Rektosel
Özet
Rektosel, rektumun anterior duvarının vajinanın posterior duvarına doğru fıtıklaşmasıyla karakterize bir pelvik taban bozukluğudur ve sıklıkla multipar, 50 yaş üzeri kadınlarda görülür. En yaygın risk faktörleri vajinal doğum, ileri yaş ve obeziteyken; hastalar sıklıkla zor dışkılama, pelvik baskı ve cinsel işlev bozukluklarından şikayet ederler. Tanı esas olarak fizik muayene ile konulsa da, klinik bulguların yetersiz kaldığı durumlarda defekografi ve MRG gibi görüntüleme yöntemlerinden faydalanılır. Tedavi yaklaşımı öncelikle diyet düzenlemeleri ve laksatifler gibi konservatif yöntemleri içerir; cerrahi ise semptomların yaşam kalitesini bozduğu ve medikal tedavinin yetersiz kaldığı durumlarda gündeme gelir. Cerrahi yöntemler rektoselin konumuna (yüksek, orta, alçak) göre transanal, transvajinal veya abdominal yaklaşımlar arasından seçilir; günümüzde laparoskopik ventral rektopeksi yüksek rektoseller için altın standart kabul edilmektedir. Tedavi süreci, eşlik eden diğer pelvik organ sarkmaları ve hastanın bireysel faktörleri göz önünde bulundurularak uzman cerrahlarca planlandığında başarı oranı oldukça yüksektir.
Rectocele is a pelvic floor disorder characterized by the herniation of the anterior rectal wall into the posterior vaginal wall, most commonly occurring in multiparous women over the age of 50. While the most prevalent risk factors include vaginal delivery, advanced age, and obesity, patients often suffer from symptoms such as obstructed defecation, pelvic pressure, and sexual dysfunction. Although diagnosis is primarily established through physical examination, imaging techniques like defecography and MRI are utilized when clinical findings are inconclusive. The treatment approach initially involves conservative methods such as dietary adjustments and laxatives, whereas surgery is considered when symptoms impair quality of life and medical therapy fails. Surgical procedures are selected from transanal, transvaginal, or abdominal approaches based on the location of the rectocele (high, middle, low), with laparoscopic ventral rectopexy currently regarded as the gold standard for high rectoceles. When the treatment process is planned by specialist surgeons considering accompanying pelvic organ prolapses and individual patient factors, success rates are high with low morbidity.
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