[Anteroposterior rectopexy for disorders of rectal stasis: clinical and radiologic results. Value of digital subtraction rectography. Apropos of 30 cases].
We report the results of 30 antero-posterior rectopexies (APR) for rectal kinetic disorders with descending perineum syndrome. All patients were investigated by digital subtraction defecography and ano-rectal manometry. The associated surgical procedures were: sphincterotomy (n = 13) for outlet obstruction demonstrated by anal manometry or balloon expulsion test: hypertonic sphincter (n = 7), narrow fibrous sphincter (n = 6); 10 cases of prolapsectomy with extended anterior mucosectomy to reduce anterior rectal prolapse; 2 sigmoidectomy for dolichosigmoid. Best results (mean follow-up: 12 months, 3-26) were observed for ano-rectal or pelvic pain and rectal bleeding, which were cured in more than 80% of cases. Faecal incontinence (n = 5) was cured in all cases. Although normalisation of bowel movements and easier defecation were observed in 78% of cases, improvement in the dyschezic syndrome was differently perceived by the patients. Postoperative investigation demonstrated the probable cause of surgical failures (23%): impairment of rectal sensitivity (n = 2), anismus (n = 3), motor constipation (n = 4), with dolichosigmoid (n = 3). Severe perineal deficiency was also noted in 4 cases. Solitary ulcer (n = 6), anterior proctitis (n = 8), were cured within 2 months. Postoperative defecography showed correction of rectal intussusception without impairment of anterior rectal motility during defecation. These results confirm the efficacy of ARP for treatment of rectal intussusception or anterior rectocele. This functional rectopexy avoids the rectal "sling effect" of standard rectopexy which usually increases rectal dysfunction. Nevertheless, ARP alone seems to be insufficient when the associated functional or organic disorders implicated in rectal dysfunction are not also corrected, essentially outlet obstruction and dolichosigmoid.
Costalat
G
G
Garrigues
J M
JM
Dravet
F
F
Noël
P
P
Lopez
P
P
Veyrac
M
M
Vernhet
J
J
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011182:Postoperative Care; D019736:Prostheses and Implants; D011859:Radiography; D012005:Rectal Prolapse / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*
Rectopexie antéro-postérieure pour troubles de la statique rectale: résultats cliniques et radiologiques. Intérêt de la rectographie dynamique numérisée. A propos de trente cas.