Rektal Prolapsus
Özet
Rektal prolapsus, rektumun anüsten dışarı sarkmasıyla karakterize, kadınlarda ve ileri yaşlarda daha sık görülen anatomik bir bozukluktur. Kesin etiyolojisi net olmamakla birlikte; pelvik taban zayıflıkları, kronik kabızlık ve obezite gibi karın içi basıncı artıran faktörler risk teşkil etmektedir. Hastalar sıklıkla dışarı sarkan doku, mukus drenajı, fekal inkontinans ve kabızlık şikayetleriyle başvurur. Tanı aşamasında detaylı fizik muayeneye ek olarak defekografi, kolonoskopi ve anal fizyolojik testler kullanılabilir. Tedavide ameliyatsız yöntemler sadece semptomatik rahatlama sağlarken, kesin çözüm cerrahidir. Cerrahi yaklaşımlar abdominal ve perineal olarak ikiye ayrılır; abdominal yaklaşımlar (Ventral Mesh Rektopeksi, Frykman-Goldberg vb.) genellikle genç ve sağlıklı hastalarda tercih edilirken, perineal yaklaşımlar (Delorme, Altemeier) yüksek komorbiditesi olan ileri yaştaki hastalar için uygundur. Laparoskopik ve robotik cerrahi, açık cerrahiye oranla daha hızlı iyileşme ve daha az ağrı avantajı sunar. Güncel literatür, yaklaşımlar arasında nüks oranları açısından dramatik farklar olmadığını, bu nedenle tedavinin hastanın yaşına, semptomlarına ve cerrahın deneyimine göre bireyselleştirilmesi gerektiğini vurgulamaktadır.
Rectal prolapse is an anatomical disorder characterized by the protrusion of the rectum through the anus, occurring more frequently in women and the elderly. While its exact etiology remains unclear, factors increasing intra-abdominal pressure such as pelvic floor weaknesses, chronic constipation, and obesity pose significant risks. Patients often present with complaints of protruding tissue, mucus drainage, fecal incontinence, and constipation. In addition to a detailed physical examination, defecography, colonoscopy, and anal physiological tests can be utilized for diagnosis. Although non-surgical methods provide only symptomatic relief, the definitive treatment is surgery. Surgical approaches are divided into abdominal and perineal; abdominal techniques like Ventral Mesh Rectopexy and the Frykman-Goldberg procedure are generally preferred for younger, healthy patients, whereas perineal approaches such as Delorme and Altemeier are suitable for elderly patients with high comorbidities. Laparoscopic and robotic surgeries offer advantages such as faster recovery and less pain compared to open surgery. Current literature emphasizes that there are no dramatic differences in recurrence rates between approaches, and therefore, treatment must be individualized based on the patient's age, symptoms, and the surgeon's expertise.
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