Rektal yabancý cisimlerin cerrahi tedavisi: Tek merkez deneyimi

AMAÇ: Rektal yabancý cisimler (RYC) son yýllarda artan insidansý ile kolorektal cerrahi pratiðinde nadir görülen klinik prezentasyonlardan biridir. Standart tedavi seçeneklerinin olmamasý nedeniyle, RFB’lerin yönetimi zor olabilir. Bu çalýþma, RFB’lere tanýsal ve terapötik yaklaþýmýmýzý deðerlen-dirmeyi ve bir yönetim algoritmasý önermeyi amaçladý
GEREÇ VE YÖNTEM: Ocak 2010 ile Aralýk 2020 arasýnda hastanede yatan tüm RYC’li hastalar geriye dönük olarak incelendi. Hasta demografisi, RYC yerleþtirme mekanizmasý, yerleþtirilen nesneler, taný bulgularý, yönetim, komplikasyonlar ve sonuçlarýn tümü deðerlendirildi. Merkezin deneyi-mine baðlý olarak klinik yönetim için bir algoritma geliþtirildi.
BULGULAR: Kohort 21 hastadan oluþuyordu, 17’si (%81) erkekti. Ortanca yaþ 33 idi (19–71 arasýnda deðiþiyor). On beþ (%71.4) hastada cinsel tercihler RYC nedeniydi. On yedi (%81) hastada RYC boyutu 10 cm’nin üzerindeydi. Dört (%19) hastada acil serviste RYC’ler anestezi olmadan transanal yolla çýkarýldý; kalan 17’sinde (%81) anestezi altýnda çýkarýldý. Bunlarýn arasýnda iki (%9.5) hastada genel anestezi altýnda RYC transanal yolla çýkarýldý; sekiz (%38) hastada anestezi altýnda kolonoskop yardýmýyla; üç (%14.2) hastada laparotomi sýrasýnda transanal yola saðým yaparak; ve dört (%19) hastada baðýrsak devamlýlýðý saðlanmadan Hartmann prosedürü ile RYC çýkarýlmasý yapýldý. Medyan hastanede kalýþ süresi altý gündü (1–34 gün arasýnda deðiþiyordu). Clavien-Dindo (C-D) derece III-IV komplikasyon oraný %9.5 idi ve ameliyat sonrasý mortalite gözlenmedi.
TARTIÞMA: RYC’ler genellikle ameliyathanede uygun anestezi tekniði ve uygun cerrahi alet seçimi ile transanal yolla baþarýlý bir þekilde çýkarýlabilir.

Surgical management of rectal foreign bodies: A single-center experience

BACKGROUND: Rectal foreign bodies (RFBs) are one of the rare clinical presentations in colorectal surgical practice, with an increasing incidence over the recent years. Due to the lack of standardized treatment options, the management of RFBs can be chal-lenging. This study aimed to evaluate our diagnostic and therapeutic approach to RFBs and to suggest a management algorithm.
METHODS: All patients with RFBs who hospitalized between January 2010 and December 2020 were retrospectively reviewed. Patient demographics, RFB insertion mechanism, inserted objects, diagnostic findings, management, complications, and outcomes were all evaluated. An algorithm for clinical management was developed depending on the center’s experience.
RESULTS: The cohort consisted of 21 patients, 17 (81%) were males. The median age was 33 years (ranging, 19–71). Sexual prefer-ences were the reason for RFB in 15 (71.4%) patients. In 17 (81%) patients, the RFB size over 10 cm. In 4 (19%) patients, RFBs were removed transanally without anesthesia in the emergency department; in the remaining 17 (81%), they were removed under anesthesia. Among these, RFBs were removed transanally under general anesthesia in 2 (9.5%) patients; with the assistance of a colonoscope under anesthesia in 8 (38%) patients; by milking towards the transanal route during laparotomy in 3 (14.2%) patients; and with the Hartmann procedure without restoration of bowel continuity in 4 (19%) patients. The median hospital stay was 6 days (ranging, 1–34 days). The Clavien-Dindo grade III-IV complication rate was 9.5%, and no post-operative mortality was observed.
CONCLUSION: RFBs can usually be successfully removed transanally in the operating room with appropriate anesthetic technique and proper surgical instrument selection.