For Rectal prolapse
Key principles
• Mucosal sleeve resection • Good for small or incomplete prolapse or high risk patients
Also known as a mucosal sleeve resection, this is to treat small full thickness rectal prolapse and involves removal of prolapsing rectal mucosa with mucosal-mucosa anastomosis
Specific preoperative preparation
• Enema v. full bowel preparation • Ensure pre-op confirmation of diagnosis and exclusion of rectosigmoid malignancy
Operation Details
• Lithotomy position under GA or regional • Fixed anal retractor (eg Lonestar) + examination of prolapse • Reproduce prolapse • Infiltrate submucosal plane with saline containing adrenaline to facilitate dissection and limit bleeding • Circumferential incision through mucosa 1cm proximal to detnate line • Identify white annular fibres of rectal wall lying deep to submucosa • Develop submucosal plane circumferentially to apex of prolapse • 3-0 PDS plication sutures to the muscle at numbers of the clock face • Divide mucosa • Re-approximate mucosal edges using 3/0 vicryl • Spongostan dressing
Post-operative complications
• Immediate o Bleeding (mesentery) o Visceral injury o Anaesthetic complications • Early o Infection o Haematoma o Pain o Anastomotic break down o DVT/PE etc • Late o Prolapse recurrence o Stricture
Specific post-operative care
• Avoid constipation • Consider metronidazle