PURPOSE:Using meta-analytical techniques, this study was designed to compare open and laparoscopic abdominal procedures used to treat full-thickness rectal prolapse in adults. METHODS: Comparative studies published be...PURPOSE:Using meta-analytical techniques, this study was designed to compare open and laparoscopic abdominal procedures used to treat full-thickness rectal prolapse in adults. METHODS: Comparative studies published between 1995 and 2003, cited in the literature of open abdominal rectopexy vs. laparoscopic abdominal rectopexy, were used. The primary end points were recurrence and morbidity, and the secondary end points assessed were operative time and length of hospital stay. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed. RESULTS: Six studies, consisting of a total of 195 patients (98 open and 97 laparoscopic) were included. Analysis of the data suggested that there is no significant difference in recurrence and morbidity between laparoscopic abdominal rectopexy and open abdominal rectopexy. Length of stay was significantly reduced in the laparoscopic group by 3.5 days (95 percent confidence interval, 3.1-4; P < 0.01), whereas the operative time was significantly longer in this group, by approximately 60 minutes (60.38 minutes; 95 percent confidence interval, 49-71.8). CONCLUSIONS: Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regards to recurrence and morbidity and favorably with length of stay. However large-scale randomized trials, with comparative, sound methodology are still needed to ascertain detailed outcome measures accurately.展开更多
INTRODUCTION:This study was designed to evaluate long-term outcomes for patients undergoing Kock continent ileostomy,identify factors associated with adverse outcomes,and compare changes in quality of life after remov...INTRODUCTION:This study was designed to evaluate long-term outcomes for patients undergoing Kock continent ileostomy,identify factors associated with adverse outcomes,and compare changes in quality of life after removal of the reservoir.METHODS:The records of all patients(n = 330)undergoing continent ileostomy at the Cleveland Clinic Foundation between 1974 and 2001 were reviewed.Patient-related,intraoperative,and postoperative factors were evaluated as predictor variables of long-term pouch survival.Quality of life was evaluated using the continent ileostomy surgery follow-up questionnaire and the Cleveland Global Quality of Life scale(n = 216).These were compared between patients with continent ileostomy(n = 181)and patients who underwent removal of the continent ileostomy and conversion to an end stoma(n = 35).RESULTS:The median patient follow-up was 11(range,1-27)years.The median revision-free pouch interval was 14(95 percent confidence interval,11-17)months.The 10-year and 20-year pouch survival was 87 and 77 percent,respectively.Patients had an average of 3.7(range,1-28)complications and 2.9(range,1-27)pouch revisions during follow-up.On multivariate analysis,Crohn’s disease(hazard ratio = 4.5),female gender(hazard ratio = 2.4),fistula development(hazard ratio = 3),and body mass index(hazard ratio = 2.4 per 5 unit increase)were independent predictors of pouch failure.Quality of life measurements for patients with a continent ileostomy were higher on all scales in comparison with patients who had the Kock reservoir and then reverted to a Brooke ileostomy.CONCLUSIONS:Despite the associated morbidity with continent ileostomy surgery,long-term results and quality of life were encouraging.Continent ileostomy may be offered as an attractive long-term option to select patients whose only alternative is an end ileostomy.展开更多
文摘PURPOSE:Using meta-analytical techniques, this study was designed to compare open and laparoscopic abdominal procedures used to treat full-thickness rectal prolapse in adults. METHODS: Comparative studies published between 1995 and 2003, cited in the literature of open abdominal rectopexy vs. laparoscopic abdominal rectopexy, were used. The primary end points were recurrence and morbidity, and the secondary end points assessed were operative time and length of hospital stay. A random effect model was used to aggregate the studies reporting these outcomes, and heterogeneity was assessed. RESULTS: Six studies, consisting of a total of 195 patients (98 open and 97 laparoscopic) were included. Analysis of the data suggested that there is no significant difference in recurrence and morbidity between laparoscopic abdominal rectopexy and open abdominal rectopexy. Length of stay was significantly reduced in the laparoscopic group by 3.5 days (95 percent confidence interval, 3.1-4; P < 0.01), whereas the operative time was significantly longer in this group, by approximately 60 minutes (60.38 minutes; 95 percent confidence interval, 49-71.8). CONCLUSIONS: Laparoscopic abdominal rectopexy is a safe and feasible procedure, which may compare equally with the open technique with regards to recurrence and morbidity and favorably with length of stay. However large-scale randomized trials, with comparative, sound methodology are still needed to ascertain detailed outcome measures accurately.
文摘INTRODUCTION:This study was designed to evaluate long-term outcomes for patients undergoing Kock continent ileostomy,identify factors associated with adverse outcomes,and compare changes in quality of life after removal of the reservoir.METHODS:The records of all patients(n = 330)undergoing continent ileostomy at the Cleveland Clinic Foundation between 1974 and 2001 were reviewed.Patient-related,intraoperative,and postoperative factors were evaluated as predictor variables of long-term pouch survival.Quality of life was evaluated using the continent ileostomy surgery follow-up questionnaire and the Cleveland Global Quality of Life scale(n = 216).These were compared between patients with continent ileostomy(n = 181)and patients who underwent removal of the continent ileostomy and conversion to an end stoma(n = 35).RESULTS:The median patient follow-up was 11(range,1-27)years.The median revision-free pouch interval was 14(95 percent confidence interval,11-17)months.The 10-year and 20-year pouch survival was 87 and 77 percent,respectively.Patients had an average of 3.7(range,1-28)complications and 2.9(range,1-27)pouch revisions during follow-up.On multivariate analysis,Crohn’s disease(hazard ratio = 4.5),female gender(hazard ratio = 2.4),fistula development(hazard ratio = 3),and body mass index(hazard ratio = 2.4 per 5 unit increase)were independent predictors of pouch failure.Quality of life measurements for patients with a continent ileostomy were higher on all scales in comparison with patients who had the Kock reservoir and then reverted to a Brooke ileostomy.CONCLUSIONS:Despite the associated morbidity with continent ileostomy surgery,long-term results and quality of life were encouraging.Continent ileostomy may be offered as an attractive long-term option to select patients whose only alternative is an end ileostomy.
