Definition: partial or total downward displacement of the rectal wall, called rectal prolapse (also known as prolapse)
Classification of rectal prolapse.
Rectal prolapse can be divided into partial and complete according to the degree of prolapse as follows.
1, partial prolapse (incomplete prolapse): the prolapsed part is only the mucosa of the lower rectum, so also known as mucosal prolapse, the length of prolapse is 2 to 3 cm, the mucosal wrinkled wall is radial, the prolapsed part is composed of two layers of mucosa.
2.Complete prolapse: the whole layer of the rectum is prolapsed, and in serious cases, the rectum and anal canal can be turned out to the outside of the anus. The length of prolapse is often more than 4cm, or even 20cm, in the shape of a pagoda, the mucosal wall is arranged in a ring, the prolapse is composed of two layers of folded intestinal wall, which is thicker to touch, and there is a peritoneal gap between the two layers of intestinal wall.
Rectal prolapse grading criteria.
Ⅰ degree: when defecating or increasing abdominal pressure, the rectal mucosa prolapses out of the anus, and the length is within 3cm, and the prolapsed part can be retracted by itself after defecation, generally without clear conscious symptoms.
Degree II: when defecating or increasing abdominal pressure, the whole rectum prolapses out of the anus, with a length of 4-8 cm, which cannot be retracted by itself and needs to be retracted by hand, mostly accompanied by relaxation of the anal sphincter.
Ⅲ degree: the anal canal, rectum and part of sigmoid colon prolapse out of the anus when defecating or increasing abdominal pressure, the length is more than 8cm, and it is difficult to reset by hand, accompanied by the relaxation of anal sphincter, rectal mucosa erosion, hypertrophy, blood in the stool and other symptoms.
Rectal prolapse surgery options.
1 .Injection therapy.
Suitable for Ⅰ degree rectal prolapse, the efficacy of children and the elderly is still good; advantages: patients basically painless, few complications, short hospitalization, low medical costs, reusable, etc.; disadvantages: adults are prone to recurrence.
2.Trans-perineal surgery.
Applicable to patients with Ⅰ degree, Ⅱ degree early rectal prolapse and old and frail patients who cannot tolerate trans-perineal surgery, the procedure has.
(1) trans-perineal rectal mucosal resection.
(2) myofold suturing of the intestinal wall.
(3) anal canal loop reduction, etc.
For patients with prolapsed rectum that cannot be returned or has necrosis, the procedures are: trans-perineal rectosigmoidectomy; advantages: safe surgical operation, less perioperative complications and less pain, shorter hospital stay, faster recovery, less hospitalization costs; disadvantages: trans-perineal surgery can only solve the symptoms of rectal prolapse outside the anus, and cannot solve the cause of prolapse, and the recurrence rate is four times higher than that of trans-abdominal surgery.
3. Transabdominal surgery.
It is suitable for patients with Ⅱ degree and Ⅲ degree rectal prolapse, and there are many surgical procedures. Here, after more than 200 cases of surgical experience in our department, we recommend transabdominal rectal suspension and fixation + pelvic floor reconstruction as the preferred procedure; advantages: positive efficacy, low recurrence rate, uncomplicated surgical procedure; disadvantages: it can cause bleeding from the anterior sacral vein, and some patients can develop constipation; if patients with rectal prolapse are accompanied by constipation and redundant sigmoid colon, it is recommended to do additional sigmoid colon surgery at the same time. It is recommended to perform sigmoidectomy at the same time.