Editing Rectal prolapse (section)

=== '''Abdominal     approach - lap or open rectopexy''' ===

** Rationale is to fix the      rectum to provide adequate upwards tension to prevent a recurrence, but      allow adequate evacuation during defecation
** Recurrence rate <5%
** '''Ventral      rectopexy +/- mesh:''' expose the sacral promontory just inferior to iliac vessels,      mobilise the rectum anteriorly down to pelvic floor, suture the rectum to      a mesh or suture, and suspend the suture/mesh from the sacral promontory.      Consider closing peritoneum again to prevent SBO/pelvic adhesions.

* '''Posterior     rectopexy (Wells procedure):''' Mobilise the rectum posteriorly or both posteriorly and     anteriorly. The lateral stalks are preserved to avoid constipation except     in patients with faecal incontinence. This is followed by fixation of the     rectum to the sacral promontory with sutures or mesh.
*
* '''Anterior     mesh rectopexy (modified Ripstein procedure):''' anteriorly-based mesh sling     for fixation of the rectum to the sacral hollow
* '''Resection     rectopexy:''' Mobilise     sigmoid colon and rectum, resect a segment of the sigmoid, anastomose the     remaining colon to the rectum, and suture the rectum to the sacral     promontory.
* '''Fixation:''' 
** Suture or mesh are      appropriate
** Suture: use non-absorbable      e.g. 0 Ethibond to form horizontal mattress sutures in presacral fascia,      at or just below the level of the sacral promontory, but only on one side      of the rectal mesentery
** Mesh: Can use either      non-absorbable or biologic mesh with seemingly no difference in      complication or recurrence rates