Perineal rectosigmoidectomy: quality of life

Abstract

Aim 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. Method 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. Results 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. Conclusion Patients' experience improved general and constipation‐related QoL after perineal rectosigmoidectomy, and this was independent of age.