Abdominal ventral rectopexy with colectomy for obstructed defecation syndrome:An alternative option for selected patients

摘要

BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.