For Rectal prolapse
Key principles
• For significant full thickness rectal prolapse • Standard anastomotic principles apply
Also known as a perineal rectosigmoidectomy, this is used as a way of treating full thickness rectal prolapse and involves removal of prolapsing rectum via the anus andformation of a coloanal anastamosis with sigmoid colon.
Specific preoperative preparation
• Enema • Ensure pre-op confirmation of diagnosis and exclusion of rectosigmoid malignancy
Operation Details
• Lithotomy position under GA • Fixed anal retractor (eg Lonestar) + examination of prolapse • Key steps o Identification of the dentate line and mucosal incision approx. 1cm above this through rectal mucosa o Continue anterior dissection down to and through muscle layer to serosa o Extend laterally o Through serosa/peritoneal layer and identify sigmoid colon o Complete transection of rectal wall and ligate mesorectum o Pull through sigmoid and identify transection/anastomosis point o Ligate sigmoid mesentery o Create colostomy in anterior sigmoid and place anterior and 2x lateral anastamotic sutures to rectal cuff o Complete transection and posterior suture and continue coloanal anastomosis with interrupted full thickness sutures o Spongostan dressing
Post-operative complications
• Immediate o Bleeding (mesentery) o Visceral injury o Anaesthetic complications • Early o Infection o Haematoma o Leak o Pain o DVT/PE etc • Late o Prolapse recurrence