Rectopexy

The procedure is tailored to the patient’s age, prolapse severity, and overall health:

1. Bedore Surgery Evaluation:
   
   • Diagnosis:
     
     • Physical exam confirms prolapse, often visible during straining.
     • Defecography (X-ray during defecation) or MRI assesses prolapse extent and pelvic floor dysfunction.
     • Anorectal manometry evaluates sphincter function, especially if incontinence is present.
   • Blood tests ensure surgical fitness; patients with comorbidities (e.g., diabetes) may need optimization.
   • Bowel preparation (laxatives, enemas) clears the colon 1–2 days prior.
   • Patients are counseled on potential outcomes, including continence and recurrence risk.
2. Surgical Techniques:
   
   • Laparoscopic Rectopexy (Suture or Mesh):
     
     • The most common approach, minimally invasive, lasting 2–3 hours under general anesthesia.
     • 4–5 small abdominal incisions allow insertion of a laparoscope and instruments.
     • The rectum is mobilized by dissecting it from surrounding tissues, preserving pelvic nerves to maintain bladder/sexual function.
     • The rectum is lifted and sutured to the sacrum (suture rectopexy) or secured with a synthetic mesh (mesh rectopexy) for added support.
   • Robotic-Assisted Rectopexy:
     
     • Uses robotic systems (e.g., da Vinci) for enhanced precision in the pelvis, minimizing nerve damage.
     • Similar to laparoscopic but more expensive, available in centers like Apollo or Medanta.
   • Open Rectopexy:
     
     • For patients unsuitable for laparoscopy (e.g., extensive adhesions), using a midline abdominal incision.
     • Takes 3–4 hours; involves the same rectal fixation as laparoscopic but with a longer recovery.
   • Ventral Mesh Rectopexy (VMR):
     
     • A modern laparoscopic technique, focusing on anterior rectal support.
     • A mesh is placed between the rectum and vagina (in women) or prostate (in men), sutured to the sacrum, minimizing posterior dissection and nerve injury.
     • Preferred for patients with incontinence or internal prolapse.
   • Perineal Approaches (Rare):
     
     • Alternatives like Delorme’s procedure (mucosal resection) or Altemeier’s procedure (perineal proctosigmoidectomy) may be used in frail, elderly patients, but these are less common and have higher recurrence rates.
3. After Surgery:
   
   • Patients are monitored in the hospital for 2–5 days (laparoscopic) or 5–7 days (open).
   • Pain is managed with medications (e.g., paracetamol, NSAIDs); IV fluids support recovery.
   • Bowel function resumes within 2–4 days, starting with clear liquids.
   • Follow-up visits assess prolapse correction and bowel function.