Rectopexy Open

Open rectopexy surgery

Open rectopexy is an older traditional surgical intervention in the treatment of full-thickness rectal prolapse, the form of repositioning and securing the rectum at its anatomical position within the pelvis through an abdominal incision (open).

What is Open Rectopexy?

During this operation, the rectum prolapsed is pulled up and attached to the sacrum (lower spine) to ensure that the rectum does not slide out again. It is referred to as open rectopexy since it is performed using a bigger abdominal opening instead of a laparoscopy.

Who Needs Open Rectopexy?

Open rectopexy can be suggested when:

• The patient presents with total pelvic prolapse.
• Laparoscopy operation is contraindicated (prior abdominal operation, dense adhesion, non-existent laparoscopic)
• Repair is a tough one, which lasts.
• The patient is also medically fit to undergo abdominal surgery.

Benefits of Open Rectopexy

• Reduced recurrence rate than perineal procedures.
• Appropriate to chronic or extreme prolapse.
• Long term anatomical correction is good.

Rectopexy open procedure

Open rectopexy is an abdominal procedure that is utilized to manage full-thickness rectal prolapse. It involves mobilizing the rectum and securing it to the sacrum in order to maintain the rectum's position within its normal anatomical confines. 

Preparation before Surgery

• Diagnosis by colonoscopy or sigmoidoscopy, with imaging as necessary. 
• Preparation of bowels: According to the surgeon.
• Empty stomach: As a rule, 6-8 hours before surgery.
• Anaesthesia: The patient received general anaesthesia. 

Open Rectopexy Surgery 

Abdominal Incision

• Incision into the pelvic cavity is done lower midline or Pfannenstiel (bikini-line).

Exposure of Rectum

• The rectum is opened and thoroughly uncovered.

Rectal Mobilization

• Surrounding tissues are relieved and significant nerves preserved in order to minimize bowel and sexual dysfunction.

Rectal Fixation (Rectopexy)

• The rectum is lifted upwards into the normal position.
• It is attached to the sacral promontory with non-absorbable sutures.
• In other instances, there is the provision of mesh support.

Optional Sigmoid Resection

• In case of acute constipation, part of the sigmoid colon can be resected (resection rectopexy).

Closure

• The abdomen is closed in layers and sterile dressing is done.

Duration of Surgery

• Typically 1.5-3 hours, even with bowel resection.

Post-Procedure Care

• Hospital stay: 5–7 days
• Pain management IV oral drugs.
• Diet: Liquids → soft → normal
• Bowel movement: Recurring in a few days.
• Mobilization: Prevent clots by encouragement at an early age.

Open rectopexy recovery

Open rectopexy is a slow process to recover since it is an operation carried out on the abdomen. Patients are able to perform fairly well in case they observe postoperative instructions.

Stay in hospital

• Time: 5 to 7 days 
• Pain & discomfort: The initial few days of moderate pain in the abdomen; treated with drugs.
• Mobility: Sitting up and short walks begin at the typical rate of 24 hours.

Diet:

• Day 1–2: Liquids
• Then soft then normal diet with bowel functions back to normal.
• Bowel movement: This will start again after 2-4 days.
• Wound care: Dressing checked frequently; Stitches or staples checked regularly.

First 2 Weeks After Discharge

• Gradually improving, mild to moderate pain.
• Fatigue is common
• Light walking is recommended on a daily basis.
• Do not strain when passing bowel movements.
• Maintain cleanliness on the surgical wound.

Avoid:

• Heavy lifting
• Squatting
• Extended periods of time on the toilet.

Weeks 3–4

• Pain significantly reduced
• The bowel habits become stable.
• Majority of the patients go back to work which is a light household or desk work.
• Take stool softeners and high-fiber food as directed.

Weeks 4–6

• Go back to regular everyday life.
• Driving generally permitted provided pain free.
• Sexual activity may generally be resumed (as surgeon recommended).

Complete Recovery

• Timeline: 6–8 weeks
• Their internal healing process is carried on even after you feel better and therefore activity restriction matters.

Diet During Recovery

• Fiber-rich foods 
• Plenty of fluids 
• Prescription of stool softeners or weak laxatives.
• Aim: Painless and stress-free bowel movements.

Pain Management

• Given painkillers on the initial few days.
• Gradual replacement by weaker pain relievers.
• Do not take NSAIDs without the consent of your surgeon.

Open rectopexy complications

The operation of open rectopexy is relatively safe and not new, although, as any other significant surgery of the abdominal area, it is associated with certain risks. The awareness of these aids in the early identification and early intervention.

Early (Short-Term) Complications

• Wound-Related Problems
• Bleeding
• Infection
• Ileus (Temporary Bowel Paralysis)
• Pain and Discomfort

Intermediate Complications

• Constipation
• Urinary Problems

Late (Long-Term) Complications

• Recurrence of Rectal Prolapse
• Bowel Function Changes
• Sexual Dysfunction (Rare)
• Mesh-Related Complications

Best hospital for open rectopexy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Open rectopexy is a well-known and time-tested surgical therapy of full-thickness rectal prolapse, which provides high anatomical repair and a low rate of recurrence. Long-term outcome is mostly excellent even though the recovery is slower with postoperative discomfort higher in comparison to laparoscopic methods; when done by an experienced surgeon. Complications are rare and most of them are manageable but constipation is the most common long term issue. The selection of patients, the attention to surgical technique, and strict adherence to the postoperative instructions, in particular, avoiding straining, are important factors in the realization of successful results.

Open rectopexy surgery India GetWellGo

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FAQ

1. Does open rectopexy have superiority to perineal operations?

• The recurrence rate of open rectopexy is typically lower than that of perineal procedures (such as Delorme or Altemeier) however the recovery duration is longer.

2. Is mesh used in open rectopexy?

• No. Suture rectopexy is popular among many surgeons. Mesh is applied selectively and only in cases where extra support is required.

3. Do bowel habits normalise after surgery?

• The normal bowel functioning is generally restored slowly. Temporary or chronic constipation can also be treated using drugs and diet.

4. Is it possible to revert to rectal prolapse following open rectopexy?

• Recurrence is a rare phenomenon, with a tendency of not more than 10 percent where postoperative advice is observed.

5. Can old patients be safely operated through open rectopexy?

• Sure, as long as the patient is in good health. General health is much more significant than age.