Our Summary

This research paper compared two methods of proctectomy or removal of part or all of the rectum: the traditional open surgery and the minimally invasive procedure. It looked into how the length of the operation or operative time (OT) affects patient outcomes within 30 days after the surgery.

The researchers used data from the American College of Surgeons National Quality Improvement Program to identify patients who had undergone proctectomy. The patients were grouped based on the type of procedure they had and then further divided into quartiles based on the length of the surgery.

Results showed that the median operation time for minimally invasive proctectomy was longer than open surgery. However, while longer surgery times were linked to higher overall complications for both types of surgeries, this effect was more pronounced in patients who had open surgery.

The study also found that several factors were associated with longer surgery times. These included the specific procedure performed, male gender, higher body mass index scores, the use of diverting ileostomy (a procedure to divert stool to a bag outside the body), and in cases of cancer, tumors located in the mid or lower rectum and very advanced tumors.

In conclusion, the study suggested that while longer surgeries generally lead to worse short-term outcomes, the negative effects were less severe with minimally invasive proctectomy. Hence, the minimally invasive procedure might offer short-term advantages especially for complex cases that require longer operation times.

FAQs

  1. How does the length of the operation time (OT) affect patient outcomes after proctectomy?
  2. What factors were found to be associated with longer surgery times in proctectomy?
  3. Based on the study, which type of proctectomy procedure might be more advantageous for complex cases that require longer operation times?

Doctor’s Tip

A doctor may advise a patient undergoing proctectomy to consider the minimally invasive procedure if they have a complex case that may require a longer operation time. This method may offer better short-term outcomes compared to traditional open surgery, particularly in reducing overall complications. Additionally, the patient should be aware of factors that could contribute to longer surgery times, such as specific procedures, male gender, higher body mass index, and tumor location. It is important for the patient to discuss these factors with their surgeon to determine the best approach for their individual case.

Suitable For

Patients who are typically recommended proctectomy include those with conditions such as rectal cancer, inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), rectal prolapse, or severe hemorrhoids that do not respond to other treatments. These patients may experience symptoms such as rectal bleeding, chronic diarrhea, abdominal pain, or difficulty with bowel movements. Additionally, patients who have failed to respond to conservative treatments or who have a high risk of developing complications from their condition may also be recommended for proctectomy.

Timeline

Before the proctectomy:

  1. Patient is diagnosed with a condition that requires removal of part or all of the rectum.
  2. Patient discusses treatment options with their healthcare provider, including the possibility of a proctectomy.
  3. Patient undergoes preoperative testing and evaluation to determine their suitability for surgery.
  4. Patient receives instructions on how to prepare for the surgery, which may include dietary restrictions and medication adjustments.
  5. Patient undergoes the proctectomy procedure, either through traditional open surgery or a minimally invasive approach.

After the proctectomy:

  1. Patient is monitored closely in the immediate postoperative period for any complications or side effects.
  2. Patient may experience pain, discomfort, and fatigue as they recover from the surgery.
  3. Patient begins a gradual return to normal activities, with guidance from their healthcare provider.
  4. Patient may require a temporary colostomy or ileostomy to divert stool while the rectum heals.
  5. Patient attends follow-up appointments with their healthcare provider to monitor their recovery and address any concerns.
  6. Patient gradually resumes regular activities and adjusts to any changes in bowel function following the proctectomy.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with proctectomy surgery?
  2. How long is the typical recovery time following a proctectomy procedure?
  3. What are the long-term effects of proctectomy on bowel function and quality of life?
  4. How experienced is the surgical team in performing proctectomy procedures?
  5. Are there any alternative treatment options to consider before undergoing proctectomy?
  6. Will I need to use a temporary or permanent stoma after the surgery?
  7. How will my pain be managed during and after the surgery?
  8. What dietary changes or restrictions will I need to follow post-surgery?
  9. How often will I need follow-up appointments after the surgery?
  10. What is the success rate of proctectomy procedures at your facility?

Reference

Authors: White B, Naffouje S, Grunvald M, Bhama A, Dahdaleh F. Journal: J Gastrointest Surg. 2024 Feb;28(2):141-150. doi: 10.1016/j.gassur.2023.12.005. Epub 2024 Feb 5. PMID: 38445935