Rectal prolapse repair surgery is a surgical procedure used to treat mucosal or full-thickness rectal prolapse protruding externally. This operation is primarily targeted at patients for whom conservative treatments have failed or who exhibit severe symptoms. The surgery involves repositioning and fixing the prolapsed tissue to restore anal function and prevent complications. The surgical approach varies depending on the degree of prolapse and patient age, with options including transanal or laparoscopic techniques. The goal is to strengthen the anal sphincter support and repair levator ani muscle damage.
This therapy is suitable for patients with second to third-degree rectal prolapse, especially those experiencing symptoms such as difficulty in defecation, bleeding, or infection. Postoperative care includes physical therapy and lifestyle adjustments to reduce recurrence risk and improve quality of life.
The main surgical types include Altemeier procedure (perineal rectosigmoidectomy) and Delorme procedure (laparoscopic anterior rectal wall resection and mucosal plication). Transanal surgery involves directly removing the prolapsed mucosa and suturing the tissue, suitable for elderly patients or those unable to tolerate major surgery. Laparoscopic surgery involves repairing the puborectalis muscle through small abdominal incisions, suitable for younger patients with more severe prolapse.
The mechanism involves reconstructing the anatomical structure of the rectum and pelvic floor, such as using biological patches to enhance tissue support or resecting redundant bowel segments to reduce pressure. Postoperative care includes placing anal packing for several days and fixing tissues with sutures or metal clips to promote natural healing.
Primarily indicated for persistent complete rectal prolapse causing obstructed defecation, recurrent infections, or affecting daily activities. Surgery is recommended when patients experience severe prolapse unresponsive to non-surgical treatments such as medication or pelvic floor muscle training.
Additional indications include complex cases with anal incontinence, hemorrhoids, or gynecological prolapse. Pediatric patients with congenital rectal prolapse may also require surgery to prevent developmental issues.
The procedure is usually performed under general anesthesia. Transanal surgery takes approximately 1-2 hours, while laparoscopic procedures require 3-4 hours. Hospital stay typically lasts 2-5 days, with painkillers and antibiotics administered as per physician instructions.
Postoperative care includes a high-fiber diet, avoiding heavy lifting, and regular follow-up. There is no concept of "dosage," but recovery periods vary significantly depending on the surgical method, requiring tailored rehabilitation plans based on individual health status.
Compared to traditional open surgery, modern techniques offer advantages such as smaller incisions and fewer complications. Clinical studies show that 80-90% of patients experience significant symptom improvement within one year post-surgery.
Main risks include:
Serious complications like bowel leakage or massive bleeding are rare but life-threatening. Elderly patients should be cautious about cardiovascular and respiratory responses to anesthesia, and obese patients may have increased infection risks.
Contraindications include uncontrolled diabetes, bleeding disorders, or severe cardiopulmonary diseases. Preoperative preparations involve bowel cleansing, cardiovascular and respiratory assessments, and colonoscopy to ensure suitability for surgery.
Postoperative restrictions include avoiding heavy lifting for three months and regular monitoring of anal function. Immediate medical attention is required if experiencing pain during defecation or persistent bleeding. Absolute contraindications include severe coagulation disorders or systemic infections.
Anticoagulant medications (e.g., aspirin) should be discontinued before and after surgery, with antibiotics used to prevent infection. If hemorrhoidectomy is performed concurrently, anesthesia depth and suturing techniques should be adjusted accordingly.
Patients undergoing radiotherapy or chemotherapy should have their immune status evaluated before surgery. Medications like steroids may affect tissue healing and should be discussed with the physician for dose adjustments.
Long-term follow-up shows a success rate of over 85%, with laparoscopic techniques having a 5-year recurrence rate below 15%. Studies confirm that biological patches reduce suture rupture risk, and transanal procedures tend to have fewer complications in elderly patients.
Clinical guidelines recommend reserving surgery for those with severe symptoms, as its efficacy surpasses medication. However, overall health and surgical risks should be carefully weighed.
Non-surgical options include:
In severe cases, options such as anal sphincteroplasty or artificial mesh implantation may be considered, though these may not offer as durable results as traditional surgery.
What preparations are needed before surgery? What examinations are required?
Preoperative assessments include digital rectal examination, rectoscopy, and imaging studies (such as defecography or MRI) to evaluate the extent of prolapse and potential complications. Patients should fast and abstain from water for 12 hours before surgery, and anticoagulants should be discontinued as advised. It is also important to inform the doctor of medical history and current medications to reduce anesthesia and surgical risks.
How can postoperative pain and swelling be alleviated? What pain management options are available?
Pain can be managed with prescribed analgesics such as NSAIDs or mild opioids. Local ice packs around the anus can reduce swelling, but direct skin contact should be avoided to prevent frostbite. Sitz baths (warm water sitz baths) are recommended to promote blood circulation and wound healing, with caution to avoid straining during bowel movements.
When can normal bowel movements resume after surgery? How should diet be adjusted?
Initial postoperative constipation may occur due to anesthesia or discomfort. It is advised to increase dietary fiber intake (whole grains, vegetables) and hydration starting 2-3 days after surgery. Avoid spicy or greasy foods to minimize intestinal irritation. Relax muscles during defecation, avoid straining, and use laxatives if necessary, following medical advice.
What activities should be avoided during recovery? When can exercise be resumed?
Heavy lifting (over 5 kg), prolonged sitting, or vigorous exercise should be avoided for four weeks post-surgery to reduce intra-abdominal pressure. Light activities like walking can start one week after surgery, gradually increasing in intensity. High-impact exercises such as running or weightlifting are generally resumed after 6-8 weeks, depending on individual healing progress.
What is the success rate of rectal prolapse repair surgery? Is recurrence common?
Studies indicate that traditional open surgery has a success rate of approximately 70-90%, with laparoscopic or transanal minimally invasive procedures showing variable long-term outcomes. Adherence to lifestyle modifications, such as avoiding heavy lifting and maintaining bowel regularity, can reduce recurrence to 10-20%. Regular follow-up examinations (every six months) help detect and address issues early.
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