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Tanıtım: Rektal prolapsus 4 yaşın altındaki çocuklarda sık görülür. Önemli sayıda çocuk zamanla spontan iyileşmeye uğrar, bu nedenle bu hastalara genellikle önceden cerrahi tedavi önerilmez, bu da semptomatik çocuklarda spontan bir iyileşme umarken uzun süreli acı çekmesine neden olur. Abdominal rektopeksi, rektumun yoğun mobilizasyonunu takiben presakral fasyaya(1) sabitlenmesini içerir, böylece nervi erigentes hasar riskini artırır, sonuçta postoperatif kabızlık, mesane ve cinsel işlev bozukluğu ortaya çıkar. Bu çalışma, prolapsus patofizyolojisinin invajinasyon ile başladığı ve dolayısıyla başlangıç noktasının rektum yerine rektosigmoid olan pexing ile önlenebileceği varsayımıyla yapılmıştır. Yöntemler: Çalışmamız, tam kalınlıkta rektal prolapsus için önceden ameliyat edilen altı yıllık bir süre boyunca hastaları içeriyordu. Gerçekleştirilen ameliyat, rektal mobilizasyondan tamamen kaçınarak ve emilebilir bir ağ kullanarak rektosigmoidi presakral fasyaya sabitleyerek Well's prosedürünün bir modifikasyonuydu. Sonuçlar: 17 hasta (ortalama yaş - 7 yıl) ameliyat edildi. Bir hastada erken nüks meydana geldi. Uzamış kabızlık, mesane disfonksiyonu veya meş ile ilgili komplikasyonlar yoktu. Çözüm: Tam rektal prolapsus için önceden yapılan ameliyat, çocuğun her dışkı çıkışında yaşamak zorunda olduğu ıstırabı durdururken, ebeveynler bir tür konservatif tedavi ile kendiliğinden bir çözüm bulmayı umuyor. İzlediğimiz cerrahi teknik etkilidir ve mobilizasyon sırasında rektumun denervasyonundan kaynaklanan komplikasyonları önler.
Rectal prolapsus is common in children under the age of 4. A significant number of children get spontaneously healed over time, so these patients are often not recommended pre-chirurgical treatment, which causes symptomatic children to suffer long-term pain while hoping for spontaneous healing. Abdominal rectopsis involves the fixation of the presacral phase(1) following the intense mobilization of the rectum, thus increasing the risk of nerve erigentes damage, resulting in postoperative constipation, urine and sexual function disorders. This study was done with the assumption that prolapsus pathophysology began with invasion and therefore the starting point could be prevented by pexing, which is rectosigmoid instead of rectum. Methods: Our study included patients for a six-year period previously operated for full thickness rectal prolapsus. The surgery was a modification of Well's procedure by completely avoiding rectal mobilization and fixing the rectosigmoid to the presacral phase using an absorbable network. Results: 17 patients (medium age - 7 years) were operated. A patient had a early nursing. There were no complications associated with prolonged constipation, mesh dysfunction or mushroom. Solution: Pre-operation for full rectal prolapses stops the suffering that the child has to experience at each output, while parents hope to find a solution on their own with a kind of conservative treatment. The surgery we monitor is technically effective and prevents complications caused by the denervation of the rectum during mobilization.
SUMMARY Introduction Rectal prolapse is common in children below the age of 4 years. A significant number of children undergo spontaneous resolution over time, hence upfront surgical treatment is not commonly offered to these patients, resulting in prolonged sufferring in symptomatic children while hoping for a spontaneous resolution. Abdominal rectopexy involves extensive mobilization of the rectum followed by its fixation to the presacral fascia(1) thereby increasing the risk of damage to the nervi erigentes, with resultant postoperative constipation, bladder and sexual dysfunction. The present study was done on the premise that the pathophysiology of prolapse begins with intussusception and hence can be prevented by pexing the start point that is the rectosigmoid instead of the rectum. Methods Our study included patients over a period of six years who underwent upfront surgery for full thickness rectal prolapse. The surgery performed was a modification of the Well’s procedure, by avoiding rectal mobilisation completely and by fixing the rectosigmoid to the presacral fascia using an absorbable mesh. Results 17 patients (mean age - 7 years) underwent surgery. Early recurrence occurred in one patient. There was no prolonged constipation, bladder dysfunction or mesh related complications. Conclusion Upfront surgery for complete rectal prolapse stops the suffering a child has to undergo each time the child passes stools, while the parents are hoping for a spontaneous resolution with some form of conservative management. The surgical technique we followed is effective and avoids complications arising due to denervation of the rectum during mobilization.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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