A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Does Ventral Rectopexy Improve Pelvic Floor Function in the Long Term?
Tekijät: Mäkelä-Kaikkonen J, Rautio T, Kairaluoma M, Carpelan-Holmström M, Kössi J, Rautio A, Ohtonen P, Mäkelä J
Kustantaja: LIPPINCOTT WILLIAMS & WILKINS
Julkaisuvuosi: 2018
Journal: Diseases of the Colon and Rectum
Tietokannassa oleva lehden nimi: DISEASES OF THE COLON & RECTUM
Lehden akronyymi: DIS COLON RECTUM
Vuosikerta: 61
Numero: 2
Aloitussivu: 230
Lopetussivu: 238
Sivujen määrä: 9
ISSN: 0012-3706
eISSN: 1530-0358
DOI: https://doi.org/10.1097/DCR.0000000000000974
Tiivistelmä
BACKGROUND: Information is needed on long-term functional results, sequelas, and outcome predictors for laparoscopic ventral mesh rectopexy.OBJECTIVE: The purpose of this study was to evaluate long-term function postventral rectopexy in patients with external rectal prolapse or internal rectal prolapse in a large cohort and to identify the possible effects of patient-related factors and operative technical details on patient-reported outcomes.DESIGN: This was a retrospective review with a cross-sectional questionnaire study.SETTINGS: Data were collated from prospectively collected registries in 2 university and 2 central hospitals in Finland.PATIENTS: All 508 consecutive patients treated with ventral rectopexy for external rectal prolapse or symptomatic internal rectal prolapse in 2005 to 2013 were included.INTERVENTIONS: A questionnaire concerning disease-related symptoms and effect on quality of life was used.MAIN OUTCOME MEASURES: Defecatory function measured by the Wexner score, the obstructive defecation score, and subjective symptom and quality-of-life evaluation using the visual analog scale were included. The effects of patient-related factors and operative technical details were assessed using multivariate analysis.RESULTS: The questionnaire response rate was 70.7% (330/467 living patients) with a median follow-up time of 44 months. The mean Wexner scores were 7.0 (SD = 6.1) and 6.9 (SD = 5.6), and the mean obstructive defecation scores were 9.7 (SD = 7.6) and 12.3 (SD = 8.0) for patients presenting with external rectal prolapse and internal rectal prolapse. Subjective symptom relief was experienced by 76% and reported more often by patients with external rectal prolapse than with internal rectal prolapse (86% vs 68%; p < 0.001). Complications occurred in 11.4% of patients, and the recurrence rate for rectal prolapse was 7.1%.LIMITATIONS: This study was limited by its lack of preoperative functional data and suboptimal questionnaire response rate.CONCLUSIONS: Ventral mesh rectopexy effectively treats posterior pelvic floor dysfunction with a low complication rate and an acceptable recurrence rate. Patients with external rectal prolapse benefit more from the operation than those with symptomatic internal rectal prolapse.
BACKGROUND: Information is needed on long-term functional results, sequelas, and outcome predictors for laparoscopic ventral mesh rectopexy.OBJECTIVE: The purpose of this study was to evaluate long-term function postventral rectopexy in patients with external rectal prolapse or internal rectal prolapse in a large cohort and to identify the possible effects of patient-related factors and operative technical details on patient-reported outcomes.DESIGN: This was a retrospective review with a cross-sectional questionnaire study.SETTINGS: Data were collated from prospectively collected registries in 2 university and 2 central hospitals in Finland.PATIENTS: All 508 consecutive patients treated with ventral rectopexy for external rectal prolapse or symptomatic internal rectal prolapse in 2005 to 2013 were included.INTERVENTIONS: A questionnaire concerning disease-related symptoms and effect on quality of life was used.MAIN OUTCOME MEASURES: Defecatory function measured by the Wexner score, the obstructive defecation score, and subjective symptom and quality-of-life evaluation using the visual analog scale were included. The effects of patient-related factors and operative technical details were assessed using multivariate analysis.RESULTS: The questionnaire response rate was 70.7% (330/467 living patients) with a median follow-up time of 44 months. The mean Wexner scores were 7.0 (SD = 6.1) and 6.9 (SD = 5.6), and the mean obstructive defecation scores were 9.7 (SD = 7.6) and 12.3 (SD = 8.0) for patients presenting with external rectal prolapse and internal rectal prolapse. Subjective symptom relief was experienced by 76% and reported more often by patients with external rectal prolapse than with internal rectal prolapse (86% vs 68%; p < 0.001). Complications occurred in 11.4% of patients, and the recurrence rate for rectal prolapse was 7.1%.LIMITATIONS: This study was limited by its lack of preoperative functional data and suboptimal questionnaire response rate.CONCLUSIONS: Ventral mesh rectopexy effectively treats posterior pelvic floor dysfunction with a low complication rate and an acceptable recurrence rate. Patients with external rectal prolapse benefit more from the operation than those with symptomatic internal rectal prolapse.
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