Changes in Dynamic Pelvic Floor Magnet Resonance Imaging and Patient Satisfaction after Resection Rectopexy for Obstructed Defecation Syndrome.
Rofo
; 188(1): 38-44, 2016 Jan.
Article
em En
| MEDLINE
| ID: mdl-26327668
ABSTRACT
PURPOSE:
Resection rectopexy (RR) provides good functional results and low recurrence rates for the treatment of obstructed defecation syndrome based on rectal prolapse and cul-de-sac syndrome, whereas little is known about changes in pelvic floor dynamics and patient satisfaction after surgery. MATERIALS ANDMETHODS:
Within three years 26 consecutive female patients were prospectively included. Indications for RR (22 laparoscopic, 3 primary open and 1 converted-to-open) were rectal prolapse III° in 11 patients and cul-de-sac syndrome in 15 patients. Patients' quality of life (QOL), fecal behavior and defecation-associated pain were investigated before and after surgical treatment using anamnesis and clinical examination, Rand 36-idem health survey (SF-36), Cleveland-Clinic Incontinence Score (CCIS) and the visual analog scale for defecation-associated pain (VAS). Dynamic pelvic floor magnet resonance imaging (dPF-MRI) was used for the investigation of changes in pelvic floor anatomy and function before and after surgery.RESULTS:
RR improved the rate of fecal incontinence (pâ<â0.01) and CCIS (pâ=â0.01). The use of laxatives (pâ=â0.01), the need for self-digitation (pâ=â0.02) and VAS (pâ<â0.01) were decreased, leading to improvements in QOL (overall pâ<â0.01). RR led to shortening of the H-line but not of the M-line under rest (pâ<â0.01) and during defecation (pâ=â0.04). A rectocele was co-incident in all patients in dPF-MRI before surgery. RR led to a reduction (pâ<â0.01) and declined protrusion (pâ=â0.03) of the rectocele. This results in a decreased rate of cul-de-sac (pâ<â0.01) and increased rate of complete defecation (pâ<â0.01) after surgery. At the 36-month follow-up no recurrence was observed.CONCLUSION:
RR promises high rates of patient satisfaction and improvement in pelvic floor anatomy in select patients. KEY POINTS â¢âRR improves the pelvic floor anatomy of patients suffering from ODS. â¢âRR improves the QOL of patients suffering from ODS. â¢âAn improvement in pelvic floor anatomy led to an improved QOL. â¢âRR is an adequate treatment for select patients suffering from ODS.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Reto
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Imageamento por Ressonância Magnética
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Satisfação do Paciente
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Diafragma da Pelve
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Defecação
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Distúrbios do Assoalho Pélvico
Limite:
Adult
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Aged
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Female
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Humans
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Middle aged
Idioma:
En
Revista:
Rofo
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Alemanha