Vertical reduction rectoplasty: a new treatment for idiopathic megarectum

Background: The aetiology of idiopathic megarectum is unknown and the resul ts of surgery are often unsatisfactory. Rectal hyposensation is common and poor perception of rectal filling may contribute to the poor evacuatory fun ction. By reducing the capacity of the rectum, it was hypothesized that sen sory thresholds to rectal distension and perception of urge to defaecate wo uld be improved. Methods: Vertical reduction rectoplasty (VRR) and concomitant sigmoid colec tomy was performed on six patients with idiopathic megarectum. Patients wer e evaluated before and after operation by detailed questionnaire and anorec tal physiology. Postoperative rectal compliance was also studied by means o f a programmable electronic barostat. Where appropriate, physiological data were compared with those obtained in eight healthy volunteers. Results: Bowel frequency increased from a preoperative median of 2.5 to 16 per month after operation. Four patients reported improved rectal perceptio n of the urge to defaecate. Thresholds for defaecatory urge and maximum tol erated volume were significantly reduced following VRR (P < 0.05). Post-VRR rectal compliance was no different from that in healthy volunteers. Coloni c transit time decreased significantly after VRR (P < 0.05) and evacuation on proctography increased from a median of 30 per cent to 50 per cent. At a median of 57 weeks' follow-up five of the six patients expressed continued satisfaction with the results. Conclusion: VRR is a new approach to the treatment of idiopathic megarectum . Clinical and physiological studies confirm that it can improve sensory fe edback and defaecation. The procedure needs further evaluation as the numbe r of patients undergoing the procedure increases.