Oruc Mustafa, Erol Timucin
Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey.
World J Clin Cases. 2023 Jun 6;11(16):3680-3693. doi: 10.12998/wjcc.v11.i16.3680.
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
直肠脱垂是直肠经肛门的全层环形突出。这是一种罕见疾病,仅影响0.5%的普通人群。已描述了多种治疗方式,且随着时间推移有显著变化。特别是在过去十年中,采用不同游离技术的腹腔镜和机器人手术方法,结合药物治疗,已得到广泛应用。由于患者出现的症状范围广泛(从腹部不适到排便不尽、黏液排出、便秘、腹泻和大便失禁),了解症状程度并排除鉴别诊断对于选择合适的手术方法至关重要。使用术前评分系统评估这些附加症状及其严重程度至关重要。此外,放射学和生理学评估可能解释一些模糊症状并揭示伴随的盆腔疾病。然而,关于直肠固定的最佳游离范围、手术类型和所用材料,尚无共识或标准化;这使得在并发症最少的情况下为患者提供最大益处变得困难。即使是最近的出版物和系统评价也未推荐最合适的治疗选择。本综述解释了针对不同情况的合适诊断工具,并根据现有文献和专家意见总结了当前的治疗方法。