Our Summary

This research paper provides a detailed guide on how to perform a specific surgical procedure called Delorme’s mucosectomy and muscular plication. This approach is favored for patients who are weak and can’t handle the gas pressure in the abdomen required for less invasive surgeries. The main goals of this operation are to decrease the occurrence of a certain type of rectal prolapse (when part of the rectum slides out of place), to address issues of incontinence (lack of voluntary control over urination or defecation), and to prevent issues with obstructive defecation (difficulty with bowel movements despite the urge to go). The paper also includes a series of high-quality images to help illustrate the process.

FAQs

  1. What is the purpose of Delorme’s mucosectomy and muscular plication in rectal prolapse surgery?
  2. Why is the prone jack-knife position preferred for frail patients undergoing rectal prolapse surgery?
  3. What is the goal of this rectal prolapse surgery technique?

Doctor’s Tip

One helpful tip a doctor might tell a patient about rectal prolapse surgery is to follow post-operative care instructions carefully to promote healing and prevent complications. This may include taking prescribed medications, maintaining proper hygiene, avoiding heavy lifting or straining, and following a recommended diet to prevent constipation. It is also important to attend all follow-up appointments with your healthcare provider to monitor your recovery progress.

Suitable For

Rectal prolapse surgery is typically recommended for patients who have tried conservative treatments such as pelvic floor physical therapy and medications without success. Candidates for rectal prolapse surgery may include:

  1. Patients with full-thickness rectal prolapse, where the rectal wall protrudes through the anus during bowel movements.
  2. Patients with recurrent or chronic rectal prolapse that significantly impacts their quality of life, including difficulty with bowel movements, fecal incontinence, and discomfort.
  3. Patients with associated symptoms such as rectal bleeding, mucous discharge, and pelvic pressure or pain.
  4. Patients who are in good overall health and able to tolerate surgery, including elderly patients who are otherwise fit and healthy.
  5. Patients who have a high risk of complications from untreated rectal prolapse, such as those with a history of fecal impaction, urinary retention, or recurrent rectal prolapse episodes.

Ultimately, the decision to recommend rectal prolapse surgery will depend on the individual patient’s symptoms, overall health, and goals for treatment. It is important for patients to discuss their options with a colorectal surgeon to determine the best course of action for their specific situation.

Timeline

Before rectal prolapse surgery:

  1. Patient may experience symptoms such as rectal bleeding, pain, and a feeling of a bulge or protrusion from the rectum.
  2. Patient may undergo diagnostic tests such as a physical examination, colonoscopy, and imaging studies to confirm the diagnosis of rectal prolapse.
  3. Patient may undergo conservative treatments such as dietary changes, pelvic floor exercises, and medication to manage symptoms.

After rectal prolapse surgery:

  1. Patient will be placed in a prone jack-knife position for the Delorme’s mucosectomy and muscular plication procedure.
  2. Surgeon will perform the surgery to reduce the prolapse, relieve incontinence, and prevent obstructive defecation.
  3. Patient will be monitored closely post-operatively for any complications such as infection, bleeding, or bowel obstruction.
  4. Patient will undergo a period of recovery and rehabilitation, including pain management, wound care, and physical therapy.
  5. Patient will follow up with their surgeon for post-operative appointments to monitor their progress and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about rectal prolapse surgery may include:

  1. What is the specific procedure you are recommending for my rectal prolapse?
  2. What are the potential risks and complications associated with this surgery?
  3. What is the expected recovery time and outcome after the surgery?
  4. Will I need any special accommodations or lifestyle changes after the surgery?
  5. How experienced are you in performing this type of surgery?
  6. Are there any alternative treatment options available for my condition?
  7. Will I need any follow-up appointments or additional treatments after the surgery?
  8. How long will I need to stay in the hospital after the surgery?
  9. How soon can I expect to return to normal activities after the surgery?
  10. Are there any specific dietary or activity restrictions I should follow before or after the surgery?

Reference

Authors: Lonne MLR, Sakata S, Papas CP, Stevenson ARL. Journal: ANZ J Surg. 2023 Jun;93(6):1694-1696. doi: 10.1111/ans.18448. Epub 2023 Apr 6. PMID: 37025032