背景:阻塞性排便综合征(ODS)定义了一种排便过程紊乱,通常与女性盆腔器官脱垂(POP)相关,严重影响生活质量。保守管理提供有限的救济,可能需要手术干预。其特征在于个别方法。研究目的:这项回顾性单中心研究评估了新型跨学科腹腔镜切除直肠切除术(L-RRP)与mesh-sc结直肠切除术(L-SCP)对患有ODS和POP的女性的手术和临床短期结果。
方法:研究参与者接受了跨学科腹腔镜手术。安全性是主要终点,通过Clavien-Dindo量表分类的术后发病率评估。次要结果包括肠功能评估,12个月随访时的大便和尿失禁和盆腔器官脱垂状态。此外,向女性提供了一个生物网(BM),谁要求替代合成网状材料(SM)。
结果:在44例连续需要进行ODS和POP手术的患者中,36例患者行跨学科手术入路;28例患者为SM,8例患者为BM。共发生5种并发症,其中四人被列为未成年人。在BM组中观察到一个较小的并发症。SM组发生吻合口漏1例。两个ODS得分,肠功能障碍评分,尿失禁评分明显改善(分别为p=0.006,p=0.003,p<0.001,p=0.0035)。29例(80%)患者术后盆底解剖完全恢复(POP-Q0)。17例患者(47%)在手术前患有尿失禁,13例患者(76.5%)恢复。
结论:使用L-RRP和L-SCP的跨学科方法以及在小的亚组中使用BM在技术上是可行的,安全,在这个单一中心设置中有效。这项研究的回顾性设计,小样本量和缺乏比较限制了需要未来随机试验的研究结果的普遍性.
背景:在clinicaltrials.gov上回顾性注册,试验编号NCT05910021,注册日期06/10/2023。
BACKGROUND: Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches. AIM OF THE
STUDY: This retrospective single center
study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP.
METHODS: The
study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM).
RESULTS: Of the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%).
CONCLUSIONS: The interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The
study\'s retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials.
BACKGROUND: Retrospectively registered at clinicaltrials.gov,
trial number NCT05910021, date of registration 06/10/2023.