title: Medium-term results of vertical reduction rectoplasty and sigmoid colectomy for idiopathic megarectum.
abstract: BACKGROUND
  Vertical reduction rectoplasty (VRR) was devised specifically to address the physiological abnormalities present in the rectum of patients with idiopathic megarectum (IMR). This study evaluated the medium-term clinical and physiological results of VRR.
  
  
  METHODS
  VRR and sigmoid colectomy was performed in ten patients with IMR and constipation (six women). Patients were evaluated before and a median of 60 (range 28-74) months after surgery by assessment of symptoms using scoring systems and anorectal physiological measurements. Independent, detailed postoperative evaluation of rectal diameter, compliance, and sensory and evacuatory function was performed.
  
  
  RESULTS
  There were no deaths or late complications. Symptoms recurred necessitating permanent ileostomy formation in two patients. Median (range) constipation scores improved from 22 (18-27) before to 10 (0-24) after surgery (P = 0.016). Median (range) bowel frequency increased from 1.5 (0.2-7) to 7 (0.5-21) per week (P = 0.016). Rectal diameter, compliance and sensory function were normal in seven of eight patients after surgery. Evacuatory function and colonic transit were each normalized in two of eight patients after VRR.
  
  
  CONCLUSIONS
  VRR corrected rectal diameter, compliance and sensory function in most patients, and clinical benefit was sustained in the medium term. The procedure was associated with a low morbidity, and no mortality and should be considered in the surgical management of IMR.
authors.affiliation: Centre for Academic Surgery (Gastrointestinal Physiology Unit), St Bartholomew's and The Royal London Hospital, Queen Mary's School of Medicine and Dentistry, Whitechapel, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Gladman
authors.forename: N S
authors.initials: NS
authors.lastname: Williams
authors.forename: S M
authors.initials: SM
authors.lastname: Scott
authors.forename: O A
authors.initials: OA
authors.lastname: Ogunbiyi
authors.forename: P J
authors.initials: PJ
authors.lastname: Lunniss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery*; D003248:Constipation / Q000503:physiopathology / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D012002:Rectal Diseases / Q000503:physiopathology / Q000601:surgery*; D012810:Sigmoid Diseases / Q000601:surgery*; D016896:Treatment Outcome