TY - JOUR
T1 - Functional Outcome after Laparoscopic Posterior Sutured Rectopexy Versus Ventral Mesh Rectopexy for Rectal Prolapse
T2 - Six-year Follow-up of a Double-blind, Randomized Single-center Study
AU - Hidaka, Jin
AU - Elfeki, Hossam
AU - Duelund-Jakobsen, Jakob
AU - Laurberg, Søren
AU - Lundby, Lilli
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Background: Laparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been implemented to reduce postoperative bowel symptoms. The preoperative-to-postoperative change in a double-blinded, randomized study comparing it to laparoscopic posterior sutured rectopexy (LPSR) found no significant difference between the two procedures after one year. The aim of this study was to investigate the long-term functional outcomes. Methods: From November 2006–January 2014, 75 patients were randomized to LVMR (n = 37) or LPSR (n = 38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS, CCIS) were mailed to all the patients included in the RCT. Prolapse recurrences and mesh complications were recorded. Finding: Sixty-nine patients were available for long-term follow-up. Questionnaires were completed by 64 patients (94.4%). The median follow-up was 6.1 years. The total PAC-QoL was significantly lower in the LVMR group 0.26 (0.14–0.83) compared to the LPSR group 0.93(0.32–1.61)(P = 0.008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0.21–0.87) compared to the LPSR group 1.0 (0.5–1.5)(P = 0.031). Except for CCIS, the ODS and the CCCS significantly favored the LVMR group at six years (P = 0.011 & 0.017). Only three(8.82%) patients in the LVMR group developed recurrence compared to seven(23.33%) in the LPSR group (P = 0.111). Interpretation: The long-term functional outcome after LVMR is superior to that after LPSR. Larger multicenter studies are warranted. Funding: None.
AB - Background: Laparoscopic ventral mesh rectopexy (LVMR) for rectal prolapse has been implemented to reduce postoperative bowel symptoms. The preoperative-to-postoperative change in a double-blinded, randomized study comparing it to laparoscopic posterior sutured rectopexy (LPSR) found no significant difference between the two procedures after one year. The aim of this study was to investigate the long-term functional outcomes. Methods: From November 2006–January 2014, 75 patients were randomized to LVMR (n = 37) or LPSR (n = 38). In March 2017, questionnaires containing constipation symptom score (PAC-SYM), quality of life score (PAC-QoL), obstructed defecation score (ODS), Cleveland clinic constipation and incontinence scores (CCCS, CCIS) were mailed to all the patients included in the RCT. Prolapse recurrences and mesh complications were recorded. Finding: Sixty-nine patients were available for long-term follow-up. Questionnaires were completed by 64 patients (94.4%). The median follow-up was 6.1 years. The total PAC-QoL was significantly lower in the LVMR group 0.26 (0.14–0.83) compared to the LPSR group 0.93(0.32–1.61)(P = 0.008). The total PAC-SYM was significantly lower in the LVMR group 0.5 (0.21–0.87) compared to the LPSR group 1.0 (0.5–1.5)(P = 0.031). Except for CCIS, the ODS and the CCCS significantly favored the LVMR group at six years (P = 0.011 & 0.017). Only three(8.82%) patients in the LVMR group developed recurrence compared to seven(23.33%) in the LPSR group (P = 0.111). Interpretation: The long-term functional outcome after LVMR is superior to that after LPSR. Larger multicenter studies are warranted. Funding: None.
KW - Functional outcome
KW - Long-term follow-up
KW - Posterior sutured rectopexy
KW - Randomized controlled trial
KW - Rectal prolapse
KW - Ventral mesh rectopexy
UR - http://www.scopus.com/inward/record.url?scp=85071399649&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2019.08.014
DO - 10.1016/j.eclinm.2019.08.014
M3 - Journal article
C2 - 31832616
AN - SCOPUS:85071399649
VL - 16
SP - 18
EP - 22
JO - EClinicalMedicine
JF - EClinicalMedicine
ER -