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腹腔镜下腹膜网片直肠固定术治疗完全性直肠脱垂:一项评估印度北部人群治疗效果的回顾性研究

Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population.

作者信息

Chandra Abhijit, Kumar Saket, Maurya Ajeet Pratap, Gupta Vishal, Gupta Vivek

机构信息

Abhijit Chandra, Saket Kumar, Ajeet Pratap Maurya, Vishal Gupta, Vivek Gupta, Rahul, Department of Surgical Gastroenterology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.

出版信息

World J Gastrointest Surg. 2016 Apr 27;8(4):321-5. doi: 10.4240/wjgs.v8.i4.321.

Abstract

AIM

To analyze the outcomes of laparoscopic ventral mesh rectopexy in the management of complete rectal prolapse (CRP) in North Indian patients with inherent bulky and redundant colon.

METHODS

The study was conducted at a tertiary health care center of North India. Between January 2010 and October 2014, 15 patients who underwent laparoscopic ventral mesh repair for CRP, were evaluated in the present study. Perioperative outcomes, improvement in bowel dysfunction or appearance of new complications were documented from the hospital records maintained prospectively.

RESULTS

Fifteen patients (9 female) with a median age of 50 years (range, 15-68) were included in the study. The median operative time was 200 min (range, 180-350 min) and the median post-operative stay was 4 d (range, 3-21 d). No operative mortality occurred. One patient with inadvertent small bowel injury required laparotomy on post-operative day 2. At a median follow-up of 22 mo (range, 4-54 mo), no prolapse recurrence was reported. No mesh-related complication was encountered. Wexner constipation score improved significantly from the preoperative value of 17 (range, 5-24) to 6 (range, 0-23) (P < 0.001) and the fecal incontinence severity index score from 24 (range, 0-53) to 2 (range, 0-53) (P = 0.007). No de novo constipation or fecal incontinence was recorded during the follow-up. On personal conversation, all patients expressed satisfaction with the outcome of their treatment.

CONCLUSION

Our experience indicates that laparoscopic ventral mesh rectopexy is an effective surgical option for CRP in North Indian patients having a bulky redundant colon.

摘要

目的

分析腹腔镜腹侧补片直肠固定术治疗北印度具有固有粗大冗长结肠的完全直肠脱垂(CRP)患者的疗效。

方法

本研究在北印度的一家三级医疗保健中心进行。2010年1月至2014年10月期间,对15例行腹腔镜腹侧补片修复术治疗CRP的患者进行了评估。从前瞻性保存的医院记录中记录围手术期结果、肠道功能障碍的改善情况或新并发症的出现。

结果

15例患者(9例女性)纳入研究,中位年龄50岁(范围15 - 68岁)。中位手术时间为200分钟(范围180 - 350分钟),中位术后住院时间为4天(范围3 - 21天)。无手术死亡发生。1例意外小肠损伤患者在术后第2天需要剖腹手术。中位随访22个月(范围4 - 54个月),未报告脱垂复发。未遇到与补片相关的并发症。Wexner便秘评分从术前的17分(范围5 - 24分)显著改善至6分(范围0 - 23分)(P < 0.001),粪便失禁严重程度指数评分从24分(范围0 - 53分)降至2分(范围0 - 53分)(P = 0.007)。随访期间未记录到新发便秘或粪便失禁。经个人交流,所有患者对其治疗结果表示满意。

结论

我们的经验表明,腹腔镜腹侧补片直肠固定术是治疗北印度具有粗大冗长结肠的CRP患者的一种有效手术选择。

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