Tsunoda Akira, Takahashi Tomoko, Matsuda Satoshi, Oka Naoki, Kusanagi Hiroshi
Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan.
Department of Pediatric Surgery, Kameda Medical Center, Kamogawa, Japan.
Asian J Endosc Surg. 2020 Jan;13(1):25-32. doi: 10.1111/ases.12701. Epub 2019 Mar 28.
Although long-term crude outcomes of laparoscopic ventral rectopexy for external rectal prolapse (ERP) have been documented, repetitive functional and quality of life (QOL) assessments are scarce. This study assessed midterm annual functional results and QOL after laparoscopic ventral rectopexy for ERP.
This study consisted of 58 patients and was a retrospective analysis of prospectively collected data. The Fecal Incontinence Severity Index, the Constipation Scoring System, and QOL instruments (ie 36-item Short-Form Health Survey and Fecal Incontinence Quality of Life scale) were administered before and after operation.
There was no mortality or major morbidity. After a median follow-up of 49 months (6-92 months), recurrence of ERP was noted in one patient (2%). There were no mesh-related complications. The median Fecal Incontinence Severity Index score was significantly reduced at 3 months (34 [10-61] vs 12 [0-50], P < 0.0001) and remained significantly reduced for 5 years. The median Constipation Scoring System score was significantly reduced at 3 months (14 [9-20] vs 7 [0-16], P < 0.0001) and remained significantly reduced for 4 years. No patients developed new-onset constipation. All of the Fecal Incontinence Quality of Life scales significantly improved overtime for 4 years. All of the 36-item Short-Form Health Survey scales were significantly improved at 3 and 6 months, but none of the scales significantly improved after 2 years.
Laparoscopic ventral rectopexy for ERP was associated with low morbidity, low recurrence, and a midterm improvement in function and fecal incontinence-specific QOL.
尽管腹腔镜下腹直肠固定术治疗直肠外脱垂（ERP）的长期粗略结果已有记录，但重复性的功能和生活质量（QOL）评估却很少。本研究评估了腹腔镜下腹直肠固定术治疗ERP后的中期年度功能结果和生活质量。
本研究包括58例患者，是对前瞻性收集数据的回顾性分析。在手术前后分别使用大便失禁严重程度指数、便秘评分系统和生活质量评估工具（即36项简短健康调查问卷和大便失禁生活质量量表）。
无死亡或严重并发症。中位随访49个月（6 - 92个月）后，1例患者（2%）出现ERP复发。无网片相关并发症。大便失禁严重程度指数的中位评分在3个月时显著降低（34 [10 - 61] 对 12 [0 - 50]，P < 0.0001），并在5年内持续显著降低。便秘评分系统的中位评分在3个月时显著降低（14 [9 - 20] 对 7 [零 - 16]，P < 0.0001），并在4年内持续显著降低。无患者出现新发便秘。所有大便失禁生活质量量表在4年中随时间显著改善。所有36项简短健康调查问卷量表在3个月和6个月时显著改善，但2年后无一量表显著改善。
腹腔镜下腹直肠固定术治疗ERP具有低发病率、低复发率，且在功能和大便失禁特异性生活质量方面有中期改善。
