Rectal prolapse transperineal resection

Rectal prolapse and perineal resection can only remove the rectum out of the anus, and can not solve the cause of prolapse. Therefore, this procedure is only suitable for cases where the rectal prolapse has severe edema, adhesions, unreturnable or necrotic. Treatment of diseases: rectal prolapse Indication This procedure is only suitable for cases where the rectal prolapse has severe edema, adhesions, inability to return or necrosis. Preoperative preparation Apply antibiotics systemically and take intestinal antibiotics to control infection 1. Preoperative factors for rectal prolapse should be removed before surgery, such as improving nutrition, enhancing physical fitness, treating diarrhea, constipation, dysuria and chronic cough. 2. There is no need for special preparation. Surgical procedure 1. Position: The lithotomy position, the buttocks are high, so that the small intestine that falls into the concave rectum (or rectum uterus) is returned to the abdominal cavity to avoid intraoperative injury. 2. Cut the outer intestine: first make two needles at the distal end of the prolapsed intestine, and then cut the outer wall of the intestine 2cm from the edge of the anus. If the intestine is long, the incision has been incision into the peritoneum, into the rectum and into the concave cavity, and communicate with the abdominal cavity; if the intestine is short, it will only cut into the gap between the inner and outer intestines, and has not yet entered the abdominal cavity. After cutting the intestinal wall, the bleeding point is ligated. 3. Sewing the anterior wall sarcoplasmic layer: suture the inner and outer layers of the intestinal tract muscle layer with thin wires (the shorter the intestine is removed, only the muscle layer is sutured), and the abdominal cavity is closed. In order to avoid contamination of the abdominal cavity, a small part of the outer intestinal wall can be cut first, and the side slit can be cut and the abdominal cavity can be closed in time. 4. After suturing the wall muscle layer: suture the posterior wall muscle layer (or muscle layer) of the inner and outer intestines by the same method to complete the outer suture. 5. Stitching the whole layer of the anterior wall: according to the side-cutting method, gradually cut off the half of the intestine in front of the inner layer, and suture the inner and outer intestines with a 2-0 or 3-0 chrome gut. This layer of stitching is to be sewn to the distal end of the first layer of suture. 6. Stitching the whole layer of the posterior wall: in the same way, the entire wall of the posterior wall is sutured and the prolapsed intestine is removed. 7. Also in the intestine: gradually use the finger to send the intestine into the anus to complete the operation. 8. Bandaging: A gauze roll is placed in the anal canal, and a 1 cm straight rectum is placed inside the tube, and then wrapped with a sterile dressing. complication 1. Anastomotic infection can spread to the pelvic and peritoneal cavity. 2. The wound is cleaved and causes intestinal fistula and pelvic infection. If such a complication occurs, the proximal colostomy should be performed immediately, and the pelvic abscess should be drained. The colostomy should be closed after the anastomosis is healed. 3. The anastomotic stenosis is caused by scar contracture of the annular anastomosis. If the anastomosis has cracked and inflammation, resulting in scar tissue hyperplasia resulting in anastomotic stricture, it is necessary to adhere to the anus.