The procedure fixes the rectum in its proper location, preventing protrusion and further displacement during daily activities.
Rectopexy Singapore
Rectopexy is a surgical procedure designed to treat rectal prolapse, a condition where the rectum slides out of its normal position and may protrude through the anus. The operation involves securing the rectum back into its proper place within the pelvis using surgical techniques that restore normal anatomy. The primary goal is to securely reposition the rectum, alleviating discomfort and improving bowel function.
Indications for Rectopexy
Rectopexy may be recommended in the following situations:
- Complete rectal prolapse (full-thickness prolapse): The entire wall of the rectum protrudes through the anus, creating a visible bulge that requires manual repositioning or occurs spontaneously.
- Internal rectal prolapse (intussusception): The rectum folds in on itself within the body, causing symptoms such as incomplete bowel emptying, straining, and a sensation of blockage during bowel movements.
- Recurrent prolapse following previous treatments: When other surgical approaches or non-surgical treatments have not provided lasting results, and the prolapse continues to cause problems.
- Faecal incontinence related to prolapse: Loss of bowel control that occurs as a direct result of the prolapse affecting the normal function of the anal sphincter muscles.
- Persistent symptoms: Ongoing discomfort, pain, bleeding, or difficulties with bowel movements that significantly impact daily life despite conservative treatments.
Benefits of Rectopexy
Rectopexy offers several advantages for patients experiencing rectal prolapse and its associated complications.
Restored anatomical position
Improved bowel control
Many patients experience better faecal continence as the procedure can help restore normal function to the anal sphincter muscles and surrounding structures.
Reduced discomfort and pain
Patients typically experience less pain, pressure, and irritation once the prolapse is corrected.
Long-lasting results
Rectopexy typically offers lasting relief, with a low risk of recurrence when performed by experienced colorectal surgeons.
Rectopexy Surgical Techniques
Several surgical approaches are available for rectopexy depending on individual patient factors and the surgeon’s assessment.
Laparoscopic (keyhole) rectopexy
This minimally invasive approach uses small incisions and a camera to guide the surgery, typically resulting in less post-operative pain and faster recovery. The rectum is mobilised and fixed using either sutures or mesh through small ports in the abdomen.
Open abdominal rectopexy
A traditional approach involving a larger abdominal incision that provides direct access to the rectum and surrounding structures. This method may be preferred in complex cases or when laparoscopic surgery is not suitable.
Suture rectopexy
The rectum is held in position using strong surgical sutures attached to the presacral fascia (tissue covering the tailbone area). This technique avoids synthetic materials while providing reliable fixation.
Mesh rectopexy
A piece of surgical mesh is used to support and hold the rectum in its proper position, anchored to the backbone area. The mesh becomes incorporated into the body’s tissues over time, providing long-term support.
Perineal rectopexy
An approach through the area between the genitals and anus, which may be suitable for patients who cannot undergo abdominal surgery. This method typically involves a shorter operation and recovery period.
Preparing for Rectopexy
Proper preparation helps ensure the best possible outcome and reduces the risk of complications.
- Pre-operative medical assessment: You will undergo a thorough medical evaluation, including blood tests, heart monitoring, and sometimes chest X-rays to ensure you are fit for surgery.
- Bowel preparation: You will receive specific instructions for cleansing your bowel before surgery, typically involving a special diet and prescribed laxatives or bowel preparation solutions.
- Medication adjustments: Your surgeon will review all current medications and may ask you to stop certain drugs, particularly blood thinners, several days before surgery.
- Fasting instructions: You will need to avoid eating and drinking for a specified period before your surgery, typically from midnight the night before your procedure.
Step-by-Step Procedure
The rectopexy procedure follows a systematic approach to ensure thorough treatment:
Anaesthesia administration
You will receive general anaesthesia, which means you will be completely asleep throughout the procedure.
Surgical access
Surgical sites will first be cleaned and prepared. For laparoscopic surgery, small ports are inserted through tiny incisions, while open surgery requires a larger abdominal incision.
Rectum mobilisation
The surgeon carefully separates the rectum from surrounding tissues and identifies the anatomical structures that need to be addressed.
Rectal fixation
The rectum is moved back into its correct position and fixed using either sutures or mesh attached to the strong tissue covering the tailbone.
Surgical closure
All incisions are carefully closed in layers using appropriate sutures or surgical staples. For laparoscopic procedures, the small port sites are closed with minimal scarring, while larger incisions require more extensive closure techniques.
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Post-Surgical Care and Recovery
Immediate Care
- Hospital monitoring: Your vital signs and comfort levels will be closely monitored as you wake from anaesthesia. Hospital stay is usually 2-4 days.
- Pain management: You will receive pain medication, initially stronger, then reduced as you heal.
- Early mobilisation: You will be encouraged to walk gently within the first day after surgery to aid healing and prevent complications.
- Bowel function monitoring: Your bowel function will be monitored, and stool softeners may be provided to ease early recovery.
Recovery Timeline
- First week: You should focus on rest while gradually increasing light activities such as short walks and basic daily tasks. Most discomfort and swelling will begin to settle during this period, though complete healing takes much longer.
- 2-6 weeks: You can usually resume driving when you can perform an emergency stop without pain, typically after 1-2 weeks for laparoscopic surgery. More normal activities can be gradually reintroduced, but heavy lifting and strenuous exercise should still be avoided.
- 6-12 weeks: Most patients can return to their regular activities, including work, depending on the physical demands of their job. Full healing and the maximum benefits of surgery may take several months to become apparent.
Follow-up Care
- Routine appointments: You will have scheduled follow-up appointments with your colorectal surgeon to monitor your healing and address any concerns. Ongoing follow-up helps ensure the success of your procedure and allows early detection of any issues.
Potential Risks and Complications
As with any surgical procedure, rectopexy has some considerations, though complications are uncommon when performed by a qualified colorectal surgeon in Singapore. Possible temporary effects include minor changes in bowel habits, constipation, or occasional incontinence, usually improving with healing.
Frequently Asked Questions
How long will I need to stay in the hospital after rectopexy in Singapore?
Most patients stay in the hospital for 2-4 days, with laparoscopic procedures often allowing shorter stays than open surgery. Your length of stay depends on your recovery progress and individual circumstances.
When can I return to work after the procedure?
This varies depending on your job and the type of surgery you have had, but most people return to desk-based work within 2-4 weeks. Jobs involving heavy lifting or physical demands may require 6-8 weeks off work.
Can rectal prolapse come back after rectopexy?
Recurrence rates are generally low when the procedure is performed appropriately, typically less than 10% over many years. Your colorectal surgeon will discuss factors that might affect your individual risk and provide guidance on reducing the likelihood of recurrence.
What activities should I avoid during recovery?
You should avoid heavy lifting (generally anything over 5kg), strenuous exercise, and straining during bowel movements for at least 6 weeks after surgery. Your surgeon will provide specific guidance based on your individual case and recovery progress.
What should I do if I have concerns during my recovery at home?
You should contact your surgical team if you experience severe pain that doesn’t respond to prescribed medication, signs of infection such as fever or unusual discharge, or significant changes in bowel function.
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Mount Alvernia Hospital, #06-52,
Medical Centre D, Singapore 574623
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