45400 Laparoscopy, surgical; proctopexy (for prolapse)

Name of the Procedure:

Laparoscopy, surgical; proctopexy (for prolapse)

Summary

Laparoscopic proctopexy is a minimally invasive surgical procedure used to correct rectal prolapse, a condition where the rectum falls out of its normal place and protrudes from the anus. The surgeon uses small incisions and a camera to guide the repair, securing the rectum back into place using mesh.

Purpose

The procedure addresses rectal prolapse, which can cause discomfort, fecal incontinence, and difficulty with bowel movements. The main goals are to restore normal anatomy, improve bowel function, and alleviate discomfort associated with prolapse.

Indications

• Persistent or severe rectal prolapse
• Discomfort, pain, or difficulty with bowel movements due to prolapse
• Fecal incontinence or chronic constipation associated with prolapse
• Patients who have not responded to non-surgical treatments

Preparation

• Patients are usually instructed to fast for 8-12 hours prior to surgery.
• Bowel-cleansing preparations, such as laxatives or enemas, may be required the day before the procedure.
• Preoperative assessments, including blood work, ECG, and possibly imaging studies of the abdomen and pelvis.
• Patients should discuss any current medications with their doctor, as adjustments may be necessary.

Procedure Description

1. The patient is given general anesthesia.
2. Several small incisions are made in the abdominal wall.
3. A laparoscope (a small camera) is inserted through one of the incisions to provide visual guidance.
4. Surgical instruments are inserted through the other incisions.
5. The rectum is freed from surrounding tissues.
6. A mesh is attached to the rectum and then fixed to the sacrum, securing the rectum in its normal anatomical position.
7. The incisions are closed with sutures or surgical glue.

Duration

The procedure typically takes 2-3 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon
• Surgical assistants or nurses
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (like the bladder or intestines)
• Mesh-related complications, such as erosion or infection
• Recurrence of prolapse
• Bowel obstruction
• Anesthetic complications

Benefits

• Resolution of rectal prolapse
• Improved bowel function and control
• Reduction or elimination of associated discomfort
• Shorter recovery time compared to open surgery

Recovery

• Patients typically stay in the hospital for 1-2 days post-surgery.
• Pain and discomfort are managed with medications.
• Gradual return to normal activities usually within 2-4 weeks.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor recovery and ensure proper healing.

Alternatives

• Non-surgical treatments, such as pelvic floor exercises and stool softeners, may be considered for mild cases.
• Open proctopexy, which involves a larger incision and longer recovery time.
• Perineal procedures, which are less invasive but may have higher recurrence rates.
• Each alternative has its own risks, benefits, and suitability depending on the patient’s specific condition and overall health.

Patient Experience

• During the procedure, the patient is under general anesthesia and won't feel anything.
• Post-procedure, patients may experience some abdominal pain or discomfort, usually managed with pain medication.
• Bloating and changes in bowel habits may occur temporarily.
• Full recovery and the resumption of normal activities are generally expected within a few weeks.