Ripstein surgery

Ripstein surgery for surgery/treatment of rectal prolapse. Rectal prolapse refers to the downward displacement of the lower end of the anal canal, rectum, or even the sigmoid colon. Only the mucosal prolapse is called incomplete prolapse, and the full rectal prolapse is called complete prolapse. If the prolapsed part is called an internal prolapse or an inner intussusception in the anorectal, it is called an external prolapse. Rectal prolapse is common in children, the elderly, and women. Children's type gradually disappears and self-healing before the age of 5, because the curvature of the tibia is gradually formed, which can effectively support the posterior wall of the rectum. As long as the adult type of rectal prolapse occurs, the prolapse will gradually increase. Prolonged prolapse will cause fecal incontinence in the genital nerve injury. According to the degree of prolapse, partial and complete two: 1 part prolapse (incomplete prolapse): the prolapse is only the lower end of the rectum, so it is also called mucosal prolapse. The length of the prolapse is 2 to 3 cm, generally not more than 7 cm, the mucosa is radial, the prolapsed part is composed of two layers of mucosa, and there is no groove between the prolapsed mucosa and the anus. Partial prolapse should be differentiated from the annular sacral prolapse. The latter can be seen as a hypertrophic sputum block, which is plum-like, easy to bleed, and there is a concave normal mucosa between the sacral blocks. The rectal examination and the anal sphincter contraction Powerful, while the rectal part of the prolapse is slack, which is an important point of identification. 2 Complete prolapse: for the full layer of the rectum, in severe cases, the rectum and anal can be turned out to the anus, the length of the prolapse often exceeds 10cm, or even 20cm, in the shape of a pagoda, the mucosal folds are arranged in a ring shape, and the prolapsed part is The two layers of folded intestinal wall are composed of thicker, and there is a peritoneal space between the two layers of intestinal wall. Treatment of diseases: rectal prolapse Indication Ripstein surgery is suitable for complete rectal prolapse in adults. Preoperative preparation 1. Same as general abdominal surgery, but requires bowel preparation. 2. Place the catheter before surgery to expose it during surgery. 3. Prepare Teflon net suspension, Ivalon or silk belt according to surgical requirements. Surgical procedure 1. Through the left midline incision, about 20cm long, cut the skin, subcutaneous layers into the abdominal cavity. Push the small intestine all over the abdomen with a warm saline gauze pad. 2. Dissipate the posterior wall of the rectum to the tip of the tailbone and raise the rectum. 3. Use a 5cm wide Teflon mesh sling to surround the upper rectum, fix the anterior tibialis fascia and periosteum under the humeral protuberance with a fine non-absorbent line, and sew the sling edge to the anterior rectal wall and its side wall without repairing the pelvic floor. . 4. Finally suture the peritoneal incision on both sides of the rectum and the layers of the abdominal wall. complication Some people reviewed the results of 1111 cases of rectal prolapse Ripstein repair, the recurrence rate was 2.3%, the complications were 16.5%, the fecal block was 6.7%, the pre-orbital hemorrhage was 2.6%, the stenosis was 1.8%, the pelvic abscess was 1.5%, and the small bowel obstruction 1.4%, impotence 1.8%, 0.4%.

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