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Laparoscopic ventral mesh rectopexy (LVMR) in the management of solitary rectal ulcer syndrome (SRUS): a cause for optimism?
MedLine Citation:
PMID:  23107777     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: The treatment of solitary rectal ulcer syndrome (SRUS) is notoriously difficult. Laparoscopic ventral mesh rectopexy (LVMR) is a non-resectional technique for patients with full thickness external rectal prolapse and internal prolapse with obstructed defaecation syndrome (ODS), features associated in the pathogenesis of SRUS. Our aim was to assess the short and long-term efficacy of LVMR in treating SRUS. METHOD: 48 patients with SRUS who underwent LVMR over a 15-yr period (December 1996 to July 2012) were identified from a prospectively maintained electronic database. RESULTS: 48 patients, 38 (79%) females, median age 43 (18-80) years, median BMI 26 kg/m(2) (21-40) underwent LVMR for SRUS after initial biofeedback.. The median follow-up (FU) was 33 months (95% CI 31-55, 1-186 months); 52% were followed for more than 3 years and 13 (27%) for more than 5 years. Five (10%) had relapsed following a response to STARR [10 additional patients have had a continued response to STARR]. Eleven (23%) had intermittent reducible external prolapse. Epithelial ulcer healing was reported in all patients at 3 months. ODS scores improved by 68% (p<0.0001) and QoL (BBUSQ-22) scores improved by 45% (p<0.0001). There was a significant improvement in bowel VAS scores at 3 and 12 months (p=0.0007). Sustained improvement in QoL and VAS scores were maintained at 2 years and continued in the 52% followed-up for between three and 15 yrs. There were four (8%) symptomatic ODS recurrences: posterior rectal wall prolapse successfully treated by STARR (3) and one symptom free two years following a temporary loop ileostomy. There were two recurrences (4%). CONCLUSION: LVMR appears to provide a sustained improvement in QoL, VAS and patient satisfaction in patients with SRUS. Morbidity, recurrence and safety profiles are low. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Authors:
Ah Badrek-Amoudi; T Roe; K Mabey; H Carter; A Mills; Ar Dixon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-29
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  -     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Affiliation:
Departments of Colorectal Surgery, Frenchay Hospital, UK.
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