Avaliação da função sexual masculina de pacientes submetidos à excisão total do mesorreto: comparação entre as vias laparoscópica e aberta

Abstract

Introduction: The male sexual dysfunction is a frequent complication after pelvic surgery. This study evaluated the sexual function, using The International Index of Erectile Function questionnaire (IIEF), in patients submitted to open total mesorectal excision (OTME) and laparoscopic total mesorectal excision (LTME). Patients and Methods: the inclusion criteria were males with normal sexual activity before surgery, submitted to OTME or LTME from 2005 to 2009 on the Coloproctology Group of Federal University of Minas Gerais (UFMG). The questionnaire used was the IIEF, validated for Portuguese in 1998. The controlgroup was 30 men with more than 35 years-old, without any previous abdominal and pelvic surgery and no symptoms of sexual dysfunction, randomly selected. Results: Seventy-seven men were submitted to total mesorectal excision, 26 were included: 13 on the OTME group and 13 on the LTME group. No statistic difference was found among the three groups (OTME, LTME and control) regarding age, presence of arterial hypertension, diabetes mellitus and smoking. Between the OTME and LTME groups, no differences were observed in surgery type (abdomino-perineal ressection or anterior resection), cancer presentation and localization (high, middle and low rectal tumor) and radiotherapy.When the three groups were compared in each domain of IIEF, there was a significant difference in erectile function (p=0,05), orgasm and ejaculation (p=0,009), sexual intercourse satisfaction (p=0,01) and overall satisfaction (p=0,025), favourable to LTME and control groups. No difference was found in sexual desire (p=0,285). The incidence of severe dysfunction was higher in OTME group on erectile function (30,8%), orgasm and ejaculation (38,5%) and sexual intercourse satisfaction (38,5%) IIEF domains compared with LTME and control groups (7,7% and 6,7% respectively). No statistic difference was found on the IIEF domains between LTME and control group. Conclusion: The laparoscopic total mesorectal excision (LTME) may have benefits on male sexual function preservation when compared to open total mesorectal excision (OTME). Although this procedure (LTME) also have a hard and difficult learning curve, the better and amplification view have potential advantages. .