Rectopexy is an operation performed to repair a rectal prolapse. In most instances it can be performed by laparoscopy (keyhole). The procedure is done under general anaesthetic (completely asleep). Antibiotics are given to minimise the risk of wound infection. Measures such as calf compressors and anticoagulants like heparin are given to reduce the risk of deep vein thrombosis. A catheter is placed in the bladder to drain and measure urine output. A 1cm incision in the umbilicus (belly button) is made and a port is placed through which a laparoscope (camera) is inserted. Three or so 5mm incisions are made through the abdominal wall and further ports are placed to allow instruments. There are a number of different ways to perform a rectopexy. The usual operation is called an anterior mesh rectopexy. A dissection is performed in front of the rectum and behind the vagina to low down in the pelvis. The prolapse is reduced back into the pelvis and the rectum is secured with a mesh (usually dissolvable) to the sacrum by a series of sutures. The wounds are then closed with deep sutures and then superficial sutures (stitches).
All going well the hospital stay can be as short as 2-3 days but a longer stay may be necessary.
The pain after the procedure is usually well controlled by medications. For the first day, A PCA (patient controlled analgesia) pump may be used. This contains morphine or a morphine type drug. In most cases, patients can be switched to oral analgesics reasonably quickly. Once discharged, analgesics are only required if pain persists. If needed Panadol (2 tablets every 4-6 hours) and/or ibuprofen (400mg 4-6hourly) can be used. Occasionally, stronger pain killers like endone are needed. Pain is always variable and can persist for a number of weeks at home. It should however slowly improve. If pain worsens, it is important to get reviewed by either your GP or surgeon.
Wounds are usually closed with stitches that are underneath the skin and are dissolvable. They do not require removing. The wounds will be covered by a waterproof dressing. You can shower and bathe with the dressing on. The dressings can be removed after 1 week. No dressings are then required and the wounds can be left open to the air. If there is still some discharge, replace the dressings.
Rectal prolapse is associated with bowel disturbance. Often people have had chronic constipation as a predisposing risk factor for the prolapse. The prolapse can also lead to faecal incontinence (leakage of stool). Fixing the prolapse can have a variable effect on the bowel function. One of the perceived benefits of anterior mesh rectopexy is that function is often improved afterwards. It is not always the case unfortunately. In the first few weeks after the operation it is important not to strain. A high fibre and fluid diet is important. A laxative such as movicol (1-2 sachets daily) is sometimes prescribed to prevent constipation.
Diet and nutrition
Once at home you can resume a normal diet as soon as you like. Appetite may not return to normal for a few weeks.
Most people return to normal after 2- 4 weeks. Don’t lift anything over 1-2kg during this time. Walking and normal activities around the house is encouraged if you feel comfortable enough. This helps recovery and minimises other risks like DVT. Don’t do any abdominal exercises for at least 4 weeks and then start slowly and continue if you don’t feel any discomfort.
One can return to work when comfortable and when the normal post-operative fatigue has lessened. Most people require between 2 – 4 weeks off work depending on the physical requirements of the job.
Rectopexy is a major surgical procedure. Most people have no complications and if complications occur, they are usually minor. There is a 1-2% risk of a major complication. If recognised early and treated appropriately, these complications can be managed successfully. Major complications include major bleeding, other organ damage, severe infections, heart and lung complications.
A general list of complications include
Bleeding – requiring blood transfusion and occasionally, return to theatre.
Wound infection or slow wound healing – redness, inflammation and discharge can be signs of a wound infection. This is usually treated by opening part of the wound to allow drainage and sometimes antibiotics.
Mesh infection/erosion – Rarely, the mesh gets infected and needs to be removed. There are reported cases of mesh eroding through the vagina and / rectum. This is less likely with absorbable meshes.
Damage to other organs – Very uncommonly other intra-abdominal organs can be damaged during rectopexy. Further surgery may be necessary if such damage occurs.
Deep vein thrombosis, pulmonary embolism, heart attack, stroke, pneumonia, urinary tract infection – these are all complications of major surgery. Many measures are undertaken to prevent these complications and the risk is very low.
Conversion to open surgery – Uncommonly, it is technically difficult or unsafe to proceed via the keyhole approach and a larger open incision is made to complete the operation.
Bowel obstruction – after any abdominal surgery adhesions (scar tissue) develops. This is essential for normal healing. Occasionally, a bowel can become blocked due to these adhesions and this may occur at any time after the surgery (from weeks to years). Keyhole surgery has the potential to form fewer adhesions and therefore reduce this risk.