Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel.
Department of Gastroenterology, Shaare Zedek Medical Center, The Hebrew University School of Medicine.
Am Surg. 2023 Apr;89(4):897-901. doi: 10.1177/00031348211047487. Epub 2021 Oct 20.
Systemic sclerosis (SSc) is a rare autoimmune connective tissue disorder. Colonic disorders are reported in 70% of patients. Only a few cases of rectal prolapse surgical repair in SSc patients were published, demonstrating high recurrence rate following any restorative surgery. The aim of this study is to present our surgical experience combined with the reported cases of SSc patients who underwent surgical interventions for rectal prolapse.
We reviewed our data and the published reports in the English literature of patients with SSc who underwent surgery for rectal prolapse. We located 6 case reports, in addition to 3 patients who were operated in our center.
A total of 19 procedures (9 patients) were included, among them 17 restorative surgeries and 2 low anterior resections (LAR) with end-colostomy. All patients were female (mean age 70.3). Index surgery was perineal rectosigmoidectomy in 5, abdominal resection rectopexy in 3, and LAR with colostomy in 1 patient. All patients following restorative surgery suffered from fecal incontinence. 5 patients (62.5%) who underwent restorative surgery required at least 1 re-operation. The 2 patients who underwent LAR and colostomy reported a complete resolution of anorectal symptoms with a major improvement in their quality of life.
High recurrence rate is expected in SSc patients with rectal prolapse who undergo a restorative procedure. Low anterior resection and permanent colostomy provide an alternative surgical option to patients with SSc and prolapse in contrast to restorative surgery. We believe that this surgical approach should be offered for these patients.
系统性硬化症（SSc）是一种罕见的自身免疫性结缔组织疾病。70%的患者报告有结肠疾病。仅少数 SSc 患者的直肠脱垂手术修复病例发表，表明任何修复手术后的复发率都很高。本研究旨在介绍我们的手术经验，并结合 SSc 患者接受直肠脱垂手术干预的报道病例。
我们回顾了我们的数据和发表在英文文献中的 SSc 患者接受直肠脱垂手术的报告。我们找到了 6 个病例报告，此外还有 3 个在我们中心接受手术的患者。
共包括 19 例手术（9 例患者），其中 17 例为修复性手术，2 例为低位前切除术（LAR）伴结肠造口术。所有患者均为女性（平均年龄 70.3 岁）。索引手术为经会阴直肠乙状结肠切除术 5 例，腹部直肠固定术 3 例，LAR 伴结肠造口术 1 例。所有接受修复性手术的患者均患有大便失禁。5 例（62.5%）接受修复性手术的患者至少需要再次手术。2 例接受 LAR 和结肠造口术的患者报告说，肛门直肠症状完全缓解，生活质量显著改善。
接受修复性手术的 SSc 患者直肠脱垂复发率高。与修复性手术相比，低位前切除术和永久性结肠造口术为 SSc 合并脱垂的患者提供了另一种手术选择。我们认为应该为这些患者提供这种手术方法。
