Ferrari Linda, Cuinas Karina, Hainsworth Alison, Darakhshan Amir, Schizas Alexis, Kelleher Cornelius, Williams Andrew Brian
Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK.
Tech Coloproctol. 2023 Oct;27(10):859-866. doi: 10.1007/s10151-023-02822-1. Epub 2023 May 22.
Determine predictors of success for transvaginal rectocoele repair (TVRR). Primary aim is to establish predictors of successful treatment analysing patients' characteristics, baseline symptoms, pelvic floor test results and pre-operative conservative treatment.
Retrospective single institution study in a tertiary referral centre for pelvic floor disorders. 207 patients underwent TVRR for symptomatic rectocoele. Information about symptoms related to obstructive defaecation, anal incontinence and vaginal prolapse, results of pelvic floor investigations, multimodality conservative management and variation in surgical technique have been recorded. Symptom related information have been collected at surgical follow-up.
115 patients had residual symptoms after surgical repair of rectocoele, while 97 were symptoms free. Factors associated with residual symptoms after surgical repair are previous proctological procedures, urge AI symptoms, absence of vaginal bulge symptoms, use of transanal irrigation and having a concomitant enterocoele repair during procedure.
Factors able to predict a less favourable outcome after TVRR in patients with concomitant ODS are previous proctological procedures, presence of urge AI, short anal canal length on anorectal physiology, seepage on defaecating proctography, use of transanal irrigation, absence of vaginal bulge symptoms and enterocoele repair during surgery. These information are important for a tailored decision making process and to manage patients' expectations before surgical repair.
确定经阴道直肠膨出修补术（TVRR）成功的预测因素。主要目的是通过分析患者特征、基线症状、盆底检查结果和术前保守治疗来确定成功治疗的预测因素。
在一家盆底疾病三级转诊中心进行回顾性单机构研究。207例有症状的直肠膨出患者接受了TVRR。记录了与排便梗阻、肛门失禁和阴道脱垂相关的症状信息、盆底检查结果、多模式保守治疗及手术技术的差异。在手术随访时收集了症状相关信息。
115例患者在直肠膨出手术修复后仍有残留症状，而92例患者无症状。手术修复后残留症状相关因素包括既往直肠手术史、急迫性肛门失禁症状、无阴道膨出症状、使用经肛门冲洗以及术中同时进行小肠膨出修补。
对于伴有排便障碍综合征（ODS）的患者，TVRR术后预后较差的预测因素包括既往直肠手术史、存在急迫性肛门失禁、肛肠生理检查时肛管长度较短、排粪造影时有渗漏、使用经肛门冲洗、无阴道膨出症状以及术中进行小肠膨出修补。这些信息对于制定个性化的决策过程以及在手术修复前管理患者的期望非常重要。
