Gray Phillip J, Goldwag Jenaya L, Eid Mark A, Trooboff Spencer W, Wilson Matthew Z, Ivatury Srinivas J
From the Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Geisel School of Medicine, Hanover, NH.
Ann Surg Open. 2021 Nov 18;2(4):e110. doi: 10.1097/AS9.0000000000000110. eCollection 2021 Dec.
To evaluate long-term changes to bowel function after elective sigmoidectomy for diverticular disease.
For patients with diverticular disease, choosing surgery is often based on the presumption of improvement in preoperative symptoms. Our group previously reported bowel function does not change in the early perioperative period; however, studies of long-term outcomes are limited.
This is an observational study of patients that underwent elective sigmoidectomy for diverticular disease and completed the Colorectal Functional Outcome (COREFO) questionnaire before surgery. Patients were stratified into two groups based on presence or absence of a preoperative symptomatic score (i.e., total COREFO ≥ 15). Long-term bowel function (>1 year from surgery) was assessed using the COREFO questionnaire via telephone or subsequent clinic visit. Paired t-tests compared mean preoperative scores to mean long-term scores.
Fifty-one patients met inclusion criteria (21 symptomatic, 30 asymptomatic). All symptomatic patients had uncomplicated disease, whereas 90% of asymptomatic patients had complicated disease. Median time from operation to questionnaire completion was 23 months (IQR = 13-34). Asymptomatic patients demonstrated impaired bowel function, predominantly driven by changes in the social impact domain. Symptomatic patients demonstrated improved bowel function, driven by changes in the incontinence, social impact, stool-related aspects, and need for medication domains.
In the long-term after elective sigmoidectomy for diverticular disease, patients with symptomatic bowel function preoperatively improve substantially, while those with asymptomatic preoperative scores demonstrate statistically significant impairment. Patients determined to be symptomatic with patient-reported outcomes likely benefit long-term from sigmoid resection.Mini-Abstract: In this manuscript, long-term changes to patient-reported bowel function were assessed using a validated questionnaire after sigmoidectomy for diverticular disease. We found that in patients with symptomatic preoperative bowel function, long-term bowel function improved after elective resection. Alternatively, patients with asymptomatic preoperative bowel function demonstrated long-term impairment in bowel function.
评估择期乙状结肠切除术治疗憩室病后肠道功能的长期变化。
对于憩室病患者，选择手术通常基于术前症状会改善的推测。我们团队之前报告称围手术期早期肠道功能没有变化；然而，关于长期预后的研究有限。
这是一项对因憩室病接受择期乙状结肠切除术且术前完成结直肠功能结局（COREFO）问卷的患者进行的观察性研究。根据术前症状评分（即COREFO总分≥15）的有无将患者分为两组。通过电话或后续门诊就诊，使用COREFO问卷评估术后超过1年的长期肠道功能。采用配对t检验比较术前平均评分与长期平均评分。
51例患者符合纳入标准（21例有症状，30例无症状）。所有有症状患者的疾病均无并发症，而90%的无症状患者有复杂疾病。从手术到完成问卷的中位时间为23个月（四分位间距=13 - 34）。无症状患者表现出肠道功能受损，主要由社会影响领域的变化所致。有症状患者的肠道功能得到改善，这是由失禁、社会影响、粪便相关方面以及用药需求领域的变化所驱动。
在因憩室病接受择期乙状结肠切除术后的长期随访中，术前有症状性肠道功能的患者有显著改善，而术前无症状评分的患者则表现出统计学上的显著受损。通过患者报告结局确定为有症状的患者可能从乙状结肠切除术中长期获益。
在本论文中，使用经过验证的问卷评估了憩室病乙状结肠切除术后患者报告的肠道功能的长期变化。我们发现，术前有症状性肠道功能的患者择期切除术后长期肠道功能得到改善。相反，术前无症状性肠道功能的患者表现出长期肠道功能受损。
