van den Esschert J W, van Geloven A A W, Vermulst N, Groenedijk A G, de Wit L Th, Gerhards M F
Department of Surgery, Tergooi Ziekenhuizen, Van Riebeeckweg 212, Hilversum, 1213 XZ, The Netherlands.
Surg Endosc. 2008 Dec;22(12):2728-32. doi: 10.1007/s00464-008-9771-9. Epub 2008 Mar 5.
Obstructed defecation remains a serious syndrome. Several procedures have been applied to treat it. A concomitant enterocele excludes some of these procedures, because of potential threat of damaging the bowel. The aim of this study was to assess the outcome of patients who underwent laparoscopic nerve sparing ventral rectopexy for obstructed defecation syndrome with concomitant enterocele.
Seventeen patients were included. Data about clinical history, physical examination and a defecogram were collected. All patients underwent a laparoscopic ventral rectopexy. Complications, hospital stay, postoperative morbidity and long-term outcome were documented.
All patients underwent laparoscopic ventral rectopexy. The median operating time was 199 min (range 186-239 min). One conversion laparotomy was required. Six patients had postoperative complications (ileus n = 2, posttraumatic leg dystrophy n = 1, wound infection n = 1, incisional hernia n = 2). The median hospital stay was 6 days (range 3-24 days). Fifteen patients had improvement of their defecation problem, although six patients still had minor constipation symptoms. In one patient the mesh was rejected and finally removed.
Obstructed defecation syndrome is a combined functional and mechanical problem. In selected patients, especially when an enterocele is present, laparoscopic ventral rectopexy is a feasible technique, with an acceptable number of complications.
排便梗阻仍然是一种严重的综合征。已经应用了多种手术方法来治疗它。合并肠膨出会排除其中一些手术方法，因为存在损伤肠道的潜在风险。本研究的目的是评估因排便梗阻综合征合并肠膨出而接受腹腔镜保留神经腹直肌固定术的患者的治疗效果。
纳入17例患者。收集了有关临床病史、体格检查和排粪造影的数据。所有患者均接受了腹腔镜腹直肌固定术。记录了并发症、住院时间、术后发病率和长期治疗效果。
所有患者均接受了腹腔镜腹直肌固定术。中位手术时间为199分钟（范围186 - 239分钟）。需要1例中转开腹手术。6例患者出现术后并发症（肠梗阻2例、创伤后腿部营养不良1例、伤口感染1例、切口疝2例）。中位住院时间为6天（范围3 - 24天）。15例患者的排便问题得到改善，尽管6例患者仍有轻微便秘症状。1例患者的补片被排斥，最终被取出。
排便梗阻综合征是一个功能性和机械性相结合的问题。在选定的患者中，特别是存在肠膨出时，腹腔镜腹直肌固定术是一种可行的技术，并发症数量可接受。
