Today, for the treatment of rectal prolapse only apply surgical techniques. Treatment as an internal rectal prolapse usually begins with conservative measures.
Surgical treatments for colon there are many (over 200). Most of them are very similar. But they all shared essentially the five main options:
manipulation of the fallen part of the rectum
Plastic anal canal and pelvic floor
intra-abdominal colon resection
fixation of the distal (distal) parts of the colon
combined methods
Manipulation of the fallen part of the rectum
Up until the middle of last century, surgical treatment of this group consisted in touching the precipitated part of the rectum. Of course, today is the treatment does not apply.
Excision (resection), the precipitated portion of the rectum is carried out only for specific indications, especially in elderly patients, the presence of severe comorbidities.
The most common surgical treatment for rectal prolapse, the following operations:
Mikulicz operation - is in a circular excision of the rectum area that fell.
Nelatona surgery - amputation of precipitating a patchwork of cancer.
Delorme operation - it is to cut off the mucous membrane of the precipitated portion of the rectum, followed by suturing the muscle wall in the form of a roller, which is located above the anal canal.
Currently, surgeons often use Delorme operation. It is simple in its execution, after it has the largest lower incidence of complications after her.
Plastic anal canal and pelvic floor
This operation consists in narrowing the anus of copper (or silver), wire (by Thiersch operation). In consequence, instead of the wire have been used other materials (silver chain, a silk thread or lavsan, various stripes of autoplastic and synthetic materials). However, this technique into practice was characterized by a high frequency of postoperative complications and a high percentage of recurrence of rectal prolapse.
This group also includes plastic operations of the pelvic floor muscles by stitching the edges, levator. The purpose of locating operations - is keeping the rectum in its normal anatomical and physiological regulations.
For operations of this group include:
way Zerenina-Kümmel. Is to fix the rectum to the spine of his cape.
Ripshteyna way - is to fix the rectum to the promontory of spine using Teflon mesh.
Modification of the method Ripshteyna - is the fixation of the rectum to the sacrum using synthetic mesh.
Experience has shown that the operation Zerenina-Kümmel allows you to securely fix the rectum and thereby achieve the prevention of its loss, but sometimes this method enhances constipation.
In recent decades, laparoscopic surgery is marked flowering of interventions, the advantage of which is much less traumatic. Not paid attention to technique and laparoscopic rectal prolapse. Laparoscopic surgery for rectal prolapse is its fixation with Teflon mesh. It is important to note that this technique can reduce the postoperative period of 4-5 days.
Combined Methods
Quite often in the surgical treatment of rectal prolapse is necessary to resort to combined methods. They consist in a combination of different methods of fixation, plastics and even resection of the colon.
Such methods include, for example, the operation Venglovsky, which combines resection of the fallen part of the rectum with levatoroplastikoy, or method Vishnevsky - it is the narrowing of the anal canal, as well as fixation of the rectum to the sacrum and the intra-fixation of the rectum to the uterus (or urinary bladder).
