Preoperative Investigations and Management

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Preoperative investigations are important to ensure that patients receive the appropriate treatment or procedure. Flexible sigmoidoscopy or colonoscopy is necessary to exclude any possibility of a malignant or benign lesion that may act as a lead point for intussusception. In addition, other conditions such as solitary rectal ulcer, suggestive of internal rectal prolapse, should be excluded.

Prolonged constipation prior to rectal prolapse is suggestive of colonic inertia, thus mandating a combined approach of resection with rectopexy.3-5 In patients with suspected incontinence, anal ultrasonography, manometry, and pudendal nerve latency tests should be performed prior to the procedure. It is suggested that these patients would benefit mostly from a suture rectopexy without the addition of bowel resection.6 These tests may be of some predictive value and serve as a point of reference in monitoring postoperative improvement. Also, they may dictate the preference of one method over the other.

The objectives of the surgical treatment are to eliminate the rectal prolapse and improve any condition associated with it; thus it is up to the surgeon to decide what should be the most appropriate course of investigation and surgical management.

Figure 22.1. Port positioning for robotic-assisted laparoscopic suture rectopexy. The patient is placed in the lithotomy Trendelenburg position to accommodate the robotic slave-cart. Ports are placed similarly to the conventional laparoscopic procedure. The surgeon is seated at the master console, equipped with stereoptic vision and working tips with seven degrees of freedom of motion. (Courtesy of St. Mary's Hospital, London, UK, 2002.)

Figure 22.1. Port positioning for robotic-assisted laparoscopic suture rectopexy. The patient is placed in the lithotomy Trendelenburg position to accommodate the robotic slave-cart. Ports are placed similarly to the conventional laparoscopic procedure. The surgeon is seated at the master console, equipped with stereoptic vision and working tips with seven degrees of freedom of motion. (Courtesy of St. Mary's Hospital, London, UK, 2002.)

Figure 22.2. Robotic-assisted suturing of the mesorectum to the sacral promontorium. Stereoscopic vision together with powerful magnification and wrist-like working tips provide the surgeon with marked enhancement of dexterity, making intracorporeal suturing and knot tying as easy as if it were performed by hand. Two sutures only are placed fixing the posterior rectum to the sacrum. (Courtesy of St. Mary's Hospital, London, UK, 2002.)

Figure 22.2. Robotic-assisted suturing of the mesorectum to the sacral promontorium. Stereoscopic vision together with powerful magnification and wrist-like working tips provide the surgeon with marked enhancement of dexterity, making intracorporeal suturing and knot tying as easy as if it were performed by hand. Two sutures only are placed fixing the posterior rectum to the sacrum. (Courtesy of St. Mary's Hospital, London, UK, 2002.)

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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