Patient reported and physician recorded bowel dysfunction following colorectal resection and radical cystectomy: a prospective, comparative study
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2020
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Ng, K.-S.
Gladman, M.A.
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Colorectal Disease, 2020; 22(10):1336-1347
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Kheng-Seong Ng, Marc A Gladman
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AIM: Bowel dysfunction following anterior resection (AR) is termed 'low anterior resection syndrome (LARS)'. It is unclear whether such dysfunction occurs following other bowel/pelvic operations as well. This study aimed to characterise and compare bowel dysfunction following AR, right hemicolectomy (RH) and radical cystectomy (RC). METHOD: A prospective study of consecutive patients undergoing AR, RH, and RC (2002-2012) was performed at a tertiary referral centre in Sydney, Australia. Outcome measures included: (i) patient-reported (satisfaction with bowel function, self-described bowel function, and self-reported change in bowel function); (ii) objective assessment of bowel function using validated criteria to identify symptoms and stratify patients into those with constipation and/or faecal incontinence (FI); and (iii) health-related quality of life (SF-36v2). RESULTS: Of 743 eligible patients, 70% participated (AR: n=338, mean age 69.6yrs [SD11.9], 59% male; RH: n=150, 75.8yrs [SD10.5], 54% male; RC: n=34, 71.1yrs [SD14.1], 71% male). AR patients were three times more likely to report change in bowel function post-surgery, and self-judged their bowel function as 'abnormal' more frequently (64%) than following RH (35%) and RC (35%) (P<0.01). AR patients were four times more likely to meet criteria for concomitant constipation and FI. Patients with concomitant constipation and FI had lower physical and mental SF-36v2 scores (P<0.001). CONCLUSION: Bowel dysfunction occurred after RH and RC but rates were higher following AR. This suggests that LARS occurs due to a direct impact of partial/complete loss of the rectum rather than just due to loss of bowel length and/or the consequence(s) of pelvic dissection.
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This article is protected by copyright. All rights reserved [Wiley]