الفهرس | Only 14 pages are availabe for public view |
Abstract Rectoanal intussusception is the circumferential full thickness infolding of the midrectum during the effort of straining to evacuate. Patients most frequently present with constipation, excessive straining at stool, a sensation of incomplete evacuation, and not infrequently fecal incontinence. Defecography is the main investigatory tool to diagnose RI and to determine its grade according to Oxford grading system, anorectal manometry and endoanal ultrasound also are important to detect any weakness of the anal sphincters and abnormally low anal pressures. The treatment of rectal intussusception associated with obstructed defecation remains challenging. Conservative management using dietary modification and biofeedback yield disappointing results. Surgical treatment divides into transanal or abdominal approaches, with transanal approaches tending to have lower morbidity, and abdominal approaches having lower recurrence rates. In this study, 28 patients with rectoanal intussusception were divided into 2 equal groups; Laparoscopic ventral mesh rectopexy and Laparoscopic resection rectopexy, then they were followed up for one year. Lap resection rectopexy proved to be superior as regard symptoms improvement with least recurrence rate inspite of its drawbacks as longer operative time and hospital stay which increase both potential morbidity and health care costs. On the other hand, lap ventral mesh rectopexy although not as efficient as the resection rectopexy in controlling the symptoms yet it proves to be safer, easier and less time consuming, thus the choice between the two procedures should be careful and tailored to each individual patient. |