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Laparoscopic Ventral Rectopexy (LVR)


WHAT IS LAPAROSCOPIC VENTRAL RECTOPEXY

The term “rectopexy” refers to an operation in which the rectum (the part of the bowel that is nearest the anus) is put back into its normal position in the body.

WHEN IS LAPAROSCOPIC VENTRAL RECTOPEXY PERFORMED?

One of the most common reasons for carrying out this procedure is for patients with external rectal prolapse (bowel coming out through the anus).

A newer reason for surgery is internal prolapse or “intussusception” when the rectum slides in on itself, without coming out of the anus. This may cause obstructed defecation syndrome or faecal incontinence.

WHAT OTHER TESTS WILL I NEED BEFORE THE SURGERY?

You will need to see your surgeon in clinic to assess your symptoms and to perform an examination.

Most patients who have this operation will have an endoscopic (telescope) test on the bowel. We will also look at how well the anal sphincter muscle works using ultrasound tests and special X- ray tests that show what happens to your bowel and rectum when you empty your bowels.

All of these tests are necessary to check that laparoscopic ventral rectopexy is right for you.

HOW DO I PREPARE FOR THE SURGERY?

The hospital will contact you before your operation to arrange for you to come in for a pre-assessment visit. This normally lasts 30-60 minutes.

At your visit you will have some basic health checks to ensure you are fit for surgery. These may include:

  • Blood Pressure
  • Pulse
  • Weight
  • Urine Analysis
  • Electrocardiogram (ECG)
  • Medical History Questionaire
  • MRSA Screen

The nurse will advise whether you should continue to take any regular medication.

You will also be given instructions about when to stop eating and drinking before your operation, what to bring into hospital with you and when to arrive.

You do not normally need to take bowel preparation or strong laxative to clear your bowel before the operation, but sometimes your surgeon will recommend this.

WHAT DOES THE OPERATION INVOLVE?

The operation is laparoscopic (keyhole surgery) and it involves a little cut just below the umbilicus (belly button) and two other small cuts on the right side of the tummy.

It is performed under general anaesthetic (whilst you are asleep) and usually takes about one and a half hours.

This operation pulls the bowel up out of the pelvis and a mesh (sterile sheet of netting) is put in place to hold the bowel in its normal place in the abdomen. The mesh will also prevent it from prolapsing back down into the pelvis (intussusception).

 © 2013 Lisa Clark courtesy of Cook Medical

© 2013 Lisa Clark courtesy of Cook Medical

WHAT IS RECOVERY LIKE?

After the operation you will normally have a urinary catheter in place (a tube into your bladder) and a drip in your arm. You will be allowed to eat and drink as soon as you want to after the operation, and your drip will be removed once you are drinking enough.

Your anaesthetist will talk about pain control with you before the operation but usually painkilling tablets and liquids will be enough. Usually, at 6am on the day after your operation your catheter will be removed and you can walk to the toilet to pass urine. You should be able to go home the day after the operation.

It is important to avoid constipation and straining in the first few weeks after surgery. We will give you laxatives to take for six weeks (usually Movicol).

You should be fit to drive after a week and return to work after 2-4 weeks. You should not lift anything heavier than a full kettle for at least six weeks as this can cause excess strain on the pelvic floor muscles and can delay healing; this includes supermarket shopping, housework, lifting children and sports.

Click the link at the bottom of the page for a pdf giving detailed information about recovering from this operation.

HOW EFFECTIVE IS THE SURGERY?

For patients with an external prolapse, the operation has a very low rate of recurrence (the prolapse coming back). In our experience of around 300 operations for external prolapse, fewer than 2% recur.

If the operation is performed due to an internal prolapse, obstructed defaecation syndrome or faecal incontinence, about four out of five patients report a significant improvement in their symptoms.

Some patients do not benefit from surgery, but there are additional treatments available which can help with the symptoms which you should discuss with your surgeon.

WHAT ARE THE RISKS?

This is relatively low risk surgery because no bowel is removed. Bleeding is very occasionally seen though blood transfusion is highly unlikely. Minor infections (mostly bladder infections or sometimes wound infections) occur in about 5% of patients. In males, due to the closeness of the nerves around the prostate, there is a 6% risk of impotence or ejaculation disturbances.

During this operation the nerves are avoided. Rarely, constipation may become worse, but most patients with pre-existing constipation report that this improves after laparoscopic ventral rectopexy. Some patients with obstructed defecation and incontinence will not have a significant improvement in their symptoms, but are rarely worse after rectopexy.

There are small risks of other problems including a hernia or bulge at one of the wounds or a problem with the mesh entering or piercing the bowel or vagina. This can happen months or even years after surgery. Mesh complications occur in around 2-3% of patients and should not be taken lightly. Patients with this problem may experience bloody discharge with pus and pain from either vagina or rectum. Surgery to deal with the problem may be difficult and may be major; rarely, it may even require the removal of part of the bowel and formation of a temporary stoma or bag. It may be done through the vagina or rectum or may need a bigger operation done through the tummy either by keyhole surgery or with a bigger cut. Read more abut Mesh Implants here.

You will have the opportunity to discuss all the risks and benefits of the operation with your surgeon before signing the consent form.

IS THIS SURGERY SUITABLE FOR EVERYONE?

Occasionally it is impossible to perform this operation on patients who have had extensive previous abdominal surgery because of adhesions (scar tissue in the abdomen). A previous appendicectomy or hysterectomy is not normally a problem.

IS LAPAROSCOPIC VENTRAL MESH RECTOPEXY BETTER THAN OTHER PROLAPSE OPERATIONS?

A laparoscopic (keyhole) procedure leaves less scarring and is less painful than open surgery (a cut down the middle of the tummy).  A mesh implant is used as this gives a longer lasting result than not using it, carefully avoid damaging the important pelvic nerves which can cause constipation.

Prolapse rarely comes back after laparoscopic surgery (2%) as opposed to operations through the perineum (20%). You should discuss options in detail with your surgeon.

 

 


Please be advised that the information on this website is not a substitute for professional medical advice, diagnosis or treatment