Prospective evaluation of functional outcome after laparoscopic sigmoid colectomy.
Fiche publication
Date publication
février 2009
Auteurs
Membres identifiés du Cancéropôle Est :
Pr MARESCAUX Jacques
Tous les auteurs :
Forgione A, Leroy J, Cahill RA, Bailey C, Simone M, Mutter D, Marescaux J
Lien Pubmed
Résumé
OBJECTIVE: To prospectively determine the functional impact of elective laparoscopic sigmoidectomy after prior acute diverticulitis. SUMMARY BACKGROUND DATA: Decision-analysis for elective colonic resection after acute diverticulitis is predicated on future risk estimates of disease recurrence and complication rates. Quality of life alone is rarely countenanced as sufficient to warrant the supposed risk of intervention. METHODS: Consecutive patients undergoing laparoscopic sigmoid colectomy for prior diverticulitis over 18 months were studied at baseline (preoperative) and again subsequently (3, 6, and 12 months postoperatively) regarding quality of life and bowel symptomatology [gastrointestinal quality of life index (GIQLI)]. All patients also had enquiry made into urinary and sexual function at the same time points (men underwent international prostate symptom severity and international index of erectile function, respectively, whereas for women the urinary dysfunction index and a modified questionnaire for the evaluation of sexual function were used). RESULTS: Forty-six patients (mean age 58.3, 26 men) were studied, 45 of whom had their surgery completed laparoscopically. Quality of life significantly improved in the group overall, with 36 patients having an increase in their GIQLI >10 points (23 patients >20 points). This improvement was evident by 3 months and maintained thereafter. The improvement was due to increments in gastrointestinal symptomatology subdomain and was most significant in those with lowest preoperative scoring. Five patients' GIQLI score deteriorated without obvious predictive event. Not one of the patients presented evident alteration in urinary and sexual functioning postoperatively. CONCLUSIONS: Significant improvement in quality of life and social functioning accrues from elective sigmoid resection in the majority of patients. Avoidance of subsequent episodic attacks therefore should not represent the sole reason for operating but instead patient-centered issues should be prioritized.
Référence
Ann Surg. 2009 Feb;249(2):218-24.