Delorme surgery for colonic mucosal prolapse after intersphincteric resection
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ORIGINAL ARTICLE
Delorme surgery for colonic mucosal prolapse after intersphincteric resection Satoshi Narihiro1 · Naoko Miura1 · Yuji Nishizawa1 · Hiro Hasegawa1 · Koji Ikeda1 · Koichi Teramura1 · Yuichiro Tsukada1 · Takeshi Sasaki1 · Masaaki Ito1 Received: 21 June 2020 / Accepted: 23 September 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Mucosal prolapse at the site of anastomosis is a long-term complication unique to ISR. It reduces the QOL of patients due to a worsened anal function and local symptoms around the anus. We herein sought to assess the surgical outcomes after Delorme surgery for these patients. Methods ISR was performed in 720 patients with low rectal cancer between January 2001 and March 2019 at the National Cancer Center Hospital East. Among these patients, the 33 (4.5%) who underwent initial Delorme surgery for postoperative colonic mucosal prolapse were identified from the medical records and then were analyzed retrospectively. We estimated the anal function using Wexner’s incontinence score and assessed whether local anal symptoms due to the prolapse improved postoperatively. Results Stoma closure was performed before Delorme surgery in 15 (45.5%) patients, and we compared the preoperative and postoperative anal function in these patients. The average Wexner’s incontinence score changed from 15.1 before to 12.9 after Delorme surgery. Local symptoms around the anus improved in all 33 (100%) patients. Recurrence of colonic mucosal prolapse occurred in 5 patients (15%), and Delorme surgery was reperformed in these cases. Conclusion Delorme surgery for colonic mucosal prolapse following ISR has clinical benefits for both improving anal local symptoms and slightly improving the anal function. Keywords Delorme surgery · Mucosal prolapse · Intersphincteric resection · Anal symptom · Anal function
Introduction Preservation of the postoperative anal function, as well as the clearance of oncological margins, should be the main focus when treating low rectal cancers. Low rectal cancers located close to the anorectal junction were previously
treated with abdominoperineal resection [1], and anus preservation was, therefore, not realized. Recent technical improvements with intersphincteric resection (ISR) could avoid a permanent colostomy for such patients with low-lying tumors. However, some problems associated with postoperative anal dysfunction following
* Masaaki Ito [email protected]
Koichi Teramura [email protected]
Satoshi Narihiro [email protected]
Yuichiro Tsukada [email protected]
Naoko Miura [email protected]
Takeshi Sasaki [email protected]
Yuji Nishizawa [email protected]
1
Hiro Hasegawa [email protected]
Department of Colorectal Surgery, National Cancer Center Hospital East, Masaaki Ito, 6‑5‑1 Kashiwanoha, Kashiwa, Chiba 277‑8577, Japan
Koji Ikeda [email protected]
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Surgery Today
ISR still remain unresolved despite the increasing use of robotic surgery and transanal endoscop
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