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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(01): 052-057
DOI: 10.1055/s-0041-1724063
Original Article

Outcome of Fecal Incontinence in Patients with Rectal Prolapse Undergoing the Altemeier Procedure with or without Posterior Levatorplasty

Desfecho de incontinência fecal em pacientes com prolapso retal submetidos ao procedimento de Altermeier com ou sem levatorplastia posterior
Alimohammad Bananzadeh 
1   Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Hamed Shariat Razavi
1   Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Shahin Khodaei 
1   Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Maytham Hameed Al-Qanbar 
2   University of Kufa, College of Medicine, Kufa, Iraq
,
Seyed Mohammad Kazem Tadayon 
1   Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Seyed Vahid Hosseini 
1   Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,
Leila Ghahramani 
1   Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
› Author Affiliations Funding/Support The present study was funded by the Shiraz University of Medical Sciences. The study was presented at the ESCP 2019 Congress (Vienna, Austria) as a poster abstract. However, the final result and list of authors were partially changed following the second statistical analysis.
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Abstract

Objective To compare the fecal incontinence status of patients submitted to theAltemeier procedure with or without posterior levatorplasty.

Materials and Methods Medical records of the patients who underwent the Altemeier procedure at Shahid Faghihi Hospital (in Shiraz, Iran) from 2014 to 2018 were retrospectively studied. Patients older than 17 years of age who underwent the Altemeier procedure due to complete rectal prolapse were considered. In some cases, the operation was performed with posterior levatorplasty. Rectal prolapse due to collagen or connective tissue disorders, anal/sacral anomalies, immunodeficiency, history of rectal surgery, and pelvic radiotherapy were the exclusion criteria of the present study. In addition to the demographics (including age, gender, and body mass index), the fecal incontinence status of each case was determined through the Wexner scale preoperatively and 12 months after the surgery. The incontinence scores were then compared against the baseline values of the two groups of patients: those with and those without posterior levatorplasty. The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, US), software, version 21.

Results In total, 53 patients (17 men and 36 women) with a mean age of 55.23 ± 18.24 years were analyzed. The comparison of the pre- and postoperative scores on the Wexner scale between the two groups revealed no statistically significant difference (p >0.05).

Conclusion Posterior levatorplasty during the Altemeier procedure did not result in significant improvement of the fecal incontinence outcome of the patients.

Resumo

Objetivo Comparar o status de incontinência fecal de pacientes após o procedimento de Altemeier com e sem levatorplastia posterior.

Materiais e métodos Os prontuários médicos dos pacientes submetidos ao procedimento de Altemeier no Shahid Faghihi Hospital (em Shiraz, Irã) entre 2014 e 2018 foram avaliados retrospectivamente. Pacientes com idade superior a 17 anos submetidos ao procedimento de Altemeier devido a prolapso retal completo foram considerados. Em alguns casos, a operação foi realizada com levatorplastia posterior. Prolapso retal devido a distúrbios de colágeno ou do tecido conjuntivo, anomalias anais/sacrais, imunodeficiência, histórico de cirurgia retal, e radioterapia pélvica foram os critérios de exclusão deste estudo. Além dos dados demográficos (incluindo idade, sexo, e índice de massa corporal), o status da incontinência fecal de cada caso foi determinado por meio da escala de Wexner antes e doze meses após a cirurgia. Então, as pontuações de incontinência foram comparadas aos valores de referência dos dois grupos de pacientes: com e sem levatorplastia posterior. A análise estatística foi feita usando-se o programa Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY, EUA), versão 21.

Resultados No total, 53 pacientes (17 homens e 36 mulheres) com idade média de 55.23 ± 18.24 anos foram avaliados. A comparação entre os grupos das pontuações na escala de Werner no pré e pós-operatório não revelou diferença estatisticamente significativa (p > 0.05).

Conclusão Levatorplastia superior durante o procedimento de Altemeier não resultou em melhora significativa do desfecho da incontinência fecal dos pacientes.

Keywords

rectal prolapse - posterior levatorplasty - fecal incontinence

Palavras-chave

prolapso retal - levatorplastia posterior - incontinência fecal


Publication History

Received: 22 July 2020

Accepted: 23 August 2020

Article published online:
19 March 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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