prolapsse of rectum
TRANSCRIPT
Dr. Dinesh. M.GProfessor of SurgeryJ.J.M.M.C.Davangere
Introduction Rectal prolapse was known to mankind as early as 1500
B.C.
Types Partial(Mucosal) prolapseComplete(full-thickness) prolapse
Partial ProlapseMucosa and submucosa of rectum protrude outside anus
for approximately 1-4cmsComposed of double layer of mucous membrane Occurs at the extremes of life
Children: 1-3 yrsElderly
Prolapsed mucous membrane is pink while prolapsed haemorrhoids are plum coloured and pedunculated
Partial prolapse-Aetiopathology
Infants Direct downward course of rectum due to absence of sacral curveDiminished support of anal mucosa due to poor resting anal tone
ChildrenAfter an attack of diarrhoeaSevere whooping coughLoss of weight resulting in reduced fat in ischiorectal fossae
Partial prolapse-Aetiopathology
Adults Associated with 3rd degree haemorrhoidsTorn perineum in femalesStraining from urethral obstruction in malesAtony of anal sphincter in old ageAfter an operation for fistula in ano
Partial prolapse in infants
Differential diagnosis from intussusception
Treatment In infants and children
Digital reposition and treating malnutritionSubmucous injections of phenol in almond oilThiersch’s operation
In adultsSubmucous injectionsExcision of prolapsed mucosa: Goodsall’s ligatureEndoluminal stapling
Thiersch’s operation
Goodsall’s ligature
Complete prolapse(procidentia)
Less common compared to partial prolapseThe protrusion is more than 4 cm in lengthInvolves all layers of the rectal wallThe mucosa is often arranged in a series of circular foldsLax anal sphincterWomen are 6 times more affected and may be associated
with prolapse of uterusFaecal incontinence
Complete rectal prolapse
Complete rectal prolapse
Complete rectal prolapse
Complete rectal prolapse
Complete rectal prolapseTreatment
Abdominal approach Preferred in most cases as it has lower recurrence rates Open or laparoscopic
Perineal approach Preferred in elderly and debilitated patients
Abdominal proceduresMesh rectopexy
Rectum is mobilised completely Non absorbable mesh (prolene) is fixed to presacral fasciaMesh is partially wrapped around the rectum held up in
tension and fixed by stitches
Suture rectopexyResection rectopexy
Combination of anterior resection and mesh rectopexy A good option for patients with significant constipation
Anterior resection
Mesh rectopexy
Abdominal rectopexy
Perineal procedures
Anal encirclement(Thiersch’s operation)Delorme’s mucosal sleeve resection
Rectal mucosa is excised circmferentially from dentate line to the apex of prolapse
The denuded prolapsed muscle is then pleated with a sutureThe transected edges of the mucosa is sutured together
Perineal rectosigmoidectomy
Delorme’s operation
Delorme’s operation
Laparoscopic mesh rectopexy
Thank you