Langzeitevaluation der Operation nach Rehn-Delorme zur Therapie des Rektumprolapses
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Philipps-Universität Marburg
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Abstract
Although rectal prolapse is a rather rare disease with a low incidence, it is usually associated with a high level of suffering on the part of the affected person. Therapy is therefore of great importance.
In the end, the prolapse can only be corrected adequately by surgical intervention. A variety of techniques are available for this purpose. To date, no method has been able to establish itself as the technique of choice. The decision is usually made on the basis of experience. In addition to transabdominal procedures, perineal techniques are mainly used. According to the current scientific consensus, there is no significant difference in complication and recurrence rates between the individual methods.
The method evaluated in this study is Rehn-Delorme’s transanal mucosectomy and muscle tightening. In the literature, the method is associated with a low complication rate, but a relatively high recurrence rate compared to other methods.
The aim of this study was to evaluate the outcome of treatment after Rehn-Delorme’s surgery by long-term evaluation. In addition to the symptoms, the course of the complaints, and surgical data, the complication and recurrence rates were of particular interest.
The survey of the study group was conducted after a pretest by telephone, post and interviews. In addition, a proctological follow-up was recommended and offered.
The study included a total of 54 patients who underwent rectal prolapse surgery after Rehn-Delorme between May 2011 and December 2017. The electronic medical records of all 54 patients were available for data collection. Contact was made with 48/54 patients, their relatives or their general practitioners. In the course of this, 36/48 persons were willing to participate in the survey. However, 5/48 refused to participate in the study. A further 7/48 could be recorded as deceased in the follow-up interval. Due to missing contact information 6/54 persons were not reachable and were registered as Lost to follow up.
The data collected by means of questionnaires came 100 percent from female persons. The average age of the interviewees at the time of the operation was 73.9 years. The follow-up interval for the interviewed patients was 45.4 months on average. Fecal incontinence and constipation are associated with particularly high suffering. In this study, 25/36 (69.4%) of the interviewed patients suffered from preoperative stool incontinence. With regard to the course of fecal incontinence, 56.0 percent reported a lasting improvement in symptoms as a result of Rehn-Delorme’s surgery. From preoperative chronic constipation suffered 19/36 (52.8%) respondents. In summary 7/19 (36.8%) patients reported a postoperative improvement in defecation. In this study, a postoperative complication rate of 5.7 percent was recorded (n= 3 postoperative bleeding). Perioperative mortality was zero percent. The arithmetic mean of the postoperative stay was 3.5 days and that of the duration of the operation 34.0 minutes. In this study, 6/48 (12.5%) of the patients reached in the study suffered a new rectal prolapse after previous Rehn-Delorme’s surgery. Regarding the satisfaction with the surgery, 17/36 (47.2%) patients replied that they were "very satisfied" with the outcome of the surgery. A further 14/36 (38.9%) participants were "satisfied" with the operation performed. Other 3/36 (8.3%) respondents declared to be "moderately satisfied". In addition, 2/36 (5.6%) patients were "dissatisfied" with the outcome of the Rehn-Delorme procedure.
The results of this study confirm the data described in the literature, whereby the recurrence rate in the present study appears to be very low.
Prospective studies with a large random sample appear to make sense.
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Created: 2020Issued: 2020-11-24Updated: 2020-11-24
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
RektumprolapsRehn-Delormerectal prolapseProktologie
DDC-Numbers
610
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Buhmann, Julia Petra: Langzeitevaluation der Operation nach Rehn-Delorme zur Therapie des Rektumprolapses. : Philipps-Universität Marburg 2020-11-24. DOI: https://doi.org/10.17192/z2020.0405.