Patient Satisfaction and Symptomatic Outcomes Following Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome
Patient Satisfaction and Symptomatic Outcomes Following Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome
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DOI：
10.1016/j.jss.2010.07.045
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发表时间：
2011-01-01
影响因子：
2.2
通讯作者：
Haas, Eric M.
中科院分区：
文献类型：
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作者：
Patel, Chirag B.;Ragupathi, Madhu;Haas, Eric M.
背景排便障碍综合征（ODS）被认为是一种功能性（e。例如，在一个实施例中，anismus）和解剖学（e.例如，在一个实施例中，直肠前突和直肠肠套叠）骨盆底排便障碍。本研究旨在评价吻合器经肛门直肠切除术（STARR）手术治疗ODS后的结局和患者满意度。2006年5月至2009年7月，37例患者接受STARR矫正继发于直肠前突和内肠套叠的ODS。将人口统计学数据和术后结局制成表格。通过比较术前和术后Wexner便秘评分系统的子集来评估症状结局，并通过患者满意度调查来评估质量结局。37例平均年龄为52.9 ± 11.2岁的女性患者接受了STARR。排粪造影显示所有患者均有临床意义的直肠前突，81.1%伴有直肠内套叠。术后并发症13例（35.1%）。其中2例患者需要再次介入：狭窄扩张和吻合钉肉芽肿经肛门切除。平均生活质量随访时间为20.3 ± 6.5个月（中位数：20个月，范围：9-36个月）。平均术前和术后便秘亚组评分分别为11.1 ± 3.6和4.6 ± 3.9（P < 0.00001）。71.9%的患者报告总体结局为“极好”或“良好”，15.6%为“足够”，12.5%为“差”。当被问及是否会再次接受手术时，81.3%的人表示肯定。STARR手术改善了症状结局，患者满意度高，并发症发生率可接受。在选定的患者中，这种微创方法是一种可接受的手术矫正继发于直肠前突和肠套叠的ODS的程序。(C)2011 Elsevier Inc. All rights reserved.
Background. Obstructed defecation syndrome(ODS) is recognized as a functional (e. g., anismus) and anatomic (e. g., rectocele and rectal intussusception) defecatory disorder of the pelvic floor. This study was designed to evaluate outcomes and patient satisfaction following stapled transanal rectal resection (STARR) for the surgical treatment of ODS.Materials and Methods. Between May 2006 and July 2009, 37 patients underwent STARR for correction of ODS secondary to rectocele and internal intussusception. Demographic data and postoperative outcomes were tabulated. Symptomatic outcomes were assessed by comparing pre- and postoperative subsets of the Wexner constipation scoring system, and quality outcomes were evaluated with patient satisfaction surveys.Results. Thirty-seven female patients with a mean age of 52.9 +/- 11.2 y underwent STARR. All patients had clinically significant rectocele as evidenced on defecography and 81.1% had concomitant internal rectal intussusception. Postoperative complications occurred in 13 patients (35.1%). Two of these patients required reintervention: dilation of stricture and transanal excision of staple granuloma. Mean quality of life follow-up occurred at 20.3 +/- 6.5 mo (median: 20 mo, range: 9-36 mo). Mean preoperative and postoperative constipation subset scores were 11.1 +/- 3.6 and 4.6 +/- 3.9, respectively (P < 0.00001). Overall outcome was reported as "excellent" or "good" in 71.9% of patients, "adequate" in 15.6%, and "poor" in 12.5%. When asked if they would undergo the procedure again, 81.3% responded affirmatively.Conclusions. The STARR procedure results in improved symptomatic outcomes, high patient satisfaction, and an acceptable complication rate. In selected patients, this minimally invasive approach was an acceptable procedure for the surgical correction of ODS secondary to rectocele and intussusception. (C) 2011 Elsevier Inc. All rights reserved.