Surgery for Constipation
Laparoscopic Pelvic Floor Repair for
Pelvic Floor Prolapse
What is the Pelvic Floor?
The pelvic floor is the hammock of muscles in the pelvis which support the intra-abdominal organs especially the bladder, bowel and uterus. When the pelvic floor becomes weak these organs prolapse through it creating a hernia into the vagina. This causes difficulty passing bowel motions and urine and can be uncomfortable.
Pelvic Floor Repair Explained
Pelvic floor repair can be performed by either robotic, laparoscopic or open approach. Dr Allison has an extensive experience with both, and feels the robotic approach gives a better outcome and superior recovery.
For robotic pelvic floor repair, 1 port is inserted, and from there four robot ports (tubes) are placed into the abdomen through small cuts on the skin. Through these ports a telescope and operating instruments are placed. A piece (biological so it lasts 3 months and disappears) of mesh is stitched to the vagina and then fixed to the sacrum (part of the bony pelvis) to ensure the vaginal vault stays in place.
Usually patients stay in hospital for 1 to 2 days.
Postoperative Recovery for Pelvic Floor Repair
You will need to avoid heavy activity for 6 weeks. This allows the repair to become solid.
Light duties are required after this operation. Whilst defaecating is an active sport, you need to treat this repair is like a hernia repair and avoid heavy lifting and physical activity for 6 weeks if possible
Bowel (Colon) Resection for Constipation
Why Resect the Bowel for Constipation?
Sometimes constipation is caused by redundant, overly-long, large bowel which increases the transit time for the faeces.
Patients presenting to Dr Allison with this problem require investigation which may include a colonoscopy to ensure there is no bowel cancer causing the symptoms, a defaecogram (where dye is placed in the rectum and an x-ray is taken), anorectal physiology (see previously) and a colonic transit study (to assess colonic transit time).
Resection of the large bowel is called colectomy.
Colectomy Explained
Colectomy for constipation is usually performed by a laparoscopic (key-hole) approach.
Four ports (tubes) are placed into the abdomen through small cuts on the skin. Through these ports a telescope and operating instruments are placed.
The redundant colon is mobilised and removed through one of the port sites. The remaining bowel is joined together, and the anastomosis (join) is tested to ensure it is intact.
Sacral Nerve Stimulation
What is Sacral Nerve Stimulation?
The sacral nerves control the function of the rectum where the faeces are stored before a bowel movement. They are found in front of the sacrum which is the tail bone at the base of the spine. Electrical stimulation of these nerves can improve both faecal incontinence and constipation.
Sacral Nerve Stimulation Explained
Initially a temporary stimulation lead (wire) is inserted through the sacrum onto the sacral nerves. This is placed under sedation (twilight) in the operating theatre. This lead is attached to a temporary pulse generator (battery) which is about the size of a small mobile phone and worn on your belt. Constant stimulation to the sacral nerves is produced. At home you will keep a diary of bowel function.
About 2 to 3 weeks after the temporary wire has been implanted your response is assessed (This time can be shorter shorter if there is significant improvement noted earlier). A discussion will then occur about the effectiveness of the device. If appropriate, and internal battery will be inserted. Everything is then internal with no external wires.
If the device has not improved the situation, you will require sedation and removal in the operating theatre.
Rectocele Repair
What is a Rectocele?
A Rectocele is a hernia of the lower bowel or rectum into the vagina. It creates a pocket where the stool becomes lodged during defaecation making it difficult to empty the bowel – this is called obstructed defaecation. Patients report difficulty emptying the bowel or requiring several bowel movements to feel empty.
Sometimes there is an associated injury to the anal sphincter and patients may also report faecal incontinence.
Rectocele Repair Explained
Patients presenting to Dr Allison with this problem require investigations which will include a colonoscopy to ensure there is no bowel cancer causing the symptoms, a defaecogram (where dye is placed in the rectum and an x-ray is taken) is arranged through the xray department at Greenslopes Private Hospital. This helps assessing the causes of the obstructed defaecation including a rectocele, an enterocele, rectal intussusception, motility issues and pelvic floor descent. Other tests such as a anorectal physiology (click here) may be helpful.
Before the operation to repair the rectocele, an enema is given to evacuate the rectum. The operation can be performed via an abdominal or perineal approach. Dr Allison feels the abdominal approach with a robotic ventral rectopexy and rectocele repair is superior with regard to outcome and recovery. With this operation, a 5mm port (tube) is inserted into the abdominal cavity. After this, 4 robot ports are inserted. With the use of the robot, the rectum and vagina are separated to the level of the pelvic floor muscles. A biodegradable mesh is placed and fixed with sutures on to rectum to control the rectocele. After the operation, there is a 1-2 day stay in hospital. The biodegradable mesh disappears after 3 months. It is NOT permanent. After this procedure, you will have a catheter in your bladder which will be removed either 1 or 2 days post procedure.
For the perineal approach, an incision is made between anus and vagina. The rectocele is defined by separating the rectum from the vagina and repaired using a biodegradable mesh. This mesh makes the repair strong and disappears after 3 months.
After the procedure, you will have a pack in your vagina, and a catheter in the bladder. They will both be removed on the second postoperative day. The wound is left slightly open to allow discharge to drain rather than create a collection which could potentially become infected.
