Murat KAPAN, Akın ÖNDER, Serkan POLAT, İbrahim ALİOSMANOGLU, Fatih TASKESEN

Abdominal and perineal approaches in the surgical treatment of rectal prolapse

Giriş: Rektal prolapsus, sosyal ve fonksiyonel problemlere neden olan ve ideal cerrahi yöntem konusunda tartışmala-rın devam ettiği bir hastalıktır. Bu çalışmada rektal prolapsus nedeniyle cerrahi tedavi uygulanan hastalarımızda ab-dominal ve perineal yaklaşımların postoperatif erken ve geç dönem sonuçlarla beraber araştırılması amaçlandı. Gereç ve yöntem: 2006-2011 yılları arasında rektal prolapsus tanısıyla cerrahi tedavi uygulanan 21 hastanın kayıtla-rı retrospektif olarak değerlendirildi. Hastalara ait demografik ve fizik muayene bulguları, uygulanan cerrahi yöntem-ler, postoperatif erken ve geç dönemde gelişen komplikasyonlar, nüks ve mortalite oranları kaydedildi. Bulgular: Hastaların medyan yaş 43 olup, kadın/erkek oranı 1.63/1 idi. En sık başvuru şikayeti gaz kontrolünde bo-zukluk ve sıklıkla mukusla ıslanma idi. Fizik muayenede hastaların %19\'unda evre 1 ve %81\'inde evre 3 rektal pro-lapsus saptandı. En sık uygulanan cerrahi yöntem Notaras\'tı (%52.4). Hastaların % 14.3\'ünde postoperatif erken dö-nemde komplikasyon gelişti. Postoperatif mortalite, nüks ve reeksplorasyon gerektiren bir komplikasyon gözlenmedi. Perineal yaklaşım uygulanan hastalarda yaş daha ileri ve hastanede yatış süresi daha kısaydı ve sıklıkla rejyonel anestezi altında uygulandı. Postoperatif erken komplikasyonlar ve nüks gelişimi açısından istatistiksel farklılık izlen-medi. Sonuç: Cerrahi tedavi açısından risk faktörleri, hastaya ait bulgular ve cerrahın tecrübesi göz önünde bulundurularak uygulanacak abdominal veya perineal yaklaşımlara ait sonuçlar benzerdir.

Anahtar Kelimeler:

Rektal prolapsus, cerrahi, abdominal, perineal

Abdominal and perineal approaches in the surgical treatment of rectal prolapse

Introduction: Rectal prolapse is a disease, which is an important cause of social and functional problems and has a continuing debate about the ideal surgical treatment of itself. In this study, we aimed to investigate the abdominal and perineal approaches with early and late postoperative result in the patients undergoing surgery for rectal prolapse. Materials and methods: Between 2006-2011, the records of 21 patients undergoing surgery with the diagnosis of rectal prolapse were reviewed, retrospectively. The demographic and physical examination findings, surgical proce-dures, early and late postoperative complications, recurrence and mortality rates were recorded. Results: The median age was 43 years and female/male ratio was 1.63/1. The most common presenting complaint was gas control failure and often wetting with mucus. Stage 1 and stage 3 rectal prolapses was detected in 19% and 81% of the patients, respectively. The most common surgical procedure was Notaras (54%). Early postoperative complications were seen in 14.3% of the patients. There were no postoperative recurrence, mortality and complica-tion requiring re-exploration. Advanced age and shorter duration of hospital stay were determined and often per-formed under regional anesthesia in the patients undergoing perineal approach. No statistical differences were ob-served in terms of early postoperative complications and recurrence. Conclusion: Results of abdominal and perineal approaches were similar, when they were applied with taking into account the risk factors for surgical treatment, findings of the patients and the surgeon's experience.

Keywords:

rectal prolapse, surgery, abdominal, perineal.,

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