Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Medical Research Centre Oulu, Centre of Surgical Research, University of Oulu, Oulu, Finland.
Tech Coloproctol. 2021 Mar;25(3):299-307. doi: 10.1007/s10151-020-02369-5. Epub 2020 Nov 5.
Minimally invasive ventral mesh rectopexy (VMR) is a widely used surgical treatment for posterior pelvic organ prolapse; however, evidence of the utility of revisional surgery is lacking. Our aim was to assess the technical details, safety and outcomes of redo minimally invasive VMR for patients with external rectal prolapse (ERP) recurrence or relapsed symptoms of internal rectal prolapse (IRP).
This is a retrospective cohort study of patients with recurrent ERP or symptomatic IRP who underwent redo minimally invasive VMR between 2011 and 2016. The study was conducted at three hospitals in Finland. Data collected retrospectively included patient demographics, in addition to perioperative and short-term postoperative findings. At follow-up, all living patients were sent a questionnaire concerning postoperative disease-related symptoms and quality of life.
A total of 43 redo minimally invasive VMR were performed during the study period. The indication for reoperation was recurrent ERP in 22 patients and relapsed symptoms of IRP in 21 patients. In most operations (62.8%), the previously used mesh was left in situ and a new one was placed. Ten (23.3%) patients experienced complications, including 2 (4.7%) mesh-related complications. The recurrence rate was 4.5% for ERP. Three patients out of 43 were reoperated on for various reasons. One patient required postoperative laparoscopic hematoma evacuation. Patients operated on for recurrent ERP seemed to benefit more from the reoperation.
Minimally invasive redo VMR appears to be a safe and effective procedure for treating posterior pelvic floor dysfunction with acceptable recurrence and reoperation rates.
微创腹侧网片直肠固定术（VMR）是一种广泛应用于治疗后盆腔器官脱垂的手术方法；然而，关于翻修手术效果的证据尚缺乏。我们旨在评估对有外直肠脱垂（ERP）复发或内直肠脱垂（IRP）复发症状的患者进行微创 VMR 翻修的技术细节、安全性和结果。
这是一项回顾性队列研究，纳入了 2011 年至 2016 年间在芬兰的三家医院接受微创 VMR 翻修的 ERP 复发或有症状 IRP 复发的患者。收集了回顾性数据，包括患者人口统计学资料以及围手术期和短期术后发现。在随访时，所有存活的患者都收到了一份关于术后疾病相关症状和生活质量的问卷。
在研究期间共进行了 43 例微创 VMR 翻修手术。22 例患者的手术指征为 ERP 复发，21 例患者为 IRP 复发症状复发。在大多数手术中（62.8%），之前使用的网片保留在原位，并放置了新的网片。10 例（23.3%）患者发生了并发症，包括 2 例（4.7%）与网片相关的并发症。ERP 的复发率为 4.5%。43 例患者中有 3 例因各种原因再次手术。1 例患者需要术后腹腔镜血肿清除术。因 ERP 复发而接受手术的患者似乎从再次手术中获益更多。
微创 VMR 翻修似乎是一种安全有效的治疗后盆腔底功能障碍的方法，其复发率和再次手术率可接受。
