Laparoscopic Ventral Mesh Rectopexy

Transcription

1 Laparoscopic Ventral Mesh Rectopexy (LVMR) Information for patients General Surgery

2 What is a LVMR? A laparoscopic ventral mesh rectopexy (LVMR) is an operation in which the rectum (last part of the bowel) is straightened and attached back into its normal position. Why do I need a LVMR? A LVMR is most often used to repair a rectal prolapse. This is when part of your bowel comes down through your anus (back passage). This may be an external rectal prolapse (when your bowel comes out of your anus) or an internal rectal prolapse (when your bowel prolapses internally but does not come completely out through your anus). Both of these conditions can make it difficult for you to empty your bowel and you may feel that you need to strain to do so. It can also make you feel as though you have a blockage in the bowel. You may also experience faecal incontinence, which is the loss of the ability to control your bowel movements. What does the operation involve? This operation is carried out under a general anaesthetic. In most cases it is performed as a laparoscopic (keyhole) procedure. This usually involves 4 small incisions (cuts) no larger than 1cm. Occasionally the operation cannot be done as a keyhole procedure and an open operation and a larger cut is required. During the operation the lowest part of the bowel (rectum) is pulled up and released from the back wall of the vagina (in women) and from the bladder and prostate (in men). A mesh is then stitched to the front of the rectum and the other end of the mesh is attached to the lower backbone. This operation restores the rectum to its normal position and prevents it from prolapsing again. In women, the vagina is sometimes stitched to page 2 of 8

3 the back of the mesh to treat or prevent a future vaginal prolapse. During the operation a catheter (tube) will be placed into your bladder whilst you are asleep. This is either removed at the end of the operation or when you are back on the ward. The average time for this operation is one and a half hours, but it can sometimes take longer. Compared to traditional, open, surgery patients who have keyhole surgery often have less pain, a shorter recovery time and less scarring. What are the risks of surgery? Any bowel surgery has certain risks. These include bleeding, chest infection, wound infection, deep vein thrombosis (blood clot in the leg) and pulmonary embolism (blood clot in the lungs). In addition, the risks of an LVMR operation include the mesh making a hole in your bowel or vagina. There is also a risk of mesh infection. The risk of this happening is low (approximately 1%) but if it did happen then you would need further surgery. There is also a small risk of injury to your bowel and a risk of the prolapse recurring. That being said, the operation is a relatively straightforward procedure with current research showing a success rate of up to 75%. In 10-15% of patients it does not help symptoms and in up to 10%, it can slightly worsen symptoms. We cannot predict which patients will not benefit from surgery. For these patients, other treatments may be helpful. We must seek your consent for any procedure or treatment beforehand. Staff will explain the risks, benefits and alternatives where relevant before they ask for your consent. If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information. page 3 of 8

4 Is there any other treatment available? Before you are considered for this operation you will probably have tried a variety of non-surgical options. These include the use of laxatives, suppositories and enemas as well as rectal irrigation. If you would like to discuss any of these topics again before having surgery we would be happy to do so. Preparation for your operation When will my pre-operative assessment appointment be? You will be invited to come to the pre-operative assessment clinic about 2-3 weeks before the date of your surgery. The pre-assessment nurse will help you to identify any problems you may have, which might affect the progress of your recovery after the operation. Your preoperative assessment nurse will also give you important instructions on how to prepare for your operation and will take some blood samples from you. If you are cared for by a family member or friend and need them to stay with you whilst you are in hospital please discuss this with the nurse when you come in for your assessment. What happens on the day of my operation? On the day of your operation you will go to the Theatre Admissions Unit (TAU) at the Northern General Hospital. Go to the reception desk or ward and let the staff know you have arrived. You will meet the nurse who will check your details are correct and take you to the waiting area before theatre. Your surgeon and anaesthetist will see you at this time and you should ask them any questions you may have. We will ask you to sign a consent page 4 of 8

5 form to allow us to perform your operation. If you are unsure about anything please ask them to explain. Will I need something to clear my bowels out? Yes. At your pre-operative assessment meeting we will give you an enema to take at home before you come into hospital. You will be given instructions on how to do this. Will I need a blood transfusion? This will rarely be necessary, but for safety we will check your blood group by taking a small sample of your blood a few weeks before you operation and also on the day of your operation. If you do not want to receive any blood products during your stay in hospital please tell the staff at your pre-assessment visit. After your operation What happens immediately after my operation? You will probably wake up from your operation with a drip in your arm and an oxygen mask over your nose and mouth. You may have a catheter (tube) in your bladder that will be removed before you go home. Your anaesthetist will discuss pain control with you before the operation. You should be able to eat and drink within a few hours after your operation. To be able to go home you must be comfortable, be eating and drinking without being sick, be up and walking and have a normal pulse and blood pressure. You must also have a responsible adult with you at home for the first hours after the operation. page 5 of 8

6 Some patients will be discharged home on the evening of surgery, whilst others may stay in hospital for a day or two. This varies from patient to patient depending on their medical health and we will discuss this with you in clinic. Will I be allowed visitors when I am in hospital? In TAU visiting is 2.00pm pm and pm. Visitors are restricted to no more than 2 people per patient. If you have to stay in overnight then the nurse on TAU will let your relatives know which ward you are on. What do I need to do after my operation? You will need to take regular painkillers in the first few days after your surgery; these will be given to you when you are discharged. You must make sure you do not become constipated and strain after surgery. When you are discharged you will also be given laxatives to take for the first 4-6 weeks. You may gradually reduce your laxatives during this period. Patients differ in their need for laxatives but it is important that for 6 weeks your bowels are a bit looser than normal. You may be fit to drive after 2 weeks and return to work after 2-4 weeks depending on what you do. You should not lift anything heavier than a full kettle for at least 6 weeks. Avoid running or gym work for 6 weeks, but do get up and about after going home. Gentle exercise in the form of walking and swimming may be possible when you feel able to do so. Avoid sexual intercourse for 4 weeks after the surgery. Is there anything I should look out for at home? There is a possibility of bleeding after going home. If this is severe, you should attend hospital immediately. If you experience any of the following symptoms you should seek medical advice either from your GP or A&E: page 6 of 8

7 your abdomen (tummy) has suddenly become very hard and swollen you have not passed any wind from your bottom for several hours and not had your bowels opened you are vomiting and unable to keep fluids down you are shivering and feel cold you have a temperature above 37.5 C on 2 separate occasions taken 2/4 hours apart you have not passed urine for several hours and your abdomen feels uncomfortable you are unable to take a deep breath because of pain your wound has become very red and inflamed and is leaking fluid either of your calves feel painful, warm to touch and swollen Contact details If you have any questions or concerns you can also contact the ward you were discharged from: TAU (Theatre Admissions Unit) Firth Firth Will I be seen again after my operation? We will review you in clinic approximately 6 weeks after surgery and, if all is well at this point, we will discharge you back to the care of your GP. page 7 of 8

8 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD6833-PIL2668 v3 Issue Date: June Review Date: June 2020