45130 Excision of rectal procidentia, with anastomosis; perineal approach

Name of the Procedure:

Excision of Rectal Procidentia with Anastomosis; Perineal Approach
Common names: Rectal Prolapse Surgery, Altemeier Procedure

Summary

This surgical procedure involves the removal of a prolapsed section of the rectum. The prolapsed rectum is detached and then reattached (anastomosed) to the non-prolapsed part using a perineal (through the pelvis) approach.

Purpose

The procedure addresses rectal procidentia, a condition where the rectum protrudes through the anus. The goal is to restore the normal anatomical position and function of the rectum, alleviate discomfort, and prevent complications like fecal incontinence and ulceration.

Indications

• Symptoms of rectal prolapse, such as a visible bulging from the anus, bleeding, or fecal incontinence.
• Diagnosis of rectal procidentia through clinical examination or imaging.
• Patients who have not responded to non-surgical treatments and experience significant symptoms affecting quality of life.

Preparation

• Patients may be required to fast for a specific period before surgery.
• Instructions may include bowel preparation using enemas or laxatives.
• Pre-operative assessments including blood tests, ECG, and imaging studies may be needed.
• Adjustments to medications, particularly anticoagulants, might be required.

Procedure Description

1. Anesthesia: Administered regional or general anesthesia.
2. The patient is positioned appropriately, usually in the lithotomy position.
3. The surgeon makes an incision around the rectum.
4. The prolapsed rectal segment is excised.
5. Remaining ends of the rectum are sutured together (anastomosed).
6. Any additional supportive procedures, like suturing the rectum to surrounding tissues to prevent future prolapse, may be performed.

7. Closure of the incision with sutures.

   Tools/Equipment: Surgical scalpels, sutures, retractors, and possibly a stapler for anastomosis.

Duration

The procedure typically takes 1-2 hours, though the duration may vary based on complexity.

Setting

The procedure is usually performed in a hospital setting within an operating room.

Personnel

• Lead surgeon specialized in colorectal surgery.
• Surgical nurses
• Anesthesiologist
• Possibly a surgical assistant or resident

Risks and Complications

• Common risks: Bleeding, infection, reactions to anesthesia.
• Rare complications: Anastomotic leakage, stricture formation, chronic pain, recurrence of prolapse.
• Management: Close monitoring post-surgery and prompt treatment of any complications.

Benefits

• Resolution of rectal prolapse and relief from associated symptoms.
• Improved bowel function and quality of life.
• Benefits are typically noticeable within weeks after recovery.

Recovery

• Patients may stay in the hospital for 1-2 days post-surgery.
• Pain management with prescribed medications.
• Instructions on diet modifications and bowel movement management.
• Physical activity may be restricted for a few weeks.
• Follow-up appointments for monitoring healing and functionality.

Alternatives

• Conservative treatments: Pessary devices, bowel regimen, pelvic floor therapy.
• Other surgical options: Abdominal approaches, minimally invasive techniques.
• Pros and cons of alternatives should be discussed with the healthcare provider to determine the best course of action.

Patient Experience

• During the procedure: Under anesthesia, the patient will not feel pain.
• After the procedure: Mild to moderate discomfort managed with pain relief medications.
• Patients may experience some degree of swelling and require assistance with mobility initially.
• Gradual return to normal activities over several weeks with attention to the surgeon’s recovery plan.