Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 5876-5886
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5876
Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females
Yang Yang, Yong-Li Cao, Yuan-Yao Zhang, Shou-Sen Shi, Wei-Wei Yang, Nan Zhao, Bing-Bing Lyu, Wen-Li Zhang, Dong Wei
Yang Yang, Yong-Li Cao, Yuan-Yao Zhang, Shou-Sen Shi, Wei-Wei Yang, Nan Zhao, Bing-Bing Lyu, Wen-Li Zhang, Dong Wei, Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
Author contributions: Yang Y and Cao YL contributed equally to this work; Wei D, Yang Y, and Cao YL designed the research; Yang Y, Cao YL, Zhang YY, Shi SS, and Lyu BB performed the research; Zhang WL and Yang WW collected the data; Yang Y and Zhao N analyzed the data; Yang Y wrote the paper; and Wei D and Cao YL critically revised the manuscript for important intellectual content; all authors read and approved the final manuscript.
Supported by Medical Science and Technology Project of Henan Province, China, No. 2011030031.
Institutional review board statement: The protocol of this study was approved by the Ethics Committee of the 989th Hospital of The Joint Logistics Support Force of PLA. All procedures performed in studies involving human participants were conducted in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent statement: Written informed consent was obtained from all patients.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Wei, MD, Chief Doctor, Professor, Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, No. 2 Huaxia Road, Luoyang 471031, Henan Province, China. yy_150@126.com
Received: July 20, 2020
Peer-review started: July 20, 2020
First decision: September 14, 2020
Revised: September 25, 2020
Accepted: October 13, 2020
Article in press: October 13, 2020
Published online: December 6, 2020
Processing time: 136 Days and 19.7 Hours
ARTICLE HIGHLIGHTS
Research background

Functional defecation disorder refers to constipation caused by pelvic floor dysfunction or outlet obstructive constipation, accounting for 60% of chronic constipation cases. Internal rectal prolapse (IRP) is one of the most common causes of obstructive constipation. The incidence of IRP in women is approximately three times that in men. IRP is mainly treated by surgery, which can be divided into two categories: Abdominal procedures and perineal procedures. This study offers a better procedure for the treatment of internal rectal prolapse.

Research motivation

The traditional surgical procedures have their pros and cons. Therefore, surgical procedures should be designed to comply with the principle of the tissue fixation system, should focus on integral reconstruction and repair based on symptoms and examination results, and should involve various levels at different heights, with an emphasis on the uterosacral ligament, rectovaginal fascia, and perineal body. The surgery should establish a tension-free balanced system of supporting ligaments to achieve the integral reconstruction of pelvic floor function.

Research objectives

To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair (IPFLR) combined with a procedure for prolapse and hemorrhoids (PPH) and the efficacy of laparoscopic IPFLR alone in the treatment of internal rectal prolapse (IRP) in women.

Research methods

Between January 2012 and October 2014, we collected the clinical data of 130 female patients with IRP who underwent surgical treatment. The patients were divided into groups A and B. Group A had 63 patients who underwent laparoscopic IPFLR alone, and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH. The degree of internal rectal prolapse (DIRP), Wexner constipation scale (WCS) score, Wexner incontinence scale (WIS) score, and Gastrointestinal Quality of Life Index (GIQLI) score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.

Research results

All laparoscopic surgeries were successful. The general information, number of bowel movements before surgery, DIRP, GIQLI score, WIS score, and WCS score before surgery were not significantly different between the two groups (all P > 0.05). The WCS score, WIS score, GIQLI score, and DIRP in each group 6 mo and 2 years after surgery were significantly better than before surgery (P < 0.001). In group A, the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery (P < 0.001), and the GIQLI score progressively improved from 6 mo to 2 years after surgery (P < 0.05). In group B, the DIRP, WCS score and WIS score significantly improved from 6 mo to 2 years after surgery (P < 0.05), and the GIQLI score 2 years after surgery were significantly higher than that 6 mo after surgery (P < 0.05). The WCS score, WIS score, GIQLI score, and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery (all P < 0.001, Bonferroni) except DIRP at 2 years after surgery.

Research conclusions

Laparoscopic IPFLR according to the surgical principle of tissue fixation system restored the anatomical abnormalities caused by IRP and relieved the symptoms. Moreover, it had low invasiveness and a low rate of complications. When it was combined with PPH, the normal anatomical position and function of the anal canal were recovered, thus reducing the recurrence of IRP and constipation. Therefore, the clinical efficacy of the laparoscopic IPFLR combined with PPH is better than that of laparoscopic IPFLR alone.

Research perspectives

This work is a retrospective non-randomized single-center study and has certain limitations, such as not accounting for potential post-baseline covariates. We will further develop a multicenter randomized controlled study. Meanwhile, we will enlarge the sample size and conduct a randomized trial with blinded patients and assessors to further evaluate the efficacy of integral theory–guided laparoscopic IPFLR combined with PPH.