TITULO: LAPAROSCOPIC RESECTION RECTOPEXY VERSUS LAPAROSCOPIC VENTRAL RECTOPEXY FOR COMPLETE RECTAL PROLAPSE
AUTOR y COAUTORES: Dr. Henk A. Formijne Jonkers, Dr. Werner A. Draaisma, Dr. Ivo A.m.j. Broeders, Dr. Esther C.j. Consten
COAUTORES: Dr. Willem A. Bemelman
COAUTORES: Dr. Antonio M. Maya, Dr. Steven D. Wexner
Nº DE REFERENCIA 9798
TIPO PRESENTACION: Temas Libres
CATEGORIA: Coloproctología
RESUMEN DE LA PRESENTACION:
ANTECEDENTES: The optimal treatment of Rectal Prolapse (RP) is still under debate. Laparoscopic Resection Rectopexy (LRR) and Laparoscopic Ventral Rectopexy (LVR) are favored for the treatment of RP in the USA and Europe, respectively. A comparison between these approaches has however never been performed.
OBJETIVO: To perform a comparison between these approaches for the treatment of rectal prolapse.
DISEÑO: Observational
MATERIAL Y METODO: All patients who underwent LRR because of RP between 01-2000 and 01-2012 at Cleveland Clinic Florida (Weston,FL,USA) were identified and all relevant characteristics were entered in a database. This same analysis was also conducted for all patients who underwent LVR in the Meander Medical Center (Amersfoort,the Netherlands) between 01-2004 and 01-2012. These two cohorts were compared with regard to complications, functional results and recurrence.
RESULTADOS: Twenty-eight patients (all female, mean age:50.1 years) were included in the LRR cohort at a mean follow-up of 57 (range 2-140;SD±41.2) months. The LVR group consisted of 40 patients (36 females, 4 males) with a mean age of 67.0 years and a mean follow-up of 42 (range 2-82;SD± 23.8) months. A significant reduction in constipation was observed in both cohorts after surgery: 57% vs. 21% after LRR, 55% vs. 23% after LVR (both P<0.05). The incidence of incontinence also significantly decreased in both groups; 15% after LVR (55% before surgery) and 4% after LRR (61% before surgery). Analysis between these two techniques showed a trend to significance. (P=0.09). Significantly more complications occurred after LRR (n=9: 1 major,8 minor) then after LVR (n=3, 2 major,1 minor) (p<0.05). Conclusions. Both LVR and LRR are effective for the treatment of RP. Although both techniques offer significant improvements in functional symptoms, continence may be better after LRR. However LRR also had a higher complication rate than did LVR.
CONCLUSIONES: Both LVR and LRR are effective for the treatment of RP. Although both techniques offer significant improvements in functional symptoms, continence may be better after LRR. However LRR also had a higher complication rate than did LVR. |
