45540 Proctopexy (eg, for prolapse); abdominal approach

Name of the Procedure:

Proctopexy (e.g., for prolapse); abdominal approach
Common name: Abdominal Rectopexy
Technical/medical term: Abdominal Proctopexy

Summary

Abdominal Proctopexy is a surgical procedure used to correct rectal prolapse. During the procedure, the rectum is repositioned and secured to prevent it from slipping out of its normal position. This is done through an abdominal incision.

Purpose

The procedure addresses rectal prolapse, a condition where the rectum protrudes through the anus. The goals are to restore the normal position of the rectum, alleviate symptoms such as discomfort and incontinence, and improve the patient's quality of life.

Indications

• Rectal prolapse
• Symptoms include a protruding rectum, incontinence, constipation, or discomfort
• Significant impact on daily activities and quality of life
• Failure of conservative treatments like dietary changes, pelvic floor therapy, or less invasive interventions

Preparation

• Fast for at least 8 hours before the procedure
• Adjust or pause certain medications as instructed by your doctor
• Undergo preoperative assessments such as blood tests, colonoscopy, and imaging studies
• Cleansing of the bowel may be required via a specific protocol

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the pelvic cavity.
3. The surgeon carefully repositions the rectum to its proper location.
4. The rectum is then fixed to the sacrum (a bony structure within the pelvis) using sutures or a mesh.
5. The incision is closed, and the patient is monitored as they wake up from anesthesia.

Duration

The procedure typically takes around 2 to 3 hours.

Setting

Abdominal Proctopexy is performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical assistant or resident

Risks and Complications

• Common risks: bleeding, infection, and adverse reactions to anesthesia
• Rare risks: damage to nearby organs, deep vein thrombosis, recurrence of prolapse
• Possible complications: constipation, incontinence, difficulty in bowel movements
• Most complications can be managed with prompt medical intervention.

Benefits

• Relief from symptoms of rectal prolapse
• Improved bowel function
• Enhanced quality of life
• Benefits may be noticed within a few days to weeks post-surgery

Recovery

• Hospital stay of 2 to 5 days post-operation
• Gradual resumption of normal activities in 4 to 6 weeks
• Follow-up appointments to monitor recovery
• Avoid heavy lifting and straining during bowel movements initially
• Possible use of stool softeners or laxatives to ease bowel movements

Alternatives

• Conservative treatments: dietary adjustments, pelvic floor exercises, and biofeedback therapy
• Less invasive surgical procedures: perineal rectosigmoidectomy or Delorme procedure
• Pros of alternatives: less invasive, shorter recovery time
• Cons: Possible lower success rate, prolapse may recur

Patient Experience

• During the procedure: Unconscious under general anesthesia
• After the procedure: Pain managed with medication, initial discomfort at the incision site, potential temporary catheter use
• Postoperative care includes pain management, gradual return to eating and normal activities, and monitoring for any signs of complications.