C. ÇALIŞKAN, A. M. KORKUT, Ö. FIRAT, E. AKGÜN, H. OSMANOĞLU

Rektal prolapsus deneyimimiz: 27 yılda 68 vaka

Amaç : Rektal prolapsus (RP) rektumun tüm katlarıyla beraber anüsten çıkması ile karakterize nadir bir durumdur. Đlk kez MÖ 1500 yıllarında Ebers papirüsünde tanımlanmıstır. Bu yazıda prolapsus nedeniyle tedavi edilen hastaların verileri irdelenmistir. Gereç ve Yöntem : RP nedeniyle 1978-2006 yılları arasında tedavi edilen 68 hastanın verileri retrospektif olarak incelenmis, literatürde geçen diğer onarım metodlarının sonuçları ile kıyaslanması amaçlanmıstır. Bulgular : Bütün hastalar çesitli sentetik materyaller ile abdominal rektopeksi yöntemi ile tedavi edilmislerdir. Bu materyaller 37 vakada Ivalon sünger, 26 vakada prolen greft, dört vakada Gore-Tex grefttir. Osteogenesis Đmperfektalı bir olgu prolaps olan rektumun nekroza uğraması nedeniyle acil kosullarda rektal pull-through yöntemi ile tedavi edilmistir. Ortalama takip süresi 58 aydır. Bu sürede 2 vakada rekürrens saptanmıstır. Bunlardan ilki postoperatif dönemde presakral hematom nedeniyle nüks gelisen ve tekrar opere edilen hastadır. Đkinci hastada ise takibin birinci yılında rekürrens gelismis ve anterior rezeksiyon ile tedavi edilmistir. Sonuç : Günümüze değin RP ‘un tedavisi için 100’den fazla cerrahi prosedür tanımlanmıs olsa da ideal tedavi yöntemi hala net değildir. Sentetik materyaller kullanılarak yapılan rektopeksinin güvenli ve kolaylıkla uygulanabilir olması nedeniyle RP’ın tedavisinde diğer rektopeksi yöntemlerine kıyasla en uygunu olduğu kanaatindeyiz.

Rectal prolapse experience:68 cases in 27 years

Aim : Rectal Prolapse (RP) is a rare entity which is formed of intussusceptions of the rectum with all layers through out from the anus. It was first described in the Ebers papyrus in the 1500 BC. In this article , datas of patients which treated for rectal prolapse were discussed. Patients and Method : We retrospectively analyzed the patients with RP between 1978-2006 and 68 patients were detected. Results : All patients were submitted to abdominal rectopexy with various of synthetic materials that were followed as: 37 cases with Ivalon sponge, 26 cases with polypropylene mesh, four cases with Gore-tex mesh. One case with osteogenesis imperfecta underwent emergent operation and rectal pull-through was performed because of strangulation of the rectum. Mean followed-up time was 58 months. Two recurrence were observed. One of these patients had recurrence due to presacral hematoma during hospital stay and reoperated. The recurrence of the second patient occured in the first follow-up year and treated with the anterior resection. Conclusion : Although more than 100 types of surgical procedures for RP have been reported so far, the optimal method is still controversial. Because the abdominal rectopexy with synthetic materials is safely and easily performed, we suggest this surgical technique as the most appropriate one for RP rather than the other rectopexy techniques.

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