Tevfik EKER, Yusuf SEVİM, Akın KOCAAY, Mehmet SEVEN, Toygar SARI, Cihangir AKYOL

Rektal Prolapsusta Perineal Yaklaşım: Olgu Sunumu

Rektal prolapsus anal orifisten protrüde olmuş mukozal ya da tam kat rektal dokunun varlığını ifade eder. Rektal prolapsus tedavisi abdominal veya perineal cerrahilerdir. Yaşlı ve cerrahi açıdan yüksek riskli hastalarda perineal yöntemler tercih edilir ve daha sık olarak Altemeier prosedürü olarak adlandırılan rektosigmoidektomi uygulanır. Kliniğimize inkarsere rektal prolapsus ile başvuran ve Altemeier prosedürü uygulanmış 79 yaşında kadın hasta sunulmaktadır. Başvuruda son 24 saatten itibaren redükte olmamış rektal prolapsus ve 2 cm’lik polip izlediğimiz hastaya rejyonel anestezi altında Altemeier prosedürü uygulandı. Hastada, cerrahi sonrası dönemde komplikasyonu gelişmedi ve postoperatif 4. gün taburcu edildi. Altemeier prosedürü endike olduğu komorbiditesi fazla yaşlı hastalarda, düşük morbidite ve mortalite oranları ile tecrübeli hekimler tarafından güvenle uygulanabilir.

Perineal Approach in Rectal Prolapse: Case Report

Rectal prolapse is a condition where the full thickness rectal wall or mucosa of the rectum protrudes from the anus. The surgical treatment of rectal prolapse is performed either abdominally or perineally . The perineal procedures are prefered with old patients with the high risk for surgery, and rectosigmoidectomy named as Altemeier procedure is the most preffered procedure. Here in we present a 79 years-old female patient, admitted to our clinic with the history of 24 hours incarcerated rectal prolapse and 2 cm sized polip. Altemeier procedure was performed under regional anesthesia, the patient was discharged on the 4th postoperative day without any complications. Altemeier procedure can be safely administered in indicated elderly patients by experienced surgeon with low morbidity and mortality rates.

Keywords:

Rectal prolapsus, Altemeier procedure,

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Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg. 2014;18:1059-69.
Melton GB, Kwaan MR. Rectal prolapse. Surg Clin North Am. 2013;93:187-98.
Moschcowitz AV. The pathogenesis, anatomy and cure of prolapse of rectum. Surg Gynecol Obstet. 1912;15:7-21.
Broden B, Snellman B. Procidentia of the rectum studied with cineradiography. A contribution to the discussion of causative mechanism. Dis Colon Rectum. 1968;11:330-47.
Patel SM, Lembo AJ. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 8th ed. Feldman M, editor: Saunders. 2006;230.
Kairaluoma MV, Kellokumpu IH. Epidemiologic aspects of complete rectal prolapse. Scand J Surg. 2005;94:207-10.
Stein EA, Stein DE. Rectal procidentia: diagnosis and management. Gastrointest Endosc Clin N Am. 2006;16:189-201.
Senapati A, Gray RG, Middleton LJ, Harding J, Hills RK, Armitage NC, et al. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15:858-68.
Steele SR, Goetz LH, Minami S, Madoff RD, Mellgren AF, Parker SC. Management of recurrent rectal prolapse: surgical approach influences outcome. Dis Colon Rectum. 2006;49:440-5.
Zbar AP, Takashima S, Hasegawa T, Kitabayashi K. Perineal rectosigmoidectomy (Altemeier's procedure): a review of physiology, technique and outcome. Tech Coloproctol. 2002;6:109-16.
Madsen MA. Perineal approaches to rectal prolapse. Clin Colon Rectal Surg. 2008;21:100-5.
Altemeier WA, Culbertson WR, Schowengerdt C, Hunt J. Nineteen years' experience with the one- stage perineal repair of rectal prolapse. Ann Surg. 1971;173:993-1006.
Ris F, Colin JF, Chilcott M, Remue C, Jamart J, Kartheuser A. Altemeier's procedure for rectal prolapse: analysis of long-term outcome in 60 patients. Colorectal Dis. 2012;14:1106-11.
Cirocco WC. The Altemeier procedure for rectal prolapse: an operation for all ages. Dis Colon Rectum. 2010;53:1618-23.
Boccasanta P, Venturi M, Barbieri S, Roviaro G. Impact of new technologies on the clinical and functional outcome of Altemeier's procedure: a randomized, controlled trial. Dis Colon Rectum. 2006;49:652-60.
Towliat SM, Mehrvarz S, Mohebbi HA, Sate Bigdeli A. Outcomes of rectal prolapse using the altemeier procedure. Iran Red Crescent Med J. 2013;15:620-1.
Theuerkauf FJ, Jr., Beahrs OH, Hill JR. Rectal prolapse. Causation and surgical treatment. Ann Surg. 1970;171:819-35.
Porter NH. Surgery for rectal prolapse. Br Med J. 1971;3:113.
Friedman R, Muggia-Sulam M, Freund HR. Experience with the one-stage perineal repair of rectal prolapse. Dis Colon Rectum. 1983;26:789-91.
Gopal KA, Amshel AL, Shonberg IL, Eftaiha M. Rectal procidentia in elderly and debilitated patients. Experience with the Altemeier procedure. Dis Colon Rectum. 1984;27:376-81.
Prasad ML, Pearl RK, Abcarian H, Orsay CP, Nelson RL. Perineal proctectomy, posterior rectopexy, and postanal levator repair for the treatment of rectal prolapse. Dis Colon Rectum. 1986;29:547-52.
Ramanujam PS, Venkatesh KS. Perineal excision of rectal prolapse with posterior levator ani repair in elderly high-risk patients. Dis Colon Rectum. 1988;31:704-6.
Williams JG, Rothenberger DA, Madoff RD, 27. Lee SH, Lakhtaria P, Canedo J, Lee YS, Wexner Goldberg SM. Treatment of rectal prolapse in the elderly by perineal rectosigmoidectomy. Dis Colon Rectum. 1992;35:830-4.
Kim DS, Tsang CB, Wong WD, Lowry AC, Goldberg SM, Madoff RD. Complete rectal prolapse: evolution of management and results. Dis Colon Rectum. 1999;42:460-6-9.
Kimmins MH, Evetts BK, Isler J, Billingham R. The Altemeier repair: outpatient treatment of rectal prolapse. Dis Colon Rectum. 2001;44:565-70.
Glasgow SC, Birnbaum EH, Kodner IJ, Fleshman JW, Dietz DW. Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum. 2006;49:1052-8. SD. Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc. 2011;25:2699-702.
Pescatori M, Zbar AP. Tailored surgery for internal and external rectal prolapse: functional results of 268 patients operated upon by a single surgeon over a 21-year period*. Colorectal Dis. 2009;11:410-9.
Fleming FJ, Kim MJ, Gunzler D, Messing S, Monson JR, Speranza JR. It's the procedure not the patient: the operative approach is independently associated with an increased risk of complications fter rectal prolapse repair. Colorectal Dis. 2012;14:362-8.