Laparoscopic surgery for rectal prolapse
Rectal prolapse is a disease that causes many negative impacts on patients' daily and working life. Among the treatment methods, laparoscopic surgery for rectal prolapse is the technique that helps to thoroughly treat cases of total rectal prolapse in adults.
1. What is rectal prolapse?
Rectal prolapse is a condition in which the rectal wall prolapses outside the anus, visible outside the body.
People with rectal prolapse often experience symptoms such as: Urinary incontinence, sometimes only mucus secretion; constipation, incomplete bowel movements, bowel obstruction; feeling that the rectum is drooping; rectal bleeding; Diarrhea, erratic bowel habits.
Initially the prolapse only protrudes from the anus when the patient has a bowel movement and will return later. The next times, the patient has to push the prolapse back to the old position and the rectal prolapse can progress to chronic.
In the early stages, rectal prolapse can be treated with stool softeners, suppositories, or other medications. However, in most cases, the disease must be completely treated with surgery.
2. Laparoscopic surgery for rectal prolapse
Laparoscopic rectal prolapse includes dissection to release the rectum, direct suturing to the protrusion by Orr - Loygue method or improved techniques such as using Teflon, Ivalon pads as mediators, fixing the rectum into the protrusion, anterior to the sacrum.
2.1 Indications/contraindications Indications: Total rectal prolapse in adults and the prolapsed rectal segment without necrosis; Contraindications: The prolapsed rectum is necrotic or the patient's health does not allow laparoscopic surgery. 2.2 Preparation for surgery Personnel: Gastrointestinal surgeon, anesthesiologist team; Technical facilities: illuminator, cold light, anal surgery kit (ostoscope, probe, anal valve, suction machine, electric knife, pin, scissors, surgical forceps,... ); sutures, lubricants, hydrogen peroxide, methylene blue; The operating table can be rotated to different positions; 2 tool tables; Patient: The patient's condition is clearly explained, the possibility of surgery, the risk of complications, possible sequelae; complete the necessary clinical and paraclinical examination steps; the night before the surgery, it is necessary to remove the enemas and use sedation; perianal hair removal performed on the operating table after sedation or regional anesthesia; on the day of surgery the patient should fast before the surgery; Medical records: Ensure completion of prescribed procedures: detailed medical records, minutes of consultation, minutes of pre-anesthesia examination and written consent to surgery.
2.3 Performing surgery Check the patient's records and check, make sure the right person, the right disease; Patient position: Lie on your back, with your thighs slightly low and legs apart to check out bowels during surgery; Position of surgical personnel: Stand in a suitable position convenient for manipulation; Anesthesia: Endotracheal anesthesia; Place 4 trocars in the following positions: Below the navel (trocar number 1), right iliac fossa (trocar number 2), right ribs (trocar number 3) and left iliac fossa (trocar number 4); Exploration and assessment of lesions and organs in the patient's abdomen. Next, bring the patient to the maximum low head position and tilt to the right, move the small intestine up and to the right, clearly exposing the pelvis and left half of the abdomen; Rectal release: Open the right border of the sigmoid colon - rectum above the protrusion, dissection of the sigmoid colon - rectum, dissection of the posterior mesentery. Pay attention to perform gentle dissection to avoid damage to surrounding tissues; Left rectal dissection: Going down from the left iliac fossa, opening the left peritoneal leaf, exposing the posterior rectal cavity, using an ultrasound knife or an electric knife to cut the left rectal peritoneum; Anterior dissection of the rectum from the bladder, prostate, 2 seminal vesicles (in men) or uterus, vagina (in women) is sufficient. At this point, the rectum is completely free from the peritoneum and the suspended contents are retained in the pelvis; Rectal fixation: Perform suture of the rectus serosa with protrusion, avoiding suturing to the iliac vein. After fixing the rectum, it is necessary to check from the anus and pull the rectum up high enough. In addition, the rectum can be fixed with indirect protrusion with Ivalon, Teflon pads; Insert a pelvic drainage if necessary, withdraw and close the trocar holes, concluding surgery.
2.4 Post-operative follow-up Monitor the overall status including vital indicators such as: pulse, blood pressure, temperature, respiration; Closely monitor bleeding and infection after surgery; After surgery, use 2 antibiotics in combination for 5-7 days; Replenish water - electrolytes and energy daily; Feed when there is intestinal circulation; Exercise circular muscles after surgery. 2.5 Complications and management Surgical complications:
Bleeding: In case the bleeding cannot be stopped by laparoscopic surgery, then open surgery; Injury to adjacent organs: Switch to open surgery for examination and treatment according to each specific situation. Complications after surgery:
Constipation: Caused by suturing angle or narrowing the lumen of the rectum. Cases of severe constipation must have surgery again; Recurrence of rectal prolapse : Due to the reason that surgery is not enough to pull the rectum up and also need to have surgery again. Laparoscopic surgery for rectal prolapse has the advantage of helping the patient recover faster, with small surgical scars, and a short hospital stay,... compared to open surgery. When indicated to perform surgery, the patient needs to coordinate with all requirements of the doctor. This helps the surgical process go smoothly, reducing the risk of complications.
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