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Home / Articles / New procedure Transanal suture sacro-rectopexy for prolapse & intussusceptions of rectum
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New procedure Transanal suture sacro-rectopexy for prolapse & intussusceptions of rectum

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New procedure Transanal suture sacro-rectopexy for prolapse & intussusceptions of rectum
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Objective;- To achieve simple transanal  fixation of rectum to the sacrum, without dissection.

Patients:- Twenty cases of complete prolapse of the rectum were treated, during the period from January 2009 to December 2012 at Jeevan Jyot Hospital, Thane. In series of 20 cases; 6 were females and 14 were males. Average age in females was 62, ranging from 49 to 81 and in males 42 was average age, ranging from 23 to 78 years. The length of prolapsed segment ranged from 8 to 25 cm. Incontinence was reported in 7 cases. Constipation was reported by 12 out of 20 cases.

Method:- A self illuminating 20 cms. long, operating proctoscope was used. The rectal wall was fixed to the pre-sacral fascia trans-anally by 3-4 PDS suture starting from S3 to Sacro-coccygeal junction.

Results:- Patients were followed up for a period of 24 to 36 months. During this period only in one case of recurrence of complete prolapse of rectum was revealed. Incontinence was corrected in 5 out of 7 incontinent patients.

Conclusion:- Simple procedure for most difficult problem of full thickness prolapsed of rectum, solved in 19 of 20 cases. Any how long follow up and wide use will prove its efficacy.

Introduction

trans-sutureProlapse rectum is colourful entity but most distressing when associated with incontinence. Anatomically significant abnormalities are loss of adhesion to the sacrum, coccyx and pelvic wall, diastases in levater ani muscles, patulous anal sphincters, abnormally obtuse angle and redundant sigmoid colon. (1-6) Majority of surgeons are not still univocal that whether these defects are etiology or consequences. The defects are due to straining during bowel movement, child delivery & all relative chronic etiological factors increasing intra abdominal pressure. Intense straining will result in separation of the rectum from the sacrum, coccyx and pelvic wall; due to stretching and elongation of fibrous tissue resulting in loosing strength of fibrosis which adheres rectum to the sacrum. There may be familial collagen deficiency or developmental disorder responsible for genesis of rectal prolapse.  (7-9) Geographical variation in age and sex incidence indicates familial collagen disorder and different bowel habits in different countries. More than 145 procedures and their modifications are implemented to correct these defects and treat prolapse of rectum. (10) Large number of procedures suggest that none is well recognized for reconstruction. Importance was diverted to correct anatomical defects which have achieved far from desired effect. The removal prolapsed part will not cure prolapse permanently  The concept of recto-sigmoid or recto-rectal intussusceptions  recommended procedures involving fixation of prolapsed rectum to the sacrum.(11)  The survey of the huge literature and opinion of colorectal fraternities are in majority to accept the procedures involving fixation of rectum to the sacrum and coccyx either by laparotomy or laparoscopy. Amongst the choice between mesh and suture fixation most surgeons are inclined to suture rectopexy. (12-14) Some surgeons are confident in fixation even by a single suture. (16)  40 – 75 % cases of rectal prolapse are associated with varied degree of incontinence. (16-17 ) Out of these 50 -75 %  cases improve after correction of prolapse, suggesting effect like incontinence is correctable by mere correction of prolapse itself. (18-20) The remaining cases require supplementary repair for patulous sphincters and/or weak levator ani muscles. (21-22)

The old, frail medically unfit patients who could not tolerate procedures involving opening of abdomen or laparoscopy. The new procedure trans-anal suture sacro-rectopexy was performed in 6 cases that were medically unfit for any major procedure, in 2009. The promising results encouraged us to implement in all cases of rectal prolapse. The procedure was done in fit as well as unfit patients. The procedure is evaluated for recurrence, change in continence, constipation, pain in sacral region and retro rectal infection.