title: Perineal rectosigmoidectomy: quality of life.
abstract: OBJECTIVE
  For any surgical treatment of full-thickness rectal prolapse, little attention has been given to quality of life (QoL). This study prospectively evaluated continence, constipation and QoL after perineal rectosigmoidectomy for full-thickness rectal prolapse in young and elderly patients in the long term.
  
  
  METHODS
  From May 2003 to May 2010, consecutive patients suffering from full-thickness rectal prolapse and treated with perineal rectosigmoidectomy were prospectively studied. A standardized questionnaire, including the Cleveland Clinic Constipation Score (CCCS), the Cleveland Clinic Incontinence Score (CCIS) and generic [EuroQol five-dimension (EQ-5D)] and constipation-specific [Patient Assessment of Constipation-Quality of Life (PAC-QOL)] QoL scores, was administered pre- and postoperatively. The Wilcoxon test (for EQ-5D data) and two-sample Student's t-test [for EuroQol visual analogue scale (EQ-VAS), CCCS, CCIS and PAC-QOL data) were used for statistical analyses.
  
  
  RESULTS
  Fifty-three patients (47 women), 72.7 (range 30-89) years of age, underwent perineal rectosigmoidectomy. One patient died and one patient needed reoperation. Five full-thickness recurrences occurred. Thirty-seven patients completed the follow-up questionnaire at a median of 49 (range, 6-89) months. Postoperative incontinence and constipation improved significantly (CCIS from 13 ± 7.28 to 8.7 ± 6.96 and CCCS from 8.32 ± 6.96 to 3.49 ± 4.17). Furthermore, QoL, in terms of mobility, usual activity, pain/discomfort and anxiety/depression and subjective state of health, were significantly better at follow-up (P < 0.001). All dimensions of constipation-related QoL improved (P < 0.001). The results did not differ significantly between patients under or over 69 years of age.
  
  
  CONCLUSIONS
  Patients' experience improved general and constipation-related QoL after perineal rectosigmoidectomy, and this was independent of age.
authors.affiliation: Department of General, Gastrointestinal, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany. kim_m@chirurgie.uni-wuerzburg.de
authors.forename: M
authors.initials: M
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Reibetanz
authors.forename: N
authors.initials: N
authors.lastname: Schlegel
authors.forename: C-T
authors.initials: CT
authors.lastname: Germer
authors.forename: D
authors.initials: D
authors.lastname: Jayne
authors.forename: C
authors.initials: C
authors.lastname: Isbert
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D012809:Colon, Sigmoid / Q000601:surgery*; D003248:Constipation / Q000209:etiology*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012005:Rectal Prolapse / Q000150:complications* / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Perineal rectosigmoidectomy; full thickness rectal prolapse; quality of life