65 - Preissitzung
16. Mai 2019, 13:45 - 15:15, Sopra 3, 4. OG
Is laparoscopic anterior mesh rectopexy worthwhile? Analysis of functional improvement, satisfaction and quality of life
J. Spindler, S. Bischofberger, S. Bock, R. Käppeli, U. Beutner, W. Brunner, B. Schmied, L. Marti, Presenter: J. Spindler (St. Gallen)
Laparoscopic anterior mesh rectopexy (LAMR) has become a popular treatment for complete rectal prolapse (CRP) and functional disorders caused by rectal intussusception (RI). Patients with CRP often suffer from fecal incontinence (FI), rectal bleeding and a disturbing prolapse. RI can result in Obstructed Defecation Syndrome (ODS), worsening of preexisting FI or prolapsing symptoms. These symptoms lead to a decline in quality of life (QoL). LAMR may improve those symptoms by correcting anatomic pathologies. The purpose of this study was to analyze functional improvement, patients’ satisfaction and QoL after LAMR.
All patients operated on between December 2010 and December 2018 were prospectively assessed, treated and followed up following a standardized protocol. Patients were asked whether they would be willing to fill in some questionnaires; including the Wexner score (0-20, best 0), a Visual Analog Scale (VAS, 0-10, best 10) for satisfaction, the Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL, 0-4, best 0), and questions concerning sexual activities. These questionnaires, recurrence of CRP, morbidity, and mortality of all patients, who returned questionnaires, were analyzed retrospectively.
In total 145 LAMR were performed. Questionnaires of 97 female patients, median age at operation 69.5 (range 41.5-86.9) years, were available for analysis. The median follow-up was 4.7 (range 0.5-9.8) years. No postoperative mortality was observed and a complication Dindo III was found in 6 patients (6%). Only 39 patients (40%) stated to be sexually active, in 3 of them (8% (of sexually active patients)) dyspareunia improved, and in 4 (10%) it got worse. A significant (sig.) reduction in ODS (PAC-QOL from 1.8±0.9 to 1.0±0.7, p=0.003) and FI (Wexner from 10.6±5.3; to 7.7±4.6, p=0.03) was observed. In 43 women (44%) suffering from a RI, mean VAS for satisfaction was 7.1±2.9, and 90% would recommend LAMR. The remaining 54 (56%) women suffered from a CRP. A recurrence of CRP was observed in 5 patients (9%). VAS for satisfaction was 8.4±2.0 (sig. better than in RI; p=0.04), and all would recommend LAMR.
LAMR can be recommended to treat CRP and RI: it has a low morbidity, high satisfaction and improves QoL as well as function. Patients should be informed, that results are not as excellent for RI as for CRP and new dyspareunia may develop.