good idea to discuss your personal situation and potential outcomes with your healthcare provider to get the most accurate understanding of what to expect.

Adverse Events with Rectopexy

Like any surgical procedure, rectopexy carries certain risks. Common adverse events include:

• Wound infection (2-3%): Infection in the surgical wound can occur due to exposure to bacteria. It can usually be managed with antibiotics, wound care, and occasionally, additional surgery.
• Bleeding (1-2%): Bleeding may occur postoperatively. If the bleeding is severe, it may require blood transfusion or return to the operating room.
• Nerve damage (1%): Damage to nerves can result in changes in bladder function or sexual function, although these risks are low in this type of surgery.
• Recurrence of rectal prolapse (5-10%): Despite successful surgery, there’s a chance that rectal prolapse can recur. Lifestyle changes and physical therapy may help prevent recurrence.
• Mortality (<1%): Rectopexy is generally a safe procedure, and the risk of death is extremely low.

Alternatives to Rectopexy

There are several alternatives to rectopexy, including non-surgical and other surgical treatments. Non-surgical options include dietary modifications, pelvic floor exercises, and stool softeners to reduce straining. Other surgical options can include procedures such as a perineal rectosigmoidectomy, especially in patients with significant comorbid conditions or in elderly patients. It’s important to discuss all potential treatment options with your healthcare provider to determine the most appropriate approach for your individual condition.

Experimental or Emerging Technologies

Several emerging technologies are currently being investigated in the treatment of rectal prolapse. One such technology is the use of biologic grafts or meshes in rectopexy procedures. In addition, robotic surgery is becoming more prevalent and may offer certain advantages over traditional laparoscopic surgery, such as increased precision. However, these technologies are still being evaluated for their effectiveness and safety.

Conclusion

Rectopexy is a well-established and effective treatment for rectal prolapse, with a low risk of serious complications. However, like all medical procedures, it’s important to understand the potential risks and alternatives. Discuss all available treatment options with your healthcare provider to make an informed decision about your care.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.