Rectal Prolapse – Laparoscopic

What is a rectal prolapsed – laparoscopic procedure?

This procedure involves the repair of a rectal prolapsed (the slipping or falling of an organ from its normal position (laparoscopically. This means the procedure is done with the help of a video camera, tubes and some very small cuts in the abdomen.
Tubes will be put through these cuts to pass the camera and instruments through. The doctor will fill the abdominal area with carbon dioxide gas to allow access for the operation.
A segment of the bowel is removed and the remaining bowel is hitched by stitches to the pelvic bone. The gas is allowed to escape before the cuts are closed with stitches or staples.

Anaesthetic

This procedure will require an anaesthetic.

What are the risks of this specific procedure?

There are risks and complications with this procedure.
They include but are not limited to the following:

General risks:

• Infection can occur, requiring antibiotics and further treatment.
• Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
• Small areas of the lung can collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
• Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
• Heart attack or stroke could occur due to the strain on the heart.
• Blood clot in the leg (DVT) causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs.
• Death as a result of this procedure is possible.

Specific risks:

• Damage to large blood vessels causing bleeding which could require and emergency blood transfusion and abdominal surgery.
• Damage of the bowel may occur which may cause leakage of bowel fluid. This may need further surgery.
• Damage to gut and/or bladder when the instruments are inserted. This may require further surgery.
• Rarely the muscles at the anus may be over stretched or over cut with a resultant weakness in the area. This could cause problems with control of the bowels (incontinence). A pad may need to be worn for a time.
• The laparoscopic/keyhole method may not work (1 in 10 people) and the surgeon may need to do open surgery, which will require a larger cut in the abdomen.
• Deep bleeding in the abdominal cavity could occur and this may need fluid replacement or further surgery.
• Leakage at the site where the bowel was stitched or stapled back together. This may require further surgery.
• Especially in a male there may be difficulty passing urine and a tube may need to be inserted into the bladder.
• Bowel doesn’t function properly, causing abdominal bloating, vomiting and cramps. Treatment is to decompress the bowel with suction, using a tube via the nose (nasogastric tube) into the stomach or intestine. Further surgery may be required.
• Infections such as pus collections can occur in the abdominal cavity. This may need surgical drainage.
• Infection in the wound causing redness, pain and possible discharge or abscess (1 in 20 people). This may need antibiotics.
• Possible bleeding into the wound with swelling and bruising and possible blood stained discharge.
• The wound may not heal normally. The wound can thicken and turn red. The scar may be painful.
• A weakness can happen in the wound with the development of a hernia (rupture). Further surgery may be needed to correct this
• Constipation after the surgery may be a major problem and may need treatment.
• The muscles at the anus may be weak and may need local surgical treatment.
• The prolapsed may recur.
• Adhesions (bands of scar tissue) may form and cause a bowel obstruction. This can be a short term or a long term complication and may need further surgery.
• Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.