Sutured Transanal Mucosectomy And Plication (STAMP)
WHAT IS A STAMP OPERATION?
This is an operation to repair rectocoele and simultaneously repair prolapse of the inner lining of the bowel (mucosal prolapse). Correction of both can make it easier for you to completely empty your bowels and thereby stop ‘post-defaecatory soiling’.
WHAT DOES THE OPERATION INVOLVE?
A STAMP is carried out under a general anaesthetic. All the surgery is done through the anus (back passage) and therefore there are no stitches or scars on the outside.
The operation takes about an hour. The floppy inner lining of the bowel is stripped off and the bulging muscle wall is reinforced (plicated or buttressed) with multiple tiny sutures to tighten the muscles of the bowel and strengthen the wall between bowel and vagina.
The main difference between this operation and the Anterior Delormes operation is that during the STAMP operation the inner lining of the bowel is fully circumferentially corrected, while the Anterior Delormes procedure only deals with the anterior part (the part between bowel and vagina).
Discuss with your surgeon which operation is appropriate for you.
WHAT TESTS ARE NECESSARY BEFORE THE OPERATION?
Your surgeon will want to examine you in the clinic and carry out further tests including a proctogram and anorectal physiology and ultrasound. The surgeon will want more information about the rectocoele but will also need to know if there are any other associated problems.
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
- 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 a strong laxative or bowel preparation before your operation, but you may be given an enema an hour before the operation to clear out the bottom part of your bowel.
WHAT IS THE RECOVERY LIKE?
Immediately 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 as this may damage the repair. We will give you laxatives to take for six weeks (usually Movicol). You will also be prescribed a course of antibiotics for 3-7 days.
You can shower and bathe as normal after the operation. You should be fit to drive after a week and return to work after 2-4 weeks. It is best to avoid heavy lifting (anything heavier then a full kettle) or strenuous exercise (jumping/squatting/weight lifting) for 6 weeks.
WHAT ARE THE RESULTS LIKE?
It will take time for your bowels to settle down into a regular pattern after surgery This often takes 6-8 weeks, sometimes even longer. Four out of five patients will find that their symptoms improve. Less then 5% of patients report worsening of symptoms after this surgery.
WHAT ARE THE RISKS?
There is a small risk of bleeding after surgery. Minor bleeding may be seen 4-8 weeks after the operation when the stitches start to dissolve.
The main problem with this operation is infection. Because the wound lies within the bowel it is impossible to keep it clean, so wound infections are very common. This may cause discomfort and can result in a discharge through the back passage. Extending or restarting your course of antibiotics might be necessary.
Because the procedure is performed through the anus, there is a theoretical risk of damage to the anal sphincter muscles. The development of new, safer equipment means that this risk is minimal. If your surgeon thinks your sphincter muscle is already too weak, he or she will discuss alternative options with you.
You will have the opportunity to discuss all the risks and benefits of the operation with your surgeon before signing the consent form.
Please be advised that the information on this website is not a substitute for professional medical advice, diagnosis or treatment