PROCTOPEXY

REASON FOR VISIT:

• Prolapse of rectum
• Anorectal pain
• Bleeding
• Mucous discharge from the anus
• Incontinence
• Protrusion of rectal tissue while having bowel movements

RISK ASSESSMENT

 Bleeding disorder
 Advanced age
 Prior anal surgery
 History of bleeding disorders
 History of allergy to medications
 History of allergy to anesthesia
 Neurological disorders
 Cardiovascular diseases
 Respiratory diseases
 Obesity
 Smoking
 Previous abdominal surgery

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• Chest x-ray
• EKG/ECG
• Barium enema
• Video defecography
• Anal rectal manometry
 • Sitz marker study
• Rigid Proctosigmoidoscopy
• Preoperative antibiotics were administered to the patients
with diseases of the heart valves
• Aspirin and other blood-thinning medications were stopped
for several days before the surgery
• Patient was on fasting for ____hrs before surgery
• Laxative was administered
• Enema was given
• Part was prepared and draped in sterile fashion
• Antibiotic bowel preparation was done

ANESTHESIA:

General anesthesia
Spinal anesthesia

POSITION OF THE PATIENT

Prone position

THE PROCEDURE

Open
Laparoscopic

OPEN RECTOPEXY

• Large incision was given in pelvic abdomen

• Abdomen was opened in layers

Methods:

• Marlex rectopexy
• Suture rectopexy
• Resection rectopexy
MARLEX RECTOPEXY

• The entire rectum was mobilized down to the coccyx posteriorly,

• The lateral ligaments was mobilized laterally,
• The anterior cul-de-sac was mobilized anteriorly
• A nonabsorbable material, such as Marlex mesh / an Ivalon
sponge, was fixed to the presacral fascia.
• The rectum was placed on tension, and the material was partially
wrapped around the rectum to keep it in position.
• The anterior wall of the rectum was not covered with the sponge
or mesh
• The peritoneal reflections were closed to cover the foreign body.

SUTURE RECTOPEXY

• The entire rectum was mobilized down to the coccyx posteriorly,

• The lateral ligaments was mobilized laterally,
• The anterior cul-de-sac was mobilized anteriorly
• The rectum was fixed to the presacral fascia with suture

RESECTION RECTOPEXY

• The entire rectum was mobilized down to the coccyx posteriorly,

• The lateral ligaments was mobilized laterally,
• The anterior cul-de-sac was mobilized anteriorly
• The redundant sigmoid colon was resected,
• The remaining colon was anastomosed to the top of the rectum.
• The lateral ligaments / the rectal fascia were sutured to the
presacral fascia with the rectum on tension.
o The peritoneum and fascia of the transversalis muscle was
closed with a running absorbable suture.
o The remaining fascial layers were closed with the running
or interrupted absorbable sutures.
o The skin was closed with a subcuticular absorbable suture
such as Monocryl.
o Collodian or adhesive Steri-strips are placed on the wound
LAPROSCOPIC RECTOPEXY

• Three to four small incisions were made in the abdomen / in the

umbilicus (belly button).
• Laparoscope was inserted in an incision. The abdomen was filled
with gas
• Camera was inserted through one of the tubes
 Methods:

Marlex rectopexy
Suture rectopexy
Resection rectopexy

MARLEX RECTOPEXY

• The entire rectum was mobilized down to the coccyx posteriorly,

• The lateral ligaments was mobilized laterally,
• The anterior cul-de-sac was mobilized anteriorly
• A nonabsorbable material, such as Marlex mesh / an Ivalon
sponge, was fixed to the presacral fascia.
• The rectum was placed on tension, and the material was partially
wrapped around the rectum to keep it in position.
• The anterior wall of the rectum was not covered with the sponge
or mesh
• The peritoneal reflections were closed to cover the foreign body.

SUTURE RECTOPEXY

• The entire rectum was mobilized down to the coccyx posteriorly,

• The lateral ligaments was mobilized laterally,
• The anterior cul-de-sac was mobilized anteriorly
• The rectum was fixed to the presacral fascia with suture

RESECTION RECTOPEXY

• The entire rectum was mobilized down to the coccyx posteriorly,

• The lateral ligaments was mobilized laterally,
 • The anterior cul-de-sac was mobilized anteriorly
• The redundant sigmoid colon was resected,
• The remaining colon was anastomosed to the top of the rectum.
• The lateral ligaments / the rectal fascia were sutured to the
presacral fascia with the rectum on tension.
o Small incisions were sutured

AFTER PROCEDURE:

• Immediately after surgery the patient will be taken to a

recovery area
• Monitoring the blood pressure/pulse/temperature
• Nothing is taken by mouth for _____ hr

DURATION
_______hrs

POSTOPERATIVE CARE

• Take antibiotic treatment as prescribed

• Take pain medications prescribed
• Observe for in discharge from suture site
• Surgical wound dressings will be kept clean and dry
• Take liquid diet for_____ days

COMPLICATIONS

• Infection
• Bleeding
• Intestinal injury
• Anastomotic leak
• Bladder and sexual function alterations
• Constipation
• Outlet obstruction
• Myocardial infarction
• Pulmonary embolus
 • Deep vein thrombosis
• Hernia

INSTRUCTIONS:

• Rest as much as you can.

• Avoid heavy lifting or straining for a few weeks.
• Don’t strain on the toilet.
• Take measures to prevent constipation, such as eating high fibre
foods and drinking plenty of water.

FOLLOW-UP

_______days after surgery