Quality of life after transperineal rectosigmoidectomy

Abstract

Background: This study evaluated continence, constipation and quality of life before and after perineal rectosigmoidectomy for full-thickness rectal prolapse. Methods: Consecutive patients with full-thickness rectal prolapse undergoing perineal rectosigmoidectomy (Altemeier's procedure) between May 2004 and June 2008 were studied. A standardized questionnaire, including the Cleveland Clinic Constipation Score (CCCS), Cleveland Clinic Incontinence Score (CCIS) and quality of life scores (EuroQol - Five Dimensions, EuroQol - Visual Analogue Scale and Patient Assessment of Constipation - Quality of Life (PAC-QOL)), was administered before and after operation. Results: Thirty-eight patients (32 women) of mean(s.d.) age 75(13) years underwent rectosigmoidectomy. Seven patients developed postoperative complications and one died. There was one recurrence 5 months after surgery. Twenty-nine patients completed the follow-up questionnaire and were reviewed after a median of 24 (range 6-48) months. Constipation and incontinence were significantly improved after surgery (mean CCCS from 10.21 to 3.58 and CCIS from 14.17 to 11.42; P < 0.001). Quality of life, in terms of mobility, usual activities, pain/discomfort and anxiety/depression, were significantly better at follow-up (P < 0.001), as was subjective health status (P < 0.001). The PAC-QOL score improved significantly in all dimensions (P < 0.001). Conclusion: Transperineal rectosigmoidectomy improves general and constipation-related quality of life with good functional results. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.