Laparoscopic resection rectopexy in the treatment of obstructive defecation syndrome
Authors:
P. Ihnát 1,2; P. Guňková 1,2; P. Vávra 1,2; M. Lerch 1,2; M. Peteja 1,2
; A. Pelikán 1,2; P. Zonča 1,2
Authors place of work:
Chirurgická klinika FN Ostrava
přednosta: doc. MUDr. P. Zonča, Ph. D., FRCS
1; Katedra chirurgických oboru LF Ostravské univerzity, Ostrava
vedoucí katedry: doc. MUDr. P. Vávra, Ph. D.
2
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 6, s. 227-230.
Category:
Original articles
Summary
Introduction:
Obstructive defecation syndrome (ODS) presents a common medical problem, which can be caused by various pelvic disorders; multiple disorders are frequently diagnosed. At the present, a high number of corrective techniques are available via various surgical approaches. Laparoscopic resection rectopexy is a minimally invasive technique, which comprises redundant sigmoidal resection with rectal mobilisation and fixation.
Methods:
The aim of this paper was to evaluate the safety and effectiveness of laparoscopic resection rectopexy in the treatment of patients with ODS. The evaluation was performed via our own patients data analysis and via literature search focused on laparoscopic resection rectopexy.
Results:
In total, 12 patients with ODS undergoing laparoscopic resection rectopexy in University Hospital Ostrava during the study period (2012–2015) were included in the study. In our study group, mean age was 64.5 years and mean BMI was 21.9; the group included 11 women (91.6%). ODS was caused by multiple pelvic disorders in all patients. Dolichosigmoideum and rectal prolapse (internal or external) were diagnosed in all included patients. On top of that, rectocoele and enterocoele were diagnosed in several patients. Laparoscopic resection rectopexy was performed without intraoperative complications; mean operative time was 144 minutes. Mean postoperative length of hospital stay was 7 days. Postoperative 30-day morbidity was 16.6%. All postoperative complications were classified as grade II according to Clavien-Dindo classification. Mean preoperative Wexner score was 23.6 points; mean score 6 months after the surgery was 11.3 points. Significant improvement in ODS symptoms was noted in 58.3% of patients, and a slight improvement in 16.6% of patients; resection rectopexy provided no clinical effect in 25% of patients.
Conclusion:
It is fundamental to carefully select those patients with ODS who could possibly profit from the surgery. Our results, in accordance with published data, suggest that laparoscopic resection rectopexy is a valuable surgical technique in the treatment of patients with ODS caused by multiple pelvic disorders.
Key words:
obstructive defecation syndrome – constipation – resection rectopexy – operative techniques – pelvic floor disorders
Zdroje
1. Mitchell PJ, Kiff ES. Assessment and investigation of fecal incontinence and constipation. In: Brown SR, Hartley JE, Hill J, et al. Contemporary Coloproctology. 1.vyd. London, Springer 2012:347–68.
2. Horák L, Örhalmi J. Poruchy statiky a dynamiky malé pánve (syndrom pseudoobturované defekace). In: Horák L, Skřička T, Šlauf P, et al. Praktická proktologie. 1.vyd. Praha, Grada Publishing 2013:103–9.
3. Lehur PA, Meurette G. Defaecation disorders. In Herold A, Lehur PA, Matzel KE, et al. European manual of medicine: coloproctology. 1.vyd. Berlin, Springer 2008:105–14.
4. Talley NJ, Weaver AL, Zinsmeister AR, et al. Functional constipation and outlet delay: a population-based study. Gastroenterology 1993;105:781–90.
5. Suarez NC, Ford AC. Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 2011;106:1582–91.
6. Ternent CA, Bastawrous AL, Morin NA, et al. Practice parameters for the evaluation and management of constipation. Dis Colon Rectum 2007;50:2013–22.
7. Anděl P, Škrovina M, Ducháč V. Funkční poruchy pánevního dna. In: Anděl P, Škrovina M, Ducháč V. Základy praktické proktologie. 1.vyd. Praha, Galén 2012:185–208.
8. Maslekar S, Jayne DG. The Management of constipation. In: Brown SR, Hartley JE, Hill J, et al. Contemporary coloproctology. 1.vyd. London, Springer 2012:399–406.
9. Roblick UJ, Bader FG, Jungbluth T, et al. How to do it – laparoscopic resection rectopexy. Langenbecks Arch Surg 2011;396:851–5.
10. Varma M, Rafferty J, Buie WD. Practice parameters for the management of rectal prolapse. Dis Colon Rectum 2011;54:1339–46.
11. Ihnát P, Jelínek P, Guňková P, et al. Chirurgická léčba rektokély – mnoho technik, málo jednoznačných závěrů. Rozhl Chir 2014;93:188–193.
12. Magruder JT, Efron JE, Wick EC, et al. Laparoscopic rectopexy for rectal prolapse to reduce surgical-site infections and lenght of stay. World J Surg 2013;37:1110–4.
13. Ihnát P, Martínek L, Mitták M, et al. Quality of life after laparoscopic and open resection of colorectal cancer. Dig Surg 2014;31:161–8.
14. D’Hoore A. Rectal prolapse, intussusception, solitary rectal ulcer. In Herold A, Lehur PA, Matzel KE, et al. European manual of medicine: coloproctology. 1st ed. Berlin, Springer 2008:115–20.
15. Ihnát P, Martínek L, Vávra P, et al. Novel combined approach in the management of non-healing rectal ulcer syndrome – laparoscopic resection rectopexy and transanal endoscopic microsurgery. Wideochir Inne Tech Maloinwazyjne 2015;10:295–8.
16. Agachan F, Chen T, Pfeifer J, et al. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996;39:681–5.
17. Dindo D, Demartinies N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.
18. Ihnát P, Vávra P, Guňková P, et al. 3D high resolution anorectal manometry in functional anorectal evaluation. Rozhl chir 2014;93:524–9.
19. Pucciani F, Reggioli M, Ringressi MN. Obstructed defaecation: what is the role of rehabilitation? Colorectal Dis 2012;14:474–9.
20. Bharucha AE, Wald AM. Anorectal disorders. Am J Gastroenterol 2010;105:786–94.
21. Hart SL, Lee JW, Berian J, et al. A randomized controlled trial of anorectal biofeedback for constipation. Int J Colorectal Dis 2012;27:459–66.
22. Brown S. The evidence base for rectal prolapse surgery: is resection rectopexy worth the risk? Tech Coloproctol 2014;18:221–2.
23. Senapati A, Gray RG, Middleton LJ, et al. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal dis 2013;15:858–68.
24. Formijne Jonders HA, Draaisma WA, Wexner SD, et al. Evaluation and surgical treatment of rectal prolapse: an international survey. Colorectal Dis 2013;15:115–9.
25. Tou S, Brown SR, Malik AI, et al. Surgery for complete rectal prolapse in adults. Cochrane Database Syst Rev 8:CD001758.
26. Laubert T, Kleemann M, Roblick UJ, et al. Obstructive defecation syndrome: 19 years of experience with laparoscopic resection rectopexy. Tech Coloproctol 2013;17:307–14.
27. Laubert T, Bader FG, Kleemann M, et al. Outcome analysis of elderly patients undergoing laparoscopic resection rectopexy for rectal prolapse. Int J Colorectal Dis 2012;27:789–95.
28. Formijne Jonders HA, Maya A, Draaisma WA, et al. Laparoscopic resection rectopexy versus laparoscopic ventral rectopexy for complete rectal prolapse. Tech Coloproctol 2014;18:641–6.
29. Johnson E, Kjellevold K, Johannessen HO, et al. Long-term outcome after resection rectopexy for internal rectal intussusception. ISRN Gastroenterol 2012; ID 824671, dostupný z: http://dx.doi.org/10.5402/2012/8246712012:824671.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2016 Číslo 6
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Laparoscopic resection rectopexy in the treatment of obstructive defecation syndrome
- Different techniques of vessel reconstruction in kidney transplantation −10-years experiences
- Management of acute postoperative pain following thoracotomy – state of the art
- Videothoracoscopic excision of mediastinal parathyroid adenoma in primary hyperparathyroidism