Open Rectopexy

Open Rectopexy

Sarah W. Grahn

Madhulika G. Varma

Preoperative Planning

Choice of Procedure

Although this chapter focuses specifically on open abdominal rectopexies, there are certain key decisions that must be made prior to counseling a patient to undergo treatment of their rectal prolapse. Open abdominal rectopexy is an excellent operation for those patients with full-thickness rectal prolapse without significant constipation.

Abdominal or Perineal

Surgical management is aimed at correcting the prolapse, improving continence and/or constipation while minimizing morbidity, mortality, and recurrence rates.

Factors that influence the choice of procedure include the patient’s age, gender, comorbid conditions, functional status, and bowel function. In general, given the higher rates of recurrence for perineal procedures (16%) compared to abdominal approaches (5%), perineal procedures are reserved for elderly patients and those who have a significant perioperative risk for an adverse event (9). Because these procedures can often be completed with regional anesthesia, the lower risk of perioperative complications outweighs the increased recurrence rates in these high-risk patients. However, for patients who are healthy enough for general anesthesia, an abdominal approach is preferred.

Resection or Not

If the patient has chronic constipation, a sigmoid resection should be considered in addition to the rectopexy. If colonic transit times are very prolonged, a subtotal colectomy or sigmoid resection should be considered as part of the operative plan as preoperative retention of markers indicates an increased risk of postoperative constipation (10). Resection with rectopexy is associated with lower rates of postoperative constipation (11,12,13), as rectopexy alone may lead to worsening constipation (11,12).

Extent of Dissection

The extent of pelvic dissection during an abdominal rectopexy, including the lateral ligaments is a subject of debate. There is concern that division of the lateral stalks denervates the rectum and left colon increasing transit time and decreasing rectal sensation, both of which may contribute to increased postoperative constipation (14,15). However, this was challenged by Mollen and colleagues in a study of posterior rectopexy with Teflon mesh, with or without division of the lateral ligaments (16). While the

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Jun 12, 2016 | Posted by in GENERAL | Comments Off on Open Rectopexy
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