title: Rectoanal intussusception: presentation of the disorder and late results of resection rectopexy.
abstract: BACKGROUND
  Rectoanal intussusception may cause symptoms of obstructed defecation, and functional results of prosthesis rectopexy are usually not satisfactory. The aim of this study was to assess several parameters of the disorder and to evaluate the outcome of resection rectopexy.
  
  
  METHODS
  During a 10-year period, 27 female patients with symptomatic large rectoanal intussusception had resection rectopexy (23 laparoscopy; 4 laparotomy). Conservative treatment, including biofeedback treatment in 22 patients, had failed in all cases. Preoperative and postoperative evaluation included clinical assessment, anorectal manometry, evacuation defecography, and colon transit studies. Follow-up ranged between one and five years.
  
  
  RESULTS
  Length of intussusception was 2 to 4.9 cm and was significantly related to pelvic floor descent (P = 0.003) and inversely related to resting anal pressures (P < 0.001). Eleven patients had undergone a previous hysterectomy, 9 had enterocele-sigmoidocele, 7 had incontinence of varying severity, and 8 had a solitary rectal ulcer. Colon transit was abnormal in all but five cases. Immediate functional results were bad in two-thirds of the cases; tenesmus, urge to defecate, and frequent stools were the main complaints. By the time these symptoms had subsided, and one year after surgery, all but two patients were satisfied with the outcome. Intussusception was reduced in all cases, anal sphincter tone recovered (P = 0.002), perineal descent decreased (P < 0.001), and colonic transit was accelerated (P < 0.001). Patients available at five-year follow-up had no or only minor defecatory problems.
  
  
  CONCLUSIONS
  Resection rectopexy improves symptoms of obstructed defecation attributed to large rectoanal intussusception.
authors.affiliation: Laboratory Unit of Gastrointestinal Motility, University Hospital of Crete, Heraklion, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Tsiaoussis
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chrysos
authors.forename: Elias
authors.initials: E
authors.lastname: Athanasakis
authors.forename: George
authors.initials: G
authors.lastname: Pechlivanides
authors.forename: Anastasios
authors.initials: A
authors.lastname: Tzortzinis
authors.forename: Odysseas
authors.initials: O
authors.lastname: Zoras
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Xynos
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology; D001004:Anus Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D001676:Biofeedback, Psychology; D003248:Constipation / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D007044:Hysterectomy; D007443:Intussusception / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D012002:Rectal Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D012007:Rectum / Q000601:surgery*