Our Summary

This research paper is about a study conducted to understand the factors that influence the surgical treatment of rectal prolapse, a condition where the rectum slips out of its normal place. Right now, surgery is the only known treatment for this condition, but there are over 100 different surgical procedures, and it’s not clear which one is best for each patient.

In this study, 91 patients who were 18 years or older and had a severe form of rectal prolapse were examined. The researchers collected information about the patients’ symptoms, other health conditions, and the surgeon’s judgment, and what the patients preferred. Then, they studied what kind of treatment was recommended: surgery in the abdomen, surgery in the perineum (the area between the genitals and anus), or no surgery at all.

They found that surgery was recommended for 93% of the patients. Among these, most were recommended a type of surgery done using a robot in the abdomen, with the most common being a procedure called robotic ventral mesh rectopexy.

The researchers also found that older patients, those with higher health risk scores, those with heart or lung conditions, those who experienced pain as a main symptom, those whose rectal prolapse always descended, and those whom the surgeon were concerned might be too frail for general anesthesia, were more likely to be recommended perineal surgery. However, after further analysis, only age and concerns about long anesthesia were still related to a recommendation for perineal surgery. Among patients older than 80, only 15% were recommended abdominal surgery.

In conclusion, the study highlighted that the type of surgical treatment for rectal prolapse depends on the surgeon’s decision and a variety of factors. It emphasized the importance of perineal procedures for higher-risk individuals. However, the most commonly recommended operation was a type of robotic surgery, but it’s not available to all patients and surgeons. This represents the particular preference of the surgeon involved in this study.

FAQs

  1. What is the most common surgical procedure recommended for rectal prolapse?
  2. What factors influence a surgeon’s recommendation for rectal prolapse surgery?
  3. Are there alternatives to surgical intervention for rectal prolapse?

Doctor’s Tip

A helpful tip a doctor might tell a patient about rectal prolapse surgery is to carefully consider all available treatment options and discuss them with your surgeon to determine the best approach for your individual case. Factors such as age, comorbidities, symptoms, and surgeon expertise should all be taken into consideration when making a decision about surgery. Additionally, it is important to follow post-operative care instructions closely to ensure optimal recovery and long-term success of the surgery.

Suitable For

Patients who are typically recommended rectal prolapse surgery are those who have external and/or high-grade internal rectal prolapse and are experiencing symptoms such as pain, difficulty with bowel movements, and fecal incontinence. Factors that may influence surgical recommendations include age, comorbidities such as cardiopulmonary issues, frailty, and general anesthesia concerns. In some cases, perineal procedures may be recommended for older patients or those with higher surgical risks, while abdominal procedures such as robotic ventral mesh rectopexy may be recommended for younger, healthier patients. Overall, surgical recommendations for rectal prolapse are individualized based on the patient’s specific symptoms, comorbidities, and surgeon judgment.

Timeline

Before rectal prolapse surgery, a patient may experience symptoms such as rectal pain, bleeding, and a feeling of a bulge or protrusion from the rectum. They may also undergo diagnostic tests such as a physical examination, colonoscopy, and imaging studies to confirm the diagnosis of rectal prolapse.

After surgery, the patient may experience pain, swelling, and discomfort in the rectal area. They will be closely monitored for complications such as infection, bleeding, or recurrence of the prolapse. The patient will also undergo a period of recovery and rehabilitation, which may include dietary changes, pelvic floor exercises, and follow-up appointments with their surgeon. Over time, the patient can expect improvements in their symptoms and quality of life following successful rectal prolapse surgery.

What to Ask Your Doctor

  1. What are the different surgical options available for rectal prolapse and which one do you recommend for me?
  2. What are the potential risks and complications associated with rectal prolapse surgery?
  3. What is the expected recovery time after rectal prolapse surgery?
  4. Will I need to make any lifestyle changes or follow a special diet after the surgery?
  5. How likely is it that the prolapse will recur after surgery?
  6. Are there any alternative treatments or non-surgical options for rectal prolapse that I should consider?
  7. How many rectal prolapse surgeries have you performed and what is your success rate?
  8. Will I need to undergo any additional tests or evaluations before the surgery?
  9. What should I expect during the hospital stay and post-operative care?
  10. Are there any long-term effects or considerations I should be aware of after rectal prolapse surgery?

Reference

Authors: Lee A, Kin C, Syan R, Morris A, Gurland B. Journal: Postgrad Med. 2020 Apr;132(3):256-262. doi: 10.1080/00325481.2019.1669330. Epub 2019 Sep 25. PMID: 31525304