Discussion
constipation, incontinence, colorectal resection, pain
INFREQUENT BOWEL MOVEMENTS, SECONDARY, SURGICAL COMPLICATIONS, INCONTINENCE
To the best of our knowledge, this is the first prospective randomized study on bowel function, quality of life, and pain outcomes of two different specimen extraction techniques for the surgical treatment of recto-sigmoideal DE.We observed no statistically significant difference in the occurrence of LARS and GIQLI scores in our cohort of patients who underwent either the NOSE-technique or the conventional nerve and vessel-sparing bowel resection after one year of follow-up. We found no evidence confirming the superiority of the NOSE-technique technique over conventional laparoscopic segmental resection in terms of bowel function and quality of life.The complex of symptoms consisting of incontinence due to flatus and/or feces, constipation, and frequent bowel movements is referred to as LARS. However, little is known about the exact cause of LARS. Several studies have addressed the symptoms of LARS, but significant variability exists in the reporting of outcomes after anterior resectionRiiskjaer In the prospective cohort trial by Hudelist In the present study, GIQLI scores were comparable in both groups and showed a statistically significant improvement over time from the baseline values until 1 year after surgery in the NC group (Similar to previously published dataAs secondary outcomes, we assessed the occurrence of major surgical complications, time to recovery, and length of hospitalization. Our data correlate with previously reported dataRecently, a meta-analysis by Liu In agreement with recent findingsKeane In the present study, the difference between specimen extraction techniques after colorectal resection for DE had no effect on the functional/surgical outcome or quality of life.The wider implication of our study is that NOSE colectomy offers the same benefits regarding bowel function, amelioration of pain symptoms, and quality of life as conventional laparoscopic anterior resection. Furthermore, after both procedures, the occurrence of LARS was lower than that previously reportedAs all surgeries were performed by the same surgical team, it is less likely that unbalanced patient enrollment significantly affected the outcomes.An obvious study limitation was our lack of blinding; however, this was not feasible because of the clinical nature of our study. The simple randomization method used in our study represents another limitation, because it resulted in unequal study groups.We report no imprecision in patient selection or detection, but a potential source of attrition bias in our data occurred in one case (loss to follow-up) exclusively in the NOSE group.