16B: Patient reported outcomes of the Trans‐Obturator Post‐Anal Sling (TOPAS) procedure

Abstract

16B Patient reported outcomes of the TransObturator Post-Anal Sling (TOPAS) procedure W. D. Winkelman, V. O. Demtchouk, L. Brecher, P. L. Rosenblatt Mount Auburn Hospital, Cambridge, MA, Beth Israel Deaconess Medical Center, Boston, MA, Harvard Medical School, Boston, MA, Tufts Medical School, Boston, MA OBJECTIVES: The goal of this study was to assess long-term patient reported outcomes following the trans-obturator post-anal sling (TOPAS) procedure for the treatment of fecal incontinence. MATERIALS AND METHODS: A prospective cohort study was conducted. All patients who underwent the TOPAS procedure at a single institution were identified through review of Current Procedural Terminology codes, and patients were eligible for the study if they had valid contact information in the medical records and were conversant in English. At their preoperative visit patients completed the Pelvic Floor Distress Inventory (PFDI-20). Patients were then contacted by telephone and asked to complete Likert-scale questions on their overall satisfaction, the Patient Global Impression of Improvement (PGI-I), the Wexner Score, the Fecal Incontinence Qualify of Life scale (FIQOL), and the Decision Regret Scale RESULTS: There were 66 eligible patients of whom 48 (72.7%) agreed to participate. A total of 5 (7.6%) could not remember having surgery, 4 (6.1%) declined participation, and 9 (13.6%) agreed to participate but have not yet been able to schedule a telephone interview. Patients were a mean of 65.9 years old at the time of surgery and telephone surveys were completed a mean of 5.4 years after their initial surgery. There was a significant decrease in the CRADI-8 scores postoperatively when compared to preoperatively (25.31 vs 43.47, p1⁄40.001). Similarly, there was a significant decrease in the PFDI-20 scores postoperatively when compared to preoperatively (49.32 vs 109.51, p<0.001). Patients reported a mean postoperative Wexner Score of 6.93. The mean postoperative FIQOL scores were 3.52 for lifestyle, 2.93 for coping, 3.82 for depression, and 3.15 for embarrassment. Patients reported an average PGI-I score of 2.88 after surgery which falls between “a little better” and “much better”. Most patients (70.8%) would recommend the surgery to someone else. While 16 patients (33.3%) were either somewhat or very dissatisfied with the outcomes of surgery, only 5 (10.4%) reported that their symptoms were worse postoperatively and only 2 (4.2%) felt that surgery did them harm. Seven patients (14.6%) regretted having surgery. The mean score on the Decision Regret Scale was 19.58. CONCLUSION: Patients report excellent long-term subjective outcomes following the TOPAS procedure. The high overall satisfaction and low prevalence of patient reported pelvicfloor symptoms support the ongoing use of TOPAS as a treatment option for refractory fecal incontinence.