Rectal Prolapse

What is it?

Rectal prolapse is a medical condition in which the rectum, the last portion of the large intestine, protrudes outside the anus. This occurs when the rectum turns itself inside out and comes out through the anal opening.

Rectal prolapse can vary in severity, and there are different types:

1. Partial or Mucosal Prolapse (Mucous Prolapse) : In this form, only the inner lining of the rectum protrudes through the anus. It often appears as a reddish or pinkish mass of tissue during bowel movements and may retract back into the anus spontaneously or with manipulation.
2. Complete Rectal Prolapse : In a complete rectal prolapse, the entire wall of the rectum protrudes through the anus. This is more severe and can be painful. The prolapsed rectum often looks like a reddish mass of tissue hanging outside the body.
3. Internal Rectal Prolapse (Intussusception) : This type occurs when one part of the rectum folds into itself, much like how a telescope collapses. It may not protrude out of the anus but can cause symptoms like difficulty with bowel movements and a sensation of incomplete emptying.

Rectal prolapse can lead to a range of symptoms, including:

1. Pain or discomfort in the anal area
2. Bleeding from the rectum
3. Incontinence or difficulty controlling bowel movements
4. Constipation or diarrhoea
5. Mucus discharge from the rectum
6. A feeling of incomplete emptying after bowel movements
7. A visible mass of tissue outside the anus (in complete rectal prolapse)

The exact cause of rectal prolapse can vary and may include factors such as weakened pelvic floor muscles, chronic constipation, straining during bowel movements, pregnancy and childbirth, age-related weakening of tissues, and certain medical conditions, such as cystic fibrosis.

Treatment for rectal prolapse depends on its severity and the individual's overall health. Mild cases of partial prolapse may be managed conservatively with dietary changes, stool softeners, and pelvic floor exercises to strengthen the muscles. In more severe cases, or when conservative measures are ineffective, surgical intervention may be necessary to repair or reposition the prolapsed rectum.

A surgical options for treating rectal prolapse include:

• Laparoscopic Ventral Mesh Rectopexy
• Delorme's Procedure
• Altemeier Procedure

Laparoscopic Ventral Mesh Rectopexy (LVMR)

A Laparoscopic Ventral Mesh Rectopexy is an operation used to treat prolapse of the rectum. It is a minimally invasive surgical technique that aims to reposition and secure the rectum, restoring its normal anatomical position within the pelvis. LVMR is performed by colorectal surgeons.

Here's an overview of how laparoscopic ventral mesh rectopexy is typically carried out:

1. Laparoscopic Approach: LVMR is performed using minimally invasive laparoscopic techniques, which involve making small incisions in the abdominal wall. Through these incisions, a laparoscope (a thin, tube with a camera at the tip) and specialised surgical instruments are inserted.
2. Visualisation: The surgeon uses the laparoscope to visualize the pelvic area and assess the condition of the rectum, as well as identify any anatomical abnormalities or prolapse.
3. Rectopexy: During the procedure, the surgeon lifts and repositions the prolapsed rectum to its normal anatomical position within the pelvis.
4. Support and Reinforcement: This involves attaching the rectum to the back of the sacrum (the triangular bone at the base of the spine) or to nearby tissues using a mesh. The mesh is used to help to prevent future prolapse.
5. Closure: After the rectopexy and any necessary repairs or reinforcements are completed, the surgical incisions are closed with sutures.

Laparoscopic ventral mesh rectopexy offers several advantages over traditional open surgical approaches:

1. Minimally Invasive: LVMR involves smaller incisions, which typically results in less post-operative pain, shorter hospital stays, and faster recovery times compared to open surgery.
2. Precise Visualization: The laparoscope provides clear and magnified images of the surgical field, allowing for precise surgical manoeuvres and a more accurate repositioning of the rectum.
3. Reduced Risk of Infection: Because the procedure is minimally invasive, there is a lower risk of infection at the surgical site.
4. Lower Risk of Scarring: The smaller incisions used in laparoscopic surgery result in smaller scars, which can be cosmetically more appealing.
5. Effective Treatment: LVMR is effective in addressing rectal prolapse and associated conditions, often providing long-term relief from symptoms. 50% of Dr Golani's patients notice improvements in their continence.

However, like all surgical procedures, laparoscopic ventral mesh rectopexy is not without potential risks and complications. The choice of surgical approach and specific techniques used may vary depending on the patient's individual medical history and diagnosis.

Patients considering laparoscopic ventral mesh rectopexy should have a thorough discussion with Dr Golani to weigh the potential benefits and risks. A consultation with Dr Golani will determine if the procedure is the most suitable option for your particular situation.

Delorme's Procedure for Rectal Prolapse

Delorme's procedure is a surgical technique used to treat rectal prolapse, a condition where the rectum protrudes through the anus. This procedure is particularly suited for elderly or high-risk patients due to its less invasive nature.

The Procedure

1. Preparation: Patients undergo bowel preparation to clear the bowel and fast for several hours before the operation.
2. Anaesthesia: The surgery is performed under general or spinal anaesthesia.
3. Surgical Technique:
• The mucosa, the inner lining of the prolapsed rectum, is circumferentially excised.
• The exposed muscle layer is then folded onto itself like a concertina and sutured to shorten and tighten the rectum.
• This folding and suturing correct the prolapse and restore the normal anatomy.

Advantages

• Less Invasive: Compared to other procedures, Delorme's is less invasive and can be performed perianally, avoiding abdominal surgery.
• Shorter Recovery: Patients typically experience a quicker recovery period.
• Suitable for High-Risk Patients: Ideal for patients who may not tolerate more extensive surgery well.

Recovery

• Hospital Stay: Usually short, with many patients returning home within a few days.
• Postoperative Care: Includes pain management, wound care, avoiding constipation and gradual return to normal activities.
• Follow-Up: Regular check-ups to ensure proper healing and function.

Patients considering Delorme's procedure should have a thorough discussion with Dr Golani to weigh the potential benefits and risks.

Altemeier Procedure for Rectal Prolapse

The Altemeier Procedure, also known as perineal rectosigmoidectomy, is a surgical procedure used to correct a full-thickness rectal prolapse.

1. How Does the Altemeier Procedure Work?
• During the Altemeier procedure, Dr Golani will:
• Pull the rectum through the anus.
• Remove a portion of the rectum and sigmoid colon.
• Attach the remaining rectum to the large intestine (colon).
2. Why Is It Done?
• The Altemeier procedure aims to:
• Correct rectal prolapse.
• Improve defecation and faecal continence.
• Enhance the patient's quality of life
• Mainly performed in cases of reoccurent Rectal Prolapse

Advantages

The Altemeier Procedure has several advantages:

• Simplicity: The Altemeier Procedure is technically less complex than abdominal ones for rectal prolapse.
• Low physiological stress: As a perineal procedure, it imposes less physiological stress on patients, making it suitable for older or frailer patients.
• Reduced operative time: The procedure typically requires less time in the operating room compared to abdominal approaches.

Patients considering Altemeier's procedure should have a thorough discussion with Dr Golani to weigh the potential benefits and risks.

Your Consultation

Dr. Golani will provide further discussion regarding the specifics of your diagnosis during your consultation. Additionally, you'll have the opportunity to select the hospital for your procedure and potentially set the date for your procedure.

The best surgical hospitals in Sydney are available for your surgery:

• Sydney Adventist Hospital, Wahroonga
• The Mater Hospital, North Sydney
• Norwest Private Hospital, Bella Vista
• Hornsby Ku-ring-gai Hospital, Hornsby

To schedule a consultation with Dr. Golani, please contact our team for a consultation with Dr Golani. We have appointments available at three convenient locations across Sydney:

• Hornsby,
• North Sydney and
• Bella Vista

Please note that a GP referral will be required prior to your consultation.

Contact Us

To make an initial consultation booking, please contact our office on 02 8599 9819.

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Hornsby Clinic Address:

Madison Building
Suite 7, 25-29 Hunter St,
Hornsby NSW 2077
Phone: (02) 8599 9819
Email: info@drgolani.com.au
Fax:(02) 9012 0976

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Our Horsnby clinic is located conviniently next to Hornsby Westfield & Hornsby Station
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Mater Clinic Address:

Suite 13, Level 1 Mater Clinic
Mater Hospital
25 Rocklands Rd, North Sydney NSW 2060
Phone: (02) 8599 9819
Email: info@drgolani.com.au
Fax:(02) 9012 0976

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Our Mater clinic is located within Mater Hospital. Parking and Entry (convenient Pickup and Drop Zone) is via 5 Gillies St, Wollstonecraft.
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Norwest Clinic Address:

Suite 301C, Level 3
Q Central Building
10 Norbrik Dr, Bella Vista NSW 2153
Phone: (02) 8599 9819
Email: info@drgolani.com.au
Fax:(02) 9012 0976

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Our Norwest - Bella Vista clinic is located within Q Central Building - opposite Norwest Private Hospital. Free Limited Parking is available within the Q Central Building. There is a drop off zone outside of the building. Paid parking is available opposite at Norwest Private Hospital. Additionally there is parking at Woolworths Norwest Circa (5 minutes walk from the Clinic)
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What do I bring to my appointment?

• Referral letter
• X-Rays/Scans
• Test results relating to referral
• Health fund card
• Medicare card

Procedures

Dr Golani performs a variety of General Surgical and Colorectal Surgical Procedures. They treat a variety of symptoms, diseases and conditions.

Bowel Cancer

Dr. Golani consistently attains outstanding results when performing laparoscopic resections for both bowel and rectal cancers.    
  

Hernia repair

Dr. Golani regularly performs various general surgical procedures, including laparoscopic surgery for inguinal, ventral, and umbilical hernias

Gall Bladder Surgery

Laparoscopic Cholecystectomy for Gall Stones, Dr Golani has performed more than 500 gall bladder procedures.    
  
  

Colonoscopy

He has been trained in advanced endoscopic skills (certified by GESA) and can remove large polyps endoscopically.    
  

Rectal Prolapse Surgery

Dr Golani's is highly skilled in performing Laparoscopic ventral mesh rectopexy for rectal prolapse.

Anal Fistulas & Fissures

Dr. Golani is available to provide treatment for the management of painful anal fistulas and fissures.     
  

Haemorrhoids

Dr. Golani possesses extensive expertise in in both conventional and innovative surgical techniques for repairing haemorrhoids.

Gastroscopy & Endoscopy

He is accredited by the Gastroenterological Society of Australia (GESA).     
  

                                  

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