Sahoo Manash Ranjan, Thimmegowda Anil Kumar, Gowda Manoj S
Department of Surgery, Shrirama Chandra Bhanj Medical College, Cuttack, Odisha, India.
J Minim Access Surg. 2014 Jan;10(1):18-22. doi: 10.4103/0972-9941.124456.
The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy.
In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs) were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity.
Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7) days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1%) patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3%) patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery.
There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.
本研究旨在比较腹腔镜补片与缝合直肠固定术的效果。
在这项回顾性研究中,2007年3月至2012年6月期间,70例年龄在20岁至65岁(平均42.5岁)之间的男女患者接受了腹腔镜直肠固定术,其中38例患者接受了腹腔镜补片直肠固定术,32例患者接受了腹腔镜缝合直肠固定术。对这些患者进行了平均12个月的随访,评估首次排便、住院时间、手术时长、大便失禁、便秘、复发及发病率。
腹腔镜缝合直肠固定术的手术时长为100.8±12.4分钟,腹腔镜补片直肠固定术为120±10.8分钟。术后,缝合和补片直肠固定术首次排便的平均时间分别为38小时和40小时。平均住院时间为5天(范围:4 - 7天)。除补片直肠固定术组有1例切口感染外,无明显术后并发症。术前有不同程度失禁的患者术后有所改善。接受腹腔镜缝合直肠固定术的18例患者中有11例(61.1%),相比接受腹腔镜补片直肠固定术的19例患者中的9例(47.3%),术后便秘情况有所改善。
两组手术患者除接受缝合直肠固定术的患者在控便和便秘症状改善方面更好外,无显著差异。此外,腹腔镜补片直肠固定术中使用补片的费用在腹腔镜缝合直肠固定术组不存在。结论是腹腔镜缝合直肠固定术是一种安全可行的手术,在手术时间、发病率、肠道功能、费用和复发方面有可比的结果,甚至在某些方面比补片直肠固定术稍好。