Improvement in functional and mental outcomes after resection rectopexy for obstructive defecation syndrome ODS

Abstract

Obstructive defecation syndrome (ODS) is a condition that causes straining and may require manual evacuation and patients' thoughts circle around defecation impairing their quality of life. Mental comorbidity-related findings suggest a mental burden in ODS patients. In an observational cohort design, this study investigated the relationship between the mental distress and their clinical symptom severity for a group of patients with ODS who underwent surgical treatment. This study included 108 consecutive patients with ODS who were scheduled for laparoscopic resection rectopexy combined with pelvic floor repair, if indicated. Clinical symptom severity (Altomare score, rectal toxicity score, and Wexner incontinence score) and mental health scores (Generalized Anxiety Disorder-7 [GAD-7] and Personal Health Questionnaire-9 [PHQ-9]) were assessed before and 6 months after surgery. Before surgery, 82.5% of patients had at least mild depressive symptoms (PHQ-9 score ≥ 5), and 55.6% of patients had at least mild anxiety (GAD-7 score ≥ 5). The severity of the mental health scores correlated with the clinical symptom severity. At the 6-month follow-up, the bowel function scores improved significantly. Depression symptoms improved, whereas only slight changes in anxiety symptoms were observed. The improvement in clinical symptom severity correlated with better mental score results, whereas the severity of the preoperative mental distress did not influence the surgical or follow-up outcomes. Patients with obstructive defecation syndrome (ODS) experience significant depression and anxiety that adversely affect their quality of life. Surgical improvement of bowel function reduces depressive symptoms and, to a lesser extent, anxiety symptoms. Early multidisciplinary intervention should be considered for effective management. Future studies should further investigate mental distress caused by ODS symptoms or other underlying psychiatric comorbidities.

Keywords: Anxiety; Depression; Interdisciplinary surgery; Mental burden; Mental outcome; Obstructed defecation syndrome (ODS).

Fig. 1

Representative radiologic images of the diagnostic work up for ODS. Magnetic resonance image defecography (MRI-D) in sagittal view of a male pelvis showing (A) the situation at rest and (B) at the end of defecation with a rectal prolapse (marked with *), the signs of the descending peritoneum as in a pelvic organ prolapse (marked with X), and intussusception of the distal rectum (marked with parenthesis “}”) .The X-ray of a colonic transit time (C) with distribution of the opaque markers in the ascending colon and the rectosigmoid (circled with a white ellipse). Image of the corresponding colon enema (D) showing an elongated rectosigmoid (circled white ellipse) and some residual markers from the colonic transit time examination 5 days and a bowel preparation later (white arrows).

Fig. 2

The illustration below outlines the surgical procedure in case of a female patient with ODS and POP. (A): Colon and rectum with a pelvic organ prolapse before surgery. The dark gray structure represents the elongated rectosigmoid. (B): After colorectal resection with anastomosis, a suture rectopexy attaches the rectum to both sides of the pelvis. The apical fixation of the middle compartment shows a uterus-preserving technique with a mesh fixing the dorsal part of the cervix to the promontory [22, Copyright © 2024 Facts, Views & Vision].

Fig. 3

Distribution of preoperative Altomare score by preoperative PHQ-9 subgroup as illustrated in boxplots.

Fig. 4

Distribution of rectal toxicity scores by PHQ-9 subgroup as illustrated in boxplots.

Fig. 5

The average PHQ-9 score correlated with severity in the GAD-7 subgroups as illustrated in boxplots.

Fig. 6

Preoperative GAD-7 scores correlated with preoperative PHQ-9 scores as illustrated in boxplots.

Fig. 7

Bowel function scores preoperatively and at the 6-month follow-up were illustrated in boxplots.

Fig. 8

The mean changes in clinical scores after surgery (point) are linked (lines) in a graph according to the respective preoperative PHQ-9 subgroup.

Fig. 9

Absolute number of patients in the PHQ-9 subgroups shown in columns before (black) and 6 months after surgery (grey) (A). Changes in the PHQ-9 score after 6 months in correlation with the preoperative PHQ-9 subgroup illustrated in boxplots (B).

Fig. 10

Changes in the GAD-7 scores after 6 months in the preoperative GAD-7 (A) and PHQ-9 subgroups (B) as illustrated in boxplots.

Fig. 11

Changes in PHQ-9 scores at 6 months after surgery according to postoperative Altomare subgroup shown in Boxplots.