What is Rectal Reduction and Resection?
Sometimes the rectum protrudes from the anus, either incomplete (only the mucosa) or complete (all layers). This can cause a variety of secondary problems and leaves the exposed section at risk of injury or infection. Manual reduction or surgery may be required to correct the prolapsed section to ensure that the section is either returned to an anatomical position or is removed to prevent recurrence.
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Rectal Reduction and Resection Procedure in Dogs
Depending on the type of prolapse and the viability, different approaches to treatment can be taken. In simple prolapses with viable tissue, reduction can be used to place the prolapsed section back into its anatomical position. Before reduction can begin, the prolapse needs to be cleaned and moistened using warm saline solution; a hypertonic sugar solution of 30% dextrose or 70% mannitol can be applied topically to reduce oedema. In cases of persistent straining, an epidural may be administered.
There are no special considerations regarding anaesthesia for this procedure, the overall health of the patient should be monitored and an anaesthesia protocol should be made accordingly.
The prolapse should be lubricated well using a water based gel. Using either a finger or a bougie, the prolapsed section can be manually reduced back. A purse-string suture should be placed around the anus for five to seven days to prevent recurrence. The suture should be loose enough for fecal matter to pass, but sufficient to prevent recurrence of the prolapse during its placement. Post-surgery stool softeners and a moist diet are recommended to allow easy passage of feces and to reduce the risk of straining and recurrence.
In cases which the rectal tissue is viable but not reducible, a laparotomy with colopexy is indicated to keep the rectum in place and prevent a recurrence.
In severe cases which the prolapsed tissue has become necrotic, lacerated, or irreducible, a rectal resection should be performed to remove the damaged tissue and to anastomose the remaining rectum or colon with the anus. The prolapse should be thoroughly washed with isotonic saline solution and the area around the anus should be washed with chlorhexidine or povidone-iodine prior to surgery.
The dorsal 180º should be transected through both rectal walls, any blood vessels should be clamped or ligated accordingly. The two adjacent walls of the rectum are sutured together (leaving two long stay sutures) before the lower 180º is transected and sutured back together, clamping and ligating any blood vessels as required. Once the mass is removed, a layer of simple interrupted sutures are placed around the circumference of the rectum before the stay sutures are cut and the rectum returns to its new position.
Efficacy of Rectal Reduction and Resection in Dogs
The manual reduction of the rectum is usually successful as long as the underlying cause for the prolapse is addressed. If the underlying cause isn’t treated or managed then risk of recurrence is high. Straining and tenesmus need to be controlled in order for a successful outcome.
Resection is a successful method of treating rectal prolapse. The removal of the exposed rectum results in a lower chance of recurrence due to the absence of a section of rectum and the surgery is performed outside of the body reducing the risk of contamination of internal organs. Complications do occur; rectal stricture formation, dehiscence (rupture) of sutures, and incontinence can cause health risks and can be life-threatening.
A laparotomy with colopexy is another surgical choice when the prolapsed tissue is viable. The procedure is invasive as the abdomen is opened and the rectum is sutured in place within the pelvic canal. Recurrence still may occur if the primary cause of the prolapse isn’t treated or controlled.
Rectal Reduction and Resection Recovery in Dogs
After correction, a diet of soft wet food with stool softeners is recommended to ensure that feces pass freely without the risk of straining. The cause of the prolapse should be addressed before surgical intervention. With rectal reduction, a follow-up visit after five to seven days would be required to remove the purse-string suture and to check the overall health of the dog. After rectal resection, post-surgery visits would be required to check the healing process and to manually check for complications like stricture formation at the resection site.
Cost of Rectal Reduction and Resection in Dogs
Depending on the severity and the method of treatment, costs can vary. Typically, treatment for rectal prolapse with reduction or resection can cost between $300 and $2,500. Manual reduction of a prolapse would cost less than resection due to the simplicity and ease of correction with a single purse-string suture made to hold everything in place. The resection of the rectum requires more time and involves cutting through the rectal wall before suturing the adjacent walls together.
The laparotomy with colopexy surgical option is the most expensive option due to the complexity of the surgery when the prolapse is reduced back into the pelvic cavity and the section is attached to the pelvic wall to prevent recurrence.
Dog Rectal Reduction and Resection Considerations
When deciding on treatment of rectal prolapse, the viability of the prolapsed section must be determined to see which method of correction is most suitable. In small, simple prolapses, manual reduction is possible if the mucosa appears viable and reduction is usually successful once the cause is treated. In large prolapses with viable mucosa that cannot be manually reduced, the laparotomy with colopexy approach should be taken to preserve the rectum so there is less chance of post surgery fecal incontinence and no stricture formation at the site of resection.
Resection of the prolapsed rectum should be reserved for cases in which the mucosa of the rectum is necrotic or lacerated (or if the animal isn’t suitable for a laparotomy). Performing a resection of the rectum not only can result in fecal incontinence due to a lack of distension for conscious defecation, but can result in stricture formation or dehiscence of the anastomosis, which can be life-threatening.
Rectal Reduction and Resection Prevention in Dogs
Rectal prolapse usually occurs after excessive straining while defecating, although it can occur during whelping. Ensuring that a dog isn’t having difficulties passing feces and is regularly treated for worms will decrease the chance of a prolapse recurring. Certain conditions like perineal hernias can cause prolapses to occur due to straining. If a dog is seen straining, a visit to the veterinarian is required to investigate the cause. Dietary changes, infectious disease, genital tract, and urinary tract disorders can all result in the rectum prolapsing. In a dog that has been treated for prolapse, extra care should be taken and the dog monitored regularly whilst defecating to ensure that there aren’t signs of straining. Changes to diet or the use of stool softeners may be indicated.