van Iersel Jan J, Formijne Jonkers Hendrik A, Paulides Tim J C, Verheijen Paul M, Draaisma Werner A, Consten Esther C J, Broeders Ivo A M J
1 Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands 2 Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands.
Dis Colon Rectum. 2017 Nov;60(11):1215-1223. doi: 10.1097/DCR.0000000000000895.
Laparoscopic ventral mesh rectopexy is being increasingly performed internationally to treat rectal prolapse syndromes. Robotic assistance appears advantageous for this procedure, but literature regarding robot-assisted ventral mesh rectopexy is limited.
The primary objective of this study was to assess the safety and effectiveness of robot-assisted ventral mesh rectopexy in the largest consecutive series of patients to date.
This study is a retrospective cross-sectional analysis of prospectively collected data.
The study was conducted in a tertiary referral center.
All of the patients undergoing robot-assisted ventral mesh rectopexy for rectal prolapse syndromes between 2010 and 2015 were evaluated.
Preoperative and postoperative (mesh and nonmesh) morbidity and functional outcome were analyzed. The actuarial recurrence rates were calculated using the Kaplan-Meier method.
A total of 258 patients underwent robot-assisted ventral mesh rectopexy (mean ± SD follow-up = 23.5 ± 21.8 mo; range, 0.2 - 65.1 mo). There were no conversions and only 5 intraoperative complications (1.9%). Mortality (0.4%) and major (1.9%) and minor (<30 d) early morbidity (7.0%) were acceptably low. Only 1 (1.3%) mesh-related complication (asymptomatic vaginal mesh erosion) was observed. A significant improvement in obstructed defecation (78.6%) and fecal incontinence (63.7%) were achieved for patients (both p < 0.0005). At final follow-up, a new onset of fecal incontinence and obstructed defecation was induced or worsened in 3.9% and 0.4%. The actuarial 5-year external rectal prolapse and internal rectal prolapse recurrence rates were 12.9% and 10.4%.
This was a retrospective study including patients with minimal follow-up. No validated scores were used to assess function. The study was monocentric, and there was no control group.
Robot-assisted ventral mesh rectopexy is a safe and effective technique to treat rectal prolapse syndromes, providing an acceptable recurrence rate and good symptomatic relief with minimal morbidity. See Video Abstract at http://links.lww.com/DCR/A427.
腹腔镜腹侧补片直肠固定术在国际上越来越多地用于治疗直肠脱垂综合征。机器人辅助在该手术中似乎具有优势，但关于机器人辅助腹侧补片直肠固定术的文献有限。
本研究的主要目的是在迄今为止最大的连续系列患者中评估机器人辅助腹侧补片直肠固定术的安全性和有效性。
本研究是对前瞻性收集的数据进行回顾性横断面分析。
该研究在一家三级转诊中心进行。
对2010年至2015年间所有因直肠脱垂综合征接受机器人辅助腹侧补片直肠固定术的患者进行评估。
分析术前和术后（补片和非补片）发病率及功能结局。采用Kaplan-Meier法计算精算复发率。
共有258例患者接受了机器人辅助腹侧补片直肠固定术（平均±标准差随访时间=23.5±21.8个月；范围，0.2 - 65.1个月）。无中转病例，术中仅发生5例并发症（1.9%）。死亡率（0.4%）、严重（1.9%）和轻微（<30天）早期发病率（7.0%）低至可接受水平。仅观察到1例（1.3%）与补片相关的并发症（无症状性阴道补片侵蚀）。患者的排便梗阻（78.6%）和大便失禁（63.7%）均有显著改善（均p<0.0005）。在最后随访时，新发或加重的大便失禁和排便梗阻分别为3.9%和0.4%。精算5年直肠外脱垂和直肠内脱垂复发率分别为12.9%和10.4%。
这是一项回顾性研究，纳入的患者随访时间短。未使用经过验证的评分来评估功能。该研究为单中心研究，且无对照组。
机器人辅助腹侧补片直肠固定术是治疗直肠脱垂综合征的一种安全有效的技术，复发率可接受，症状缓解良好，发病率极低。见视频摘要：http://links.lww.com/DCR/A427 。
