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Home / Articles / New procedure Transanal suture sacro-rectopexy for prolapse & intussusceptions of rectum - Page 3
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New procedure Transanal suture sacro-rectopexy for prolapse & intussusceptions of rectum - Page 3

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New procedure Transanal suture sacro-rectopexy for prolapse & intussusceptions of rectum
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FRILL TEST FOR LAX RECTAL WALL

trans-sutureIn per rectal examination the index finger of right hand is inserted completely. Whole rectum is palpated and patient is asked to strain. In case of intussusception the apex of inner tube will be felt at tip of finger. The index finger is firmly pressed and pulled against the sacrum, in case of intussusceptions,  the rectal wall will slide down by 2- 3 cms. in old age it will slide up to 1 cm. In case of full thickness complete proalapse of rectum it will slide up to dentate line. Usually prolapsed rectum was observed best during bowel movement and straining.

RECTOCELE

In pelvic examination, after rectal examination vaginal opening is observed. Posterior vaginal wall protrudes through vaginal opening. On cough or straining the roundish swelling will increase in size. The index finger in the rectum can be pushed in posterior wall of vagina; the finger will bring the protrusion more. If the swelling protrudes up to 2 cms, it will requires no treatment. Rectocele more than 3 cms. will require repair.

RESULTS

trans-sutureNone of the patients had any retro rectal hematoma or infection, though we expected. All patients were followed first weekly for four weeks and later on every monthly for 4 months and later on every six monthly.

In the series out of 7 cases of incontinence 5 cases improved.  In remaining 3 cases, levatoroplasty and sphincter plication was performed. In all  6 female cases levateroplasty was done.  In those 3 patient with incontinence improved.  The continent patient did not develop incontinence. One patient presented recurrence after 18 months submitted to same procedure. Constipation  was present in 13 cases  improved in 9, but no fresh constipation was developed.

DISCUSSION

The incidence of rectal prolapsed related to male/ female ratio and age is different in various part of world. Familial Collagen structural disorder and different type of bowel habits may be deciding factors. Transanal procedures are present since last 60 years in form of recto-sigmoidectomy in which whole redundant part of sigmoid and rectum is excised to correct prolapsed rectum. (23) Normally the sigmoid shape is adopted due to redundant lax pelvic colon. Removal of part of sigmoid and rectum corrects prolapse in 85 to 60 % cases. (24-25) There is no fixation of rectum which results poor repair and more complications.

trans-sutureIn sophisticated modern procedure for recto-sigmoidectomy is done in piece meal- STARR procedure. Prolapse of rectum of any stage is managed by STARR procedure. The complications and cost of procedure is very high and recurrence rate reported is matching to the recto-sigmoidectomy.( 26-28  ) STAAR resects redundant bowel but does not fix it.

Transanal fixation of rectum to the sacrum after opening rectum is similar procedure. The opening and suturing of mesorectum was done and then rectal wall was sutured. Fixation of meso rectum to the sacrum will depend on development of fibrosis and fixation of the rectum to sacrum. It is likely to form haematoma and infection. (29) Dissection around the rectum is advocated before fixing the rectum to the sacrum in open abdominal or laparoscopy procedures. By dissecting around the rectum, neuro receptors situated in the pelvic wall and sacral cavity are disturbed and constipation is worsened, who had preoperative and developed in additional cases.

Transanal suture sacro rectopexy requires no dissection, only suturing is performed which is very simple. There is no anastomosis which may cause strictures infection or hematoma. No costly instruments or disposables are necessary. Learning curve is negligible.

Conclusion

transTransanal suture sacro rectopexy is very simple but effective procedure. Nearly no complications are reported. There is no increase in severity or incidence in constipation. The series need larger number and longer follow up. Confirmation of effectiveness of the procedure to repair prolapse of rectum require extensive and wide utilization.