Functional Results and Quality of Life (QOL) Following Laparoscopic Rectopexy or Posterior Rectal Resection for Rectal Prolapse and Intussusception: A Prospective Study.
Abstracts
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Rectal prolapse and intussusception are frequent reasons for anal incontinence. Optimal surgical therapy for these pathologies is still under discussion. Controlled data are rare. We, therefore, conducted a prospective study comparing laparoscopic rectopexy according to Wells (LR) and posterior rectal resection according to Altemeier (A-OP). Methods: 41 patients (pats.) diagnosed with rectal prolapse or symptomatic intussusception were assigned either to LR (23 pats.;19 f, 4 m; 52 [17-73] years) or to A-OP (18 pats; 17 f, 1 m; 66 [54-76] years). Pats. were examined preoperatively (pre-op), 6 weeks postoperatively (post-op), and again after a consecutive obligatory biofeedback-training for 3 months (post-bio) by standardized interview, proctological examination, anorectal manometry, and questionnaires concerning general QOL (QOL 1) and incontinence-dependent QOL (QOL 2). Results: Operation time was longer for LR (156 [105-225] min) than A-OP (78 [35-125] min) (p<0.001). Maximum squeeze pressure was increased after LR (pre-op 94 +/- 57, post-op 106 +/- 47, post-bio 114 +/- 29 [mmHg], p<0.01), after A-OP there was an immediate decrease followed by an increase(pre-op 99 +/- 65, post-op 90 +/- 55, post-bio 112 +/- 53 [mmHg], p<0.01). Resting pressure was unchanged after LR (pre-op 71 +/- 34, post-op 63 +/- 26, post-bio 61 +/- 31 [mmHg]) and A-OP (pre-op 62 +/- 35, post-op 61 +/- 26, post-bio 59 +/- 38 [mmHg]). Sensory thresholds at balloon distension of the rectum were elevated following LR (pain: pre-op 197 +/- 58, post-bio 243 +/- 78 ml, p<0.01), and diminuished following A-OP (pain: pre-op 196 +/- 67, post-bio 170 +/- 90 ml, p<0.01). In parallel, rectal compliance increased after LR and was diminuished after A-OP (p<0.05). Incontinence score was improved in both groups (LR: pre-op 15.5 +/- 9.2, post-op 6.7 +/- 3.1, post-bio 6.1 +/- 5.5, p<0.01; A-OP pre-op 18.7 +/- 7.6, post-op 16.8 +/- 5.8, post-bio 13.7 +/- 9.5, p<0.05); the grade of improvement was higher in LR (p<0.01). QOL was improved in both groups for QOL 1 (LR: pre-op 57.9, post-op 69.8, post-bio 73.9, p<0.01; A-OP: pre-op 65.0, post-op 70.1, post-bio 76.2, p<0.01) and for QOL 2 (LR: pre-op 69, post-op 82, post-bio 85, p<0.01; A-OP: pre-op 59, post-op 65, post-bio 73, p<0.01). Conclusion: In patients with rectal prolapse or intussusception laparoscopic rectopexy and Altemeier procedure, both, improve anal incontinence and quality of life. These results justify a randomized trial. |
