Overview

esophagus, stomach, small intestine, large intestine, rectum — Figure 1: Normal intestinal anatomy

What is rectal prolapse?

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

What is laparoscopic rectopexy?

Laparoscopic rectopexy is one of the surgeries that is 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 protrudes through the anus. Usually, stitches are used to secure the rectum, often along with mesh.

The term "laparoscopic" refers to surgery performed through several very small incisions in the abdomen. A laparoscope (a long, thin camera) is placed through an incision near the belly button in order to see the inside of the abdomen. The other small incisions are used to place instruments to perform the surgery.

Procedure Details

What happens during the laparoscopic rectopexy surgery?

There are three 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 belly button. A laparoscope will be inserted into the abdomen through this incision. Images taken by the laparoscope will be projected onto monitors.

Once the laparoscope is in place, the surgeon usually makes several more small incisions in the abdomen (figure 2). The number and position of these incisions depends on the size and shape of your abdomen, the preference of the surgeon and other factors. Long, thin surgical instruments will then be placed through these incisions to complete the surgery.

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

Step 2: Freeing up the rectum and pulling it up so it no longer protrudes

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.

Step 3: Securing the rectum

Stitches will be placed around the rectum to secure it in place. Mesh may be used along with the stitches. 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. Your stitches will be dissolvable and under the skin; you will not have any stitches that need to be removed.

Recovery and Outlook

What happens after a laparoscopic rectopexy?

After the surgery, you will be:

Admitted to the hospital.
Able to eat food as tolerated.
Given pain medications as needed.
Able to get out of bed and walk around the same night of your surgery.
Able to go home once you are able to eat, have no signs of infection, have return of bowel function, and can care for yourself 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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Laparoscopic Rectopexy