After complete external exposure of the prolapse, first display the dentate line using a Lone Star retractor. Then, under gentle traction at the tip of the prolapse with Allis clamps, perform a circular incision of the external rectal wall duplication 1-2 cm above the dentate line, so that the anastomosis later lies proximal to the puborectalis muscle.
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Insertion of the Anal Retractor; Incision of the Rectal Wall
![Insertion of the Anal Retractor; Incision of the Rectal Wall]()
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Transection of the External Rectal Wall Duplication
![Transection of the External Rectal Wall Duplication]()
Soundsettings The rectal wall is gradually transected using bipolar scissors. At each newly exposed site of this incision, the aboral rectal wall is grasped and back stitches are placed using the Gambé technique.
Note: Using a braided absorbable suture of size 3/0, the initial stitch is made from the submucosa inward, followed by the back stitch from inside to outside in a full-thickness manner. With the help of the sutures, the anal ring is circularly expanded.
Opening of the Douglas Pouch; Transection of the Rectal Pillars
The herniated Douglas pouch appears on the anterior circumference of the internal bowel loop, is op
The herniated Douglas pouch appears on the anterior circumference of the internal bowel loop, is op
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