[Value of abdominal rectopexy in obstructive disorders of defecation. A prospective study using a defecation index, manometry and radiology].
A prospective clinical, manometric, electromyographic and radiological study was conducted to judge the degree of success achieved with anterior-posterior rectopexy in 18 female patients suffering from obstructed defecation and varying degrees of incontinence. Prior to being operated on, 6 of the patients showed symptoms of intussusception, 4 an internal prolapse of the anterior rectum wall, and 5 a rectocele at least 2 cm in size; all of them had significant perianal descent. The main aim of this study was more precise definition of the pre- and postoperative bowel evacuation using a defecation index. This study shows that obstructed defecation is significantly associated with a lasting feeling of needing to defecate after evacuation, a sensation of incomplete evacuation, perianal pain and necessity for manual support during defecation. The patients had a mean age of 62 (range, 38-78) years. All underwent anterior-posterior rectopexy (Ivalon or Vicryl) with posterior pelvic repair of the puborectalis muscle. In 2 patients rectopexy was combined with sigmoidectomy, in 11 cases, with left hemicolectomy, and in 2, with subtotal colectomy. The median follow-up was 40.8 months (range, 6-66 months). Postoperatively anorectal manometry showed a significant increase in the resting anal pressure and the maximum voluntary pressure (P = 0.05). Continence was improved in 10 patients (55%), 7 (39%) of whom regained normal continence. No significant change in pelvic descent or anorectal angle was observed. Only 8 patients reported a complete evacuation of the rectum postoperatively.
Athanasiadis
S
S
Abteilung für Coloproktologie, St. Joseph-Hospital, Duisburg.
Heiligers
J
J
D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D003248:Constipation / Q000209:etiology / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000209:etiology / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D013536:Suture Techniques
Der Wert der abdominalen Rektopexie bei obstruktiven Defäkationsstörungen. Eine prospektive Studie mittels eines Defäkationsindexes, Manometrie und Radiologie.