Perineal rectosigmoidectomy: quality of life

Abstract

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. 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. 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. Patients' experience improved general and constipation-related QoL after perineal rectosigmoidectomy, and this was independent of age.