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PREOPERATIVE DIAGNOSIS
Rectal prolapse.
POSTOPERATIVE DIAGNOSIS
Rectal prolapse.
PRIMARY PROCEDURE
ABDOMINAL PROCTOPEXY.
PROCEDURE
The patient was taken to the operating room and placed on the table in the supine position. After the induction of anesthesia by the general endotracheal technique, bilateral lower extremity pneumatic compression stockings were placed. A Foley catheter was placed, and a rectal tube was placed for subsequent irrigation and testing of the proctopexy procedure.
After standard prep and drape, a midline celiotomy incision was created entering into the peritoneal cavity and subsequent exploration was without discovery of any pathology with exception of extreme laxity of the mesentery of the entire colon and a tremendous amount of redundant colon.
Attention was then directed to the rectosigmoid region where peritoneal reflections were taken down bilaterally with specific identification and protection of both ureters. The peritoneal reflection was then divided in the caudad direction, and the rectosigmoid and rectum were mobilized from the sacral hollow utilizing a combination of sharp and blunt dissection.
Once the rectum has been freed to the level of the tip of the coccyx, it was brought up under modest tension into the operative field and reflected to the patient’s left. An inverted T-shaped piece of Gore-Tex soft tissue patch was then fashioned and was subsequently secured to the sacral hollow up to the point of the sacral promontory utilizing a series of interrupted 0 Gore-Tex sutures. Subsequently the rectum was placed in mild tension within the span of 2 limbs of Gore-Tex soft tissue patch and subsequently encircled by those limbs. These were each then packed at multiple points to the rectum utilizing a series of interrupted 2-0 Prolene sutures placed in seromuscular fashion. Once the tacking procedure was done, the pelvis and retroperitoneum were irrigated with saline and evacuated.
The rectum was then irrigated with saline placed via the rectal tube and was noted to expand easily within the confines of the noncircumferential Gore-Tex sling. The rectum was then evacuated. The midline fascia was then closed utilizing #1 Prolene suture in continuous running fashion. The subcutaneous tissue was irrigated, and the skin was closed with stainless steel clips. A sterile dressing was applied. Patient was aroused from his anesthetic, extubated in the operating room and transported to the PAR in stable condition.
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SCIENCE
HEALTH SCIENCE
NURSING
