Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan.
Tech Coloproctol. 2018 Jun;22(6):425-431. doi: 10.1007/s10151-018-1811-4. Epub 2018 Jun 28.
Physiological changes after laparoscopic ventral rectopexy (LVR) in patients with rectoanal intussusception (RAI) remain unclear. This study was undertaken to evaluate physiological and morphological changes after LVR for RAI, and to study clinical outcomes following LVR with special reference to fecal incontinence (FI).
The study was conducted on patients who had LVR for RAI between February 2012 and December 2016 at our institution Patients with RAI and FI were included in the study. Patients with RAI and obstructed defecation and those with RAI and neurologic FI were not included. The patients had anorectal manometry preoperatively, and 3, 6, and 12 months postoperatively. Defecography was performed before and 6 months after the procedure. FI was evaluated using the Fecal Incontinence Severity Index (FISI).
There were 34 patients (median age 77 years (range 60-93) years). Thirty-two patients (94%) were female and the median number of vaginal deliveries was 2 (range 0-5). Neither maximum resting pressure nor maximum squeeze pressure increased postoperatively. There was an overall increase in both defecatory desire volume (median preoperative 75 ml vs. 90 ml at 12 months; p = 0.002) and maximum tolerated volume (median preoperative 145 ml vs.175 ml at 12 months; p = 0.002). Postoperatively, RAI was eliminated in all patients but one, although 13 had residual rectorectal intussusception found at defecography. There was an overall reduction in both rectocele size (median preop 29 mm vs. postop 10 mm; p = 0.008) and pelvic floor descent (median preop 26 mm vs. postop 20 mm; p = 0.005). Twelve months after surgery, a reduction of at least 50% was observed in the FISI score for 31 incontinent patients (91%).
LVR for RAI produced adequate improvement of FI, and successful anatomical correction of RAI was confirmed by postoperative proctography. Postoperative increase in the rectal volume may have a positive effect on continence.
腹腔镜腹会阴直肠固定术（LVR）后患者直肠肛管内套叠（RAI）的生理变化仍不清楚。本研究旨在评估 LVR 治疗 RAI 后的生理和形态变化，并研究 LVR 后的临床结果，特别关注粪便失禁（FI）。
本研究于 2012 年 2 月至 2016 年 12 月在我院进行，纳入接受 LVR 治疗 RAI 的患者。纳入患有 RAI 和 FI 的患者。不包括患有 RAI 和阻塞性排便以及患有 RAI 和神经源性 FI 的患者。患者术前进行肛肠测压，术后 3、6 和 12 个月进行。术前和术后 6 个月进行排粪造影。使用粪便失禁严重程度指数（FISI）评估 FI。
共有 34 例患者（中位年龄 77 岁（范围 60-93）岁）。32 例（94%）为女性，中位阴道分娩次数为 2 次（范围 0-5 次）。术后最大静息压和最大收缩压均无增加。排便欲望量总体增加（术前中位数 75ml 与术后 12 个月 90ml；p=0.002），最大耐受量总体增加（术前中位数 145ml 与术后 12 个月 175ml；p=0.002）。术后，除 1 例患者外，所有患者的 RAI 均被消除，但 13 例患者在排粪造影时发现有残余直肠内套叠。直肠前突大小总体减小（术前中位数 29mm 与术后 10mm；p=0.008），盆底下降总体减小（术前中位数 26mm 与术后 20mm；p=0.005）。术后 12 个月，31 例失禁患者的 FISI 评分至少降低 50%（91%）。
LVR 治疗 RAI 可显著改善 FI，并通过术后直肠造影证实 RAI 成功解剖矫正。术后直肠容量增加可能对控便产生积极影响。
