Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes - Hotel Dieu, France.
Colorectal Dis. 2011 Oct;13(10):e320-6. doi: 10.1111/j.1463-1318.2011.02688.x.
Minimally invasive surgery for pelvic floor prolapse has recently been shown to be feasible and safe. This study presents the results of robotic-assisted and laparoscopic rectopexy for complex rectocoele, focusing on less frequently reported outcomes of bowel and sexual function.
We prospectively assessed 41 consecutive patients who underwent ventral mesh rectopexy (robotic-assisted or laparoscopic) for a symptomatic complex rectocoele from January 2009 to January 2010. Complex rectocoele was defined as having one or more of the following features: larger than 3 cm, an enterocoele or internal rectal prolapse. Patients with cystocoele underwent bladder suspension concurrently. Both groups were assessed for anatomical recurrence and function, comparing preoperative and postoperative faecal incontinence, obstructive defaecation syndrome and Gastrointestinal Quality-of-life Index scores, as well as vaginal discomfort and sexual function.
Forty-one women underwent the procedure (16 robotic-assisted), with four (10.5%) having minor complications and two developing anatomical recurrence. There was significant relief of the commonest predominant symptoms of vaginal bulge/fullness (P<0.0001) and sexual dysfunction (P=0.02). There were three conversions to laparotomy (one robotic-assisted) and five patients declined postoperative functional assessment. In the remaining 33 patients [follow-up median 12 (8-21) months], analysis revealed no significant difference in overall functional score (P>0.740) or between patients with one or two meshes inserted (P>0.486). Only patients with a preoperative obstructive defaecation syndrome score >6 had a significant improvement postoperatively (P=0.030).
Minimally invasive ventral mesh rectopexy for complex rectocoele offers satisfactory anatomical correction and functional results, with the potential for alleviating symptoms of outlet obstruction and improving vaginal comfort and sexual dysfunction.
经阴道入路的盆底脱垂微创手术最近已被证明是可行和安全的。本研究介绍了机器人辅助和腹腔镜直肠固定术治疗复杂直肠前突的结果，重点介绍了较少报道的肠道和性功能结果。
我们前瞻性评估了 41 例因症状性复杂直肠前突而接受腹侧网片直肠固定术（机器人辅助或腹腔镜）的连续患者，该手术时间为 2009 年 1 月至 2010 年 1 月。复杂直肠前突定义为具有以下一种或多种特征：大于 3cm，存在肠膨出或直肠内脱垂。有膀胱膨出的患者同时行膀胱悬吊术。两组均评估解剖学复发和功能，比较术前和术后粪便失禁、阻塞性排便综合征和胃肠道生活质量指数评分，以及阴道不适和性功能。
41 例女性接受了该手术（16 例为机器人辅助），4 例（10.5%）出现轻微并发症，2 例出现解剖学复发。阴道膨出/饱满（P<0.0001）和性功能障碍（P=0.02）最常见的主要症状显著缓解。有 3 例转为剖腹手术（1 例为机器人辅助），5 例患者拒绝术后功能评估。在其余 33 例患者中[随访中位数 12（8-21）个月]，分析发现总体功能评分无显著差异（P>0.740）或插入一个或两个网片的患者之间无显著差异（P>0.486）。仅术前阻塞性排便综合征评分>6 的患者术后有显著改善（P=0.030）。
经阴道入路的微创网片直肠固定术治疗复杂直肠前突可获得满意的解剖学矫正和功能结果，有缓解出口梗阻症状和改善阴道舒适度和性功能障碍的潜力。
