External rectal prolapse is the protrusion of the rectum through the anus. It presents as a lump that can cause pain, bleeding, faecal incontinence. Internal prolapse can occur when the rectum prolapses but not far enough through the anus. It can present with symptoms of faecal incontinence and or obstructed defecation.
Laparoscopic Ventral Mesh Rectopexy
What is rectal prolapse?
What is laparoscopic ventral mesh rectopexy?
A rectopexy is an operation to treat external, internal rectal prolapse and sometimes rectocele.
What does the operation involve?
The operation is performed laparoscopically (Keyhole) under general anaesthesia. It involves freeing the rectum from the back wall of the vagina (the bladder in men) and pulling the prolapsed rectum back to its normal anatomical position and fixing it to the lower spine using a mesh.
What mesh is used?
Biological mesh is commonly used in Australia. It is made from organic material (e.g. Porcine small intestine).It acts as a scaffold allowing body’s own repair cells to remodel and reinforce the rectum. The mesh is dissolved with time
How successful is the surgery?
If the operation is being performed for external prolapse, the risk of the prolapse coming back is approximately 5%.
If the operation is performed for internal prolapse, 4 out of 5 patients will experience significant improvement in symptoms. 1 out of 5 patients will have no improvement in symptoms following surgery. Of those who have improved, 1 in 5 (20%) will experience recurrence of prolapse or symptoms. On rare occasions, patients may experience worsening of symptoms following surgery
Is laparoscopic ventral mesh rectopexy better than other prolapse operations?
There are two major types of rectal prolapse surgery: abdominal operations and perineal operations. Abdominal operations are superior to perineal operations. The most common abdominal operations for rectal prolapse are laparoscopic ventral and laparoscopic posterior mesh rectopexy. While there is no evidence that one kind of rectopexy is better than the other, there is evidence that ventral mesh rectopexy is associated with lower risk of postoperative constipation as it avoids dissection close to pelvic nerves
What are the risks associated with ventral mesh rectopexy?
- Conversion to open
- Bleeding – This is rarely significant but when it significant may need urgent return to surgery to stop the bleeding
- Infection – This is also uncommon but if pelvic abscess occurs then an intervention (surgery or radiology assisted) may be required
- Vaginal or rectal injury – Injury to the vagina can be safely repaired during the operation. Injury to the rectum may result in an infection requiring further surgery and potentially a stoma
- Ureteric injury
- Urinary retention
- Port site hernia
- Pain during sexual intercourse (uncommon and usually improves with time)
- Sexual dysfunction in men (rare)
- Injury to other abdominal structures (rare)
- DVT/PE – Blood clots in the legs / lungs
- Heavy lifting (>5kg) for 6 weeks after surgery. No running. No gym
- Expect that your bowel function will be different after surgery compared to before
- Avoid constipation. Take regular laxatives (e.g. Movicol one sachet twice daily)
- Avoid straining when on the toilet
- Avoid sexual intercourse for 4 weeks after surgery