Rectal Prolapse Surgery

Rectal prolapse, different types and symptoms are discussed in the conditions section. Deciding the correct treatment of the prolapse is complex and takes into consideration many factors. The factors include the type and severity of the prolapse and the general fitness and age of the patient. Sometimes lifestyle changes and gentle laxatives help to reduce the prolapse and symptoms.

However, a complete or full thickness rectal prolapse will often require surgery otherwise it will just continue to worsen, causing pain and discomfort as well as affecting control of your bowel movements.

Surgical Options

Partial rectal propose is the less serious of the two types and often can be treated along the same lines as haemorrhoids with ‘office procedures’. These include injections into the prolapse or banding. If these very well tolerated procedures fail then a small operation to remove the protruding lining is fairly straightforward, well tolerated and successful. There are some minor risks but Mr Stellakis will go through the with you.

Full thickness propose is more complex to treat. There are many different operations that have been devised over the years and what this indicates is that no one method is clearly better than another. The big problem with rectal prolapse surgery is recurrence of the propels over time. The general rule is that the better the operation in terms of avoiding recurrence the more risk is involved. When you consider that the majority of patients who suffer with this condition  are frail and elderly this is an important trade off.

The three most frequent operations in the UK are the Delormes, Altemeier and abdominal ventral rectopexy. The first two are operations performed through the bottom (perineal approach) and the latter most is through the abdomen.

Delormes Rectopexy

This is by far the safest option and carries few risks. Patients recover quickly but the big problem is a very high recurrence rate. This is accepted to be approximately 20 to 30% in the first five years. That said it can be re-done.

Altemeier Rectopexy

Similar to the Delormes this operation is carried out through the bottom and as result is quite safe. It has a lower recurrence rate than the Delormes but because it involves the actual removal of bowel and hence a join it carries more risk. It is extremely rare that the join in the bowel fails but if it does the consequences can be very serious leading to peritonitis and further major abdominal surgery. It is well tolerated and patients generally recover quickly.

Abdominal Ventral Rectopexy

This operation has the lowest recurrence rate overall but carries more risk as the operation is conducted through he abdomen where the rectum is ‘hitched up’ from the inside and secured with mesh. It is nearly always performed laparoscopically but still requires a longer recovery period than the other two procedures. This is the best procedure for fitter younger patients.

Mr Stellakis will discuss in detail which option is best for you along with the all the potential risks of each procedure.

If you have incontinence leading to accidents and faecal leakage with the prolapse then generally  a repair will improve this situation. However it may well not eliminate it completely as there is still the intrinsic issue of a weak pelvic floor. Unfortunately repairing the prolapse does not address this issue and episodes of incontinence may still occur. That said there things that can be done in addition. Please see under the incontinence section.

With the Delormes or Altemeier procedures recovery is usually quick, within a few days. Your bowels may not work for a couple of days but when they do things should go back to normal fairly quickly. The laparoscopic rectopexy involves more recovery but generally patients are fully recovered at 2 to 4 weeks.

Hospital stay on average ranges from a  day case to 2 to 3 nights depending on the patient and the procedure.

There are no specific instructions with regards to the perineal procedures. Generally a daily shower or bath is recommended and Mr Stellakis will probably prescribe you antibiotics and laxatives for the first postoperative week.