What Is Open and Laparoscopic Resection Rectopexy?

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Resection rectopexy, whether open or laparoscopic, is a surgery to repair a prolapsed rectum.

Resection rectopexy is one of the surgeries that repair a rectal prolapse. Your rectum is the last part of your intestine which helps in expulsion of the feces out of your anus. Weakness of the muscles that hold the rectum in place may cause it to drop, partially or completely protruding through the anus. This condition is known as rectal prolapse, and surgery is the only option to treat it. This surgery involves two major steps:

1. Resection: Cutting the last part of the colon (sigmoid colon) that is connected to the rectum 
2. Rectopexy: Restoring the rectum to its normal position by stitches (rectopexy) so that it no longer protrudes through the anus. 

Resection rectopexy is specifically used for patients with complete rectal prolapse, who also suffer from chronic constipation. It can be performed via either an open or a laparoscopic approach.

1. Open resection rectopexy: Your abdomen will be opened by making a large incision to perform the surgery.
2. Laparoscopic resection rectopexy: Several small incisions will be made in your abdomen, and a long camera (laparoscope) will be inserted through one of the incisions to visualize the colon and perform the surgery. 

What is done before resection rectopexy?

• The diagnosis of rectal prolapse is made through physical examination.
• Your doctor will take your complete history and examine you to check if you are fit for the surgery.
• You might have to undergo a special test known as defecography where the doctor can capture (X-ray) or see the movements (video) of your sigmoid colon and rectum while you defecate. 
• You may also be asked to undergo a procedure known as colonoscopy where a tube-like camera will be inserted into your rectum to check if there is any bleeding.
• Your doctor will counsel you about the risks and complications of the surgical procedure.
• You will be given medicated enema a night before the surgery to clear your bowels.
• You must not eat anything for six to 12 hours before your surgery. Take only necessary medicines with sips of water.

What happens during resection rectopexy?

• You’ll receive fluids through a needle inserted in your veins (IV).
• Next, you will be put under general anesthesia that makes you sleep throughout the procedure.
• Depending on the type of surgery—open or laparoscopic—incisions will be made on your abdomen.
• Your surgeon will retrieve the sigmoid colon and cut (resect) it.
• The rectum will be lifted and stitched (anastomosis) to the open end of the colon (descending colon) to restore it to its normal position.
• The rectum will also be stitched adequately to secure it in place.
• The surgical wound will be sutured closed with absorbable surgical thread and bandaged.

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What happens after resection rectopexy?

• You will be transferred to the surgical ward and observed for several hours after the surgery.
• Only oral medicines with a few sips of water will be allowed right after the surgery.
• You will be instructed to eat only a soft diet (no raw fruits and vegetables) as tolerated from the next day of your surgery.
• Pain medications will relieve your surgical wound pain.
• You will be able to get out of bed the same night of your surgery.
• If there are no complications, you will be discharged after one to seven days post-surgery. 
• The length of your hospital stay also depends on how early you are able to pass gas and stool.
• Upon discharge, your surgeon will give you specific instructions for your early recovery while at home. 
• Follow-up with your surgeon will be scheduled for around 14 days after surgery.
• You can resume your normal activities once you are home. 
• If you become constipated or have any other concerns, contact your doctor.

Is resection rectopexy major surgery?

Resection rectopexy is a major surgery that comes with the following possible complications:

• Infection (external and internal)
• Injury to adjacent structures like ureter or vagina
• Prolonged paralytic ileus (loss of muscle functioning of the colon)
• Leakage of feces from the colon
• Recurrence of rectal prolapse 
• Bowel obstruction
• Hernia
• Diarrhea
• Bowel incontinence
• Damage to surrounding nerves resulting in sexual and urinary problems