Name of the Procedure:

Proctopexy (e.g., for prolapse); perineal approach

Summary

Proctopexy via the perineal approach is a surgical procedure to correct rectal prolapse, a condition where the rectum slips out of its normal place. The surgery involves securing the rectum in its proper position through an incision made in the perineum, the area between the anus and the genitals.

Purpose

Medical Condition or Problem it Addresses:

• Rectal prolapse

Goals or Expected Outcomes:

• Stabilize the rectum in its proper position
• Resolve symptoms such as discomfort, incontinence, and bleeding
• Improve the quality of life of the patient

Indications

Specific Symptoms or Conditions:

• Visible protrusion of the rectum from the anus
• Chronic discomfort or pain in the rectal area
• Fecal incontinence or difficulty with bowel movements
• Frequent bleeding or mucus discharge

Patient Criteria:

• Failed conservative management for rectal prolapse
• Patients in suitable general health for surgery

Preparation

• Fasting for 8 hours prior to surgery
• Adjusting current medications as advised by a physician
• Preoperative evaluation, including blood tests and EKG
• Bowel preparation might be required

Procedure Description

1. Patient is given anesthesia — general or spinal.
2. An incision is made in the perineal area.
3. The rectum is accessed and any prolapsed tissue is repositioned.
4. Sutures or mesh may be used to secure the rectum to the surrounding tissues.
5. The incision is closed with sutures.

Tools, Equipment, or Technology Used:

• Surgical instruments (scalpels, forceps, sutures)
• Anesthesia equipment
• Possible use of mesh

Anesthesia or Sedation Details:

• General anesthesia or spinal anesthesia is commonly used.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeons specializing in colorectal surgery
• Operating room nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

Common Risks:

• Infection at the surgical site
• Bleeding
• Pain or discomfort post-surgery

Rare Risks:

• Recurrence of rectal prolapse
• Injury to surrounding organs (bladder, urethra)
• Deep vein thrombosis (DVT)

Possible Complications:

• Difficulty with bowel movements
• Need for additional surgery

Benefits

• Relief from symptoms of rectal prolapse
• Improved bowel function and control
• Enhanced quality of life

Expected Benefits Realization:

• Most patients experience symptom relief shortly after recovery.

Recovery

• Hospital stay for 1 to 2 days post-surgery
• Pain management with prescribed medication
• Avoid heavy lifting and straining for several weeks
• Follow-up appointments with the surgeon

Expected Recovery Time:

• Full recovery typically takes 4 to 6 weeks.

Restrictions:

• Adherence to dietary recommendations
• Gradual return to normal activities
• Monitoring the surgical site for signs of infection

Alternatives

Other Treatment Options:

• Conservative management (e.g., pelvic floor exercises, stool softeners)
• Abdominal approach for rectopexy

Pros and Cons of Alternatives:

• Conservative management may not effectively treat severe prolapse.
• Abdominal approach may involve different risks and a longer recovery time but could be more suitable in some cases.

Patient Experience

During the Procedure:

• Patient will be under anesthesia and will not feel pain during the surgery.

After the Procedure:

• Pain and discomfort managed with medication.
• Possible feeling of soreness in the perineal area.
• Instructions for wound care and activity modifications will be provided.