AI Summary & Key Takeaways
AI InsightWCS significantly improved after LVMR in patients with symptomatic rectocele combined with enterocele or sigmoidocele (p= 0.005), and significant improvement was also observed in patients with symptomaticrectocele combined with gynecologic organ prolapse, preoperative median WCS was 18 and the postoperative value fell to 8 (p= 0.005).Conclusion: LVMR is an effective surgical option for rectal and complex pelvic organ prolapse with short-term follow-up.
📌 3 Key Takeaways
Abstract
Objective: Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such asexternal rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. LVMR also allows correction of coexisted pelvic organ prolapse.This study aimed to evaluate the safety, efficacy and functional outcome of LVMR for rectal and complex pelvic organ prolapse.Material and Methods: All patients who underwent LVMR from February 2014 to October 2017 were included into the study. The patients were evaluated preoperatively and three months postoperatively. Surgical complications and functional results in terms of fecal incontinence (measured with theWexner Incontinence Score= WIS) and constipation (measured with the Wexner Constipation Score= WCS) were analyzed.Results: Thirty (4 males) patients underwent LVMR. Seventeen (56.6%) patients had complex pelvic organ prolapse according to MRI findings. Medianoperative time and postoperative stay were 110 minutes and 4 days, respectively. No mesh-related complication and recurrence were observed. Beforesurgery, 21 (70%) patients had complained about symptoms of obstructed defecation. WCS decreased significantly from median 19 to 6 (p< 0.001). Preoperative median WIS of 9 patients was 14 and went down to 6 postoperatively (p= 0.008). WCS significantly improved after LVMR in patients with symptomatic rectocele combined with enterocele or sigmoidocele (p= 0.005), and significant improvement was also observed in patients with symptomaticrectocele combined with gynecologic organ prolapse, preoperative median WCS was 18 and the postoperative value fell to 8 (p= 0.005).Conclusion: LVMR is an effective surgical option for rectal and complex pelvic organ prolapse with short-term follow-up.
Özet
Giriş ve Amaç: Laparoskopik ventral mesh rektopeksi (LVMR), eksternal rektal prolapsus (ERP), yüksek derece internal rektal prolapsus (İRP) ve rektosel gibi pelvik taban hastalıklarının tedavisinde daha çok kullanılır hale gelmiştir. LVMR ayrıca pelvik organ prolapsuslarının da tedavisine olanak sağlamaktadır. Bu çalışmada LVMR’nin, rektal ve kompleks pelvik organ prolapsuslarında güvenlik etkinlik ve kısa dönem fonksiyonel sonuçları incelenmiştir.Gereç ve Yöntem: Şubat 2014-Ekim 2017 tarihleri arasında LVMR yapılan tüm hastalar çalışmaya dahil edilmiştir. Hastalar preoperatif ve post-operatif 3. ayda değerlendirilmişlerdir. Cerrahi komplikasyonlar ve fonksiyonel sonuçlar; fekal inkontinans, Wexner İnkontinans Skoru (WİS) ve konstipasyon, Wexner Konstipasyon Skoru (WKS) ile değerlendirilmiştir.Bulgular: Otuz hastaya (4’ü erkek) LVMR yapılmıştır. On yedi (56,6%) hastada dinamik-Mr defekografi bulgularına göre kompleks pelvik organ prolapsusunun olduğu tespit edilmiştir. Ortalama operasyon ve hastanede kalış süreleri 110 dakika ve 4 gündür. Mesh komplikasyonu veya rekürrens izlenmemiştir. Preoperatif 21 (%70) hastada obstrüktif defekasyon yakınmaları olduğu tespit edilmiş olup, WKS’nin median 19’dan post-operatif 3. ayda 6’ya düştüğü görülmüştür (p< 0,001). Preoperatif WİS’in hesaplandığı ve median 14 olduğu 9 hastada postoperatif 3. ayda 6’ya düştüğü saptanmıştır (p= 0,008). Semptomatik rektosel ile birlikte enterosel ve sigmoidoseli olan hastalarda da WKS LVMR sonrası anlamlı dere-cede düzeldiği görülmüş (p= 0,005) ve ayrıca anlamlı düzelme semptomatik rektosel ve beraberinde jinekolojik organ prolapsusu olan hastalarda da izlenmiş; preoperatif median WKS’nin 18’den postoperatif 8’e gerilemiştir (p= 0,005).Sonuç: Serimizdeki hastalarda kısa dönem takiplerde LVMR’nin, etkili bir cerrahi seçenek olduğu tespit edilmiştir.