Prolapse is not very uncommon disease rectal disease. This can develop in all age groups with different etiological factors. More common in men. Surgical intervention is required when gets complicated with ulcerations and incontinence surgery. Both open and laparoscopic surgery can be employed. Laparoscopic ventral Rectopexy is most preferred treatment when indicated.

1. Rectal
Prolapse
Dr Shahzad Alam Shah
Laparoscopic and General Surgeon
Fatima Jinnah Medical University/SGRHL

2. 6/11/2020 4:33 PMDr Shahzad Alam Shah

3. Anatomy: Relations of Rectum
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4. Clinical Features of Rectal Diseases
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Dr Shahzad Alam Shah

5. Clinical Features of Rectal Diseases
• Bleeding
• This is often painless and bright red in colour and should be carefully investigated at any
age.
• Altered bowel habit
• Early morning stool frequency (spurious diarrhea) is a symptom of rectal carcinoma, while
blood-stained, frequent, loose stools characterize the inflammatory diseases.
• Discharge
• Mucus and pus are associated with rectal inflammation.
• Tenesmus
• Often described by the patient as ‘I feel I want to go but nothing happens’, this is normally
an ominous symptom of rectal cancer
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6. Clinical Features of Rectal Diseases
• Prolapse
• This usually indicates either mucosal or full-thickness rectal wall protrusion from the
anus. Internal prolapse or intussusception refers to a telescoping of the rectum into
itself without protrusion from the anus.
• Pain:
• ‘proctalgia’This is usually a severe and episodic pain resulting from spasm of the
levator ani muscle. It may last for a few seconds to minutes then recur, or it can be
constant
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7. Signs : Methods of Examination
• Inspection
• Digital examination
• Proctoscopy
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8. Signs : Methods of Examination
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Sigmoidoscopy:
Flexible and Rigid

9. Diseases of Rectum
• Injuries
• Rectal Prolapse
• Proctitis
• Rectal Polyps
• Benign Rectal Lesions
• Rectal Carcinoma
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10. Rectal Prolapse
•Mucosal prolapse
•Full-thickness prolapse
• Mucosal prolapse
• In infants
• In children
• In adults
• Third-degree haemorrhoids,
• Male
• straining from urethral
• Female
• Torn Perineum
• In old age,
• both mucosal and full-thickness prolapse are
associated with weakness of the sphincter
mechanism obstruction
6/11/2020 4:33 PMDr Shahzad Alam Shah

11. Full-Thickness Prolapse
• Commence as an intussusception of the rectum, which
descends to protrude outside the anus.
• Women are affected six times more often than men
• More than 4 cm
• Double thickness of the entire wall of rectum
• The anal sphincter is characteristically patulous
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Dr Shahzad Alam Shah

12. •Complications
• Rectal ulceration and bleeding,
• Incontinence and
• Incarceration with strangulation of the rectum can occur
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Dr Shahzad Alam Shah
Full-Thickness Prolapse

13. Treatment : Surgery
• Perineal Approach
• Thiersch operation.
• Delorme’s operation
• Altemeier’s procedure
• Abdominal Approach: Laparoscopic and Open
• Suture Rectopexy
• Ventral Rectopexy: Laparoscopic Anterior Rectopexy
• Posterior Rectopexy
Full-Thickness Prolapse
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Dr Shahzad Alam Shah

14. Laparoscopic Anterior Rectopexy
• The plane between the rectum and vagina
(or prostate) is dissected, and a strip of
mesh sutured to the anterior rectum and
posterior vaginal vault.The upper end of
the mesh is secured to the sacral
promontory with sutures or tacks, thus re-
suspending the rectum and preventing
prolapse
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Dr Shahzad Alam Shah

15. Advantages
• Prevention of long term Constipation
• Reduce Morbidity (presacral veins and nerves damage)
• Treatment of middle compartment
• Reinforcement of rectovaginal septum and genital prolapse is treated
• Vaginal Sacrocolpopexy is performed
• Sexual Dysfunction is avoided
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16. SUMMARY
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Dr Shahzad Alam Shah