Quality of Life, Functional Outcomes, and Recurrence After Resection Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse Repair.

IF 3.2 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Anna R Spivak, Marianna Maspero, Rebecca Y Spivak, Jessica Sankovic, Stephanie Norman, Caitlyn Deckard, Scott R Steele, Tracy L Hull
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Abstract

Background: Resection rectopexy and ventral mesh rectopexy are widely accepted surgical options for the treatment of rectal prolapse, however reports on long-term recurrence rates and functional outcomes are lacking.

Objective: We compared quality of life, long-term functional outcomes and prolapse recurrence after resection rectopexy versus ventral mesh rectopexy.

Design: We retrospectively reviewed our prospectively collected rectal prolapse surgery database.

Settings: Patients who underwent resection rectopexy or ventral mesh rectopexy at our center between 2009 and 2016 were included.

Patients: Two hundred twenty patients were included, of which 208 (94%) female; 85 (39%) underwent resection rectopexy, 135 (61%) ventral mesh rectopexy.

Main outcomes measure: Prolapse recurrence.

Results: The resection rectopexy group was younger (median 52 vs 60 years old, p = 0.02) and had more open procedures (20% vs 9%, p < 0.001). After a median follow-up of 110 (IQR 94 - 146) months for resection rectopexy and 113 (87 - 137) for ventral mesh rectopexy, recurrences occurred in 21 (26%) in the resection rectopexy and 50 (39%) in the ventral mesh rectopexy group (p = 0.041). Median time to recurrence was 44 (18 - 80) months in the resection rectopexy group and 28.5 (11 - 52.5) in the ventral mesh rectopexy group (p = 0.14). There were no differences in the recurrence rate for primary prolapses in resection rectopexy vs ventral mesh rectopexy. Recurrence rate for re-do prolapses was higher in the ventral mesh rectopexy group 63% at 10 years, versus 25% in resection rectopexy group (p = 0.006). Functional outcomes were similar between the two groups.

Limitations: Retrospective review, recall bias.

Conclusion: Long-term quality of life and functional outcomes after resection rectopexy and ventral mesh rectopexy were comparable. Ventral mesh rectopexy was associated with a higher prolapse recurrence rate after recurrent rectal prolapse repair. See Video Abstract.

直肠脱垂修复术中切除直肠与腹侧网片直肠术后的生活质量、功能效果和复发。
背景:切除直肠和腹侧网片直肠切除术是广为接受的治疗直肠脱垂的手术方案,但缺乏有关长期复发率和功能效果的报告:我们比较了切除直肠与腹侧网片直肠切除术后的生活质量、长期功能效果和脱垂复发情况:设计:我们对前瞻性收集的直肠脱垂手术数据库进行了回顾性审查:纳入2009年至2016年期间在本中心接受切除直肠或腹腔网片直肠切除术的患者:主要结果:脱垂复发:结果:结果:直肠切除术组年龄较小(中位 52 岁对 60 岁,P = 0.02),开放手术较多(20% 对 9%,P < 0.001)。中位随访110(IQR 94 - 146)个月(切除直肠整形术组)和113(87 - 137)个月(腹腔网直肠整形术组)后,切除直肠整形术组有21人(26%)复发,腹腔网直肠整形术组有50人(39%)复发(p = 0.041)。切除直肠整形术组的中位复发时间为 44(18 - 80)个月,腹侧网片直肠整形术组为 28.5(11 - 52.5)个月(p = 0.14)。切除直肠与腹侧网片直肠切除术的原发性脱垂复发率没有差异。腹侧网片直肠切除术组 10 年后再次脱垂的复发率为 63%,高于切除直肠切除术组的 25%(P = 0.006)。两组的功能结果相似:局限性:回顾性研究,回忆偏倚:结论:切除式直肠整形术和腹侧网片直肠整形术后的长期生活质量和功能效果相当。腹侧网片直肠切除术与复发性直肠脱垂修复术后较高的脱垂复发率有关。参见视频摘要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.50
自引率
7.70%
发文量
572
审稿时长
3-8 weeks
期刊介绍: Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.
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