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Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation

BACKGROUND: Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may ev...

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Autores principales: Solari, S., Martellucci, J., Ascanelli, S., Sturiale, A., Annicchiarico, A., Fabiani, B., Prosperi, P., Carcoforo, P., Naldini, G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637597/
https://www.ncbi.nlm.nih.gov/pubmed/36197564
http://dx.doi.org/10.1007/s10151-022-02708-8
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author Solari, S.
Martellucci, J.
Ascanelli, S.
Sturiale, A.
Annicchiarico, A.
Fabiani, B.
Prosperi, P.
Carcoforo, P.
Naldini, G.
author_facet Solari, S.
Martellucci, J.
Ascanelli, S.
Sturiale, A.
Annicchiarico, A.
Fabiani, B.
Prosperi, P.
Carcoforo, P.
Naldini, G.
author_sort Solari, S.
collection PubMed
description BACKGROUND: Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may even worsen. The aim of the present study was to identify possible predictors of functional failure after VMR. METHODS: Data of all consecutive patients who had VMR for the treatment of rectal prolapse and/or obstructed defecation between January 2017 and December 2020 in three different pelvic floor surgical centres in Italy were analysed to identify possible predictors of functional failure, intended as persistence, worsening or new onset of constipation or faecal incontinence. Symptom severity was assessed pre- and postoperatively with the Wexner Constipation score and Obstructed Defecation Syndrome score. Quality of life was assessed, also before and after treatment, with the Patients Assessment of Constipation Quality of Life questionnaire, the Pelvic Floor Disability Index and the Pelvic Floor Impact Questionnaire. Faecal incontinence was evaluated with the Cleveland Clinic Incontinence Score. The functional outcomes before and after surgery were compared. RESULTS: Sixty-one patients were included (M:F ratio 3:60, median age 64 years [range 33–88 years]). Forty-two patients (68.9%) had obstructed defecation syndrome, 12(19.7%) had faecal incontinence and 7 patients (11.5%) had both. A statistically significant reduction between pre- and postoperative Obstructed Defecation Syndrome and Wexner scores was reported (p < 0.0001 in both cases). However, the postoperative presence of constipation occurred in 22 patients (36.1%) (this included 3 cases of new-onset constipation). The presence of redundant colon and the pre-existent constipation were associated with an increased risk of persistence of constipation postoperatively or new-onset constipation (p = 0.004 and p < 0.0001, respectively). The use of postoperative pelvic floor rehabilitation (p = 0.034) may reduce the risk of postoperative constipation. CONCLUSIONS: VMR is a safe and effective intervention for correcting the anatomical defect of rectal prolapse. The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. Postoperative rehabilitation treatment may reduce this risk.
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spelling pubmed-96375972022-11-08 Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation Solari, S. Martellucci, J. Ascanelli, S. Sturiale, A. Annicchiarico, A. Fabiani, B. Prosperi, P. Carcoforo, P. Naldini, G. Tech Coloproctol Original Article BACKGROUND: Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may even worsen. The aim of the present study was to identify possible predictors of functional failure after VMR. METHODS: Data of all consecutive patients who had VMR for the treatment of rectal prolapse and/or obstructed defecation between January 2017 and December 2020 in three different pelvic floor surgical centres in Italy were analysed to identify possible predictors of functional failure, intended as persistence, worsening or new onset of constipation or faecal incontinence. Symptom severity was assessed pre- and postoperatively with the Wexner Constipation score and Obstructed Defecation Syndrome score. Quality of life was assessed, also before and after treatment, with the Patients Assessment of Constipation Quality of Life questionnaire, the Pelvic Floor Disability Index and the Pelvic Floor Impact Questionnaire. Faecal incontinence was evaluated with the Cleveland Clinic Incontinence Score. The functional outcomes before and after surgery were compared. RESULTS: Sixty-one patients were included (M:F ratio 3:60, median age 64 years [range 33–88 years]). Forty-two patients (68.9%) had obstructed defecation syndrome, 12(19.7%) had faecal incontinence and 7 patients (11.5%) had both. A statistically significant reduction between pre- and postoperative Obstructed Defecation Syndrome and Wexner scores was reported (p < 0.0001 in both cases). However, the postoperative presence of constipation occurred in 22 patients (36.1%) (this included 3 cases of new-onset constipation). The presence of redundant colon and the pre-existent constipation were associated with an increased risk of persistence of constipation postoperatively or new-onset constipation (p = 0.004 and p < 0.0001, respectively). The use of postoperative pelvic floor rehabilitation (p = 0.034) may reduce the risk of postoperative constipation. CONCLUSIONS: VMR is a safe and effective intervention for correcting the anatomical defect of rectal prolapse. The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. Postoperative rehabilitation treatment may reduce this risk. Springer International Publishing 2022-10-04 2022 /pmc/articles/PMC9637597/ /pubmed/36197564 http://dx.doi.org/10.1007/s10151-022-02708-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Solari, S.
Martellucci, J.
Ascanelli, S.
Sturiale, A.
Annicchiarico, A.
Fabiani, B.
Prosperi, P.
Carcoforo, P.
Naldini, G.
Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation
title Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation
title_full Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation
title_fullStr Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation
title_full_unstemmed Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation
title_short Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation
title_sort predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637597/
https://www.ncbi.nlm.nih.gov/pubmed/36197564
http://dx.doi.org/10.1007/s10151-022-02708-8
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