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Background and goals Sexual dysfunction is a well-documented complication of rectal cancer surgery, with a reported incidence of 18% - 59%. The objective of this study is to evaluate the incidence of sexual dysfunction (SD) in males after radical resection for rectal cancer and to compare the outcome of open versus laparoscopic rectal resection for different age groups. Patients and methods This prospective randomized study assessed outcomes in male patients that underwent rectal resection for rectal cancer from January 2012 until March 2015 at two large tertiary hospitals in Cairo, Egypt. The patients were randomly allocated into two groups (laparoscopic and open technique) of 40 patients each using the odd number policy for patient allocation. Patients included in each group were further subdivided into two groups according to the type of rectal resection either anterior resection (AR) or abdominoperineal resection (APR). Erectile function was evaluated preoperatively and postoperatively at 3 and 6 months using the International Index of Erectile Function (IIEF) questionnaire. Results There was no significant difference between the laparoscopic and open total mesorectal excision (TME) groups when comparing IIEF score preoperatively. At 3 months postoperatively, the laparoscopic arm showed better results over the open arm (abnormal IIEF in 57.5% vs. 67.5%). The study demonstrated dramatic improvement in SD in both groups at 6 months postoperatively (abnormal IIEF score of 40% in the laparoscopic vs. 42.5% in the open arm) with no significant difference in IIEF score between the two groups (p-value 0.876). At 3 and 6 months postoperatively, younger patients showed significant improvement in SD compared to older patients in both groups with more significant improvement in the laparoscopic group (16.7% vs. 40%). Patients with APR show more SD compared with AR patients whether laparoscopic or open as seen by the abnormal IIEF scores for the the two groups [the laparoscopic group APR patients showed 62.5% abnormal IIEF at 3 months that decreased to 50% after 6 months compared to 56.3% and 37.5% at 3 and 6 months respectively for lap. AR patients, and in the open group APR patients also showed higher abnormal IIEF of 71.4% and improved to 42.9% at 3 and 6 months respectively compared to 66.7% and 42.3% at 3 and 6 months respectively for open AR), which shows that APR whether laparoscopic or open causes more sexual dysfunction than AR. Conclusion In this randomized prospective study, there was no significant difference between the laparoscopic and open TME when we compared IIEF scores. In patients younger than 30 years, the significant improvement in the laparoscopic arm adds to the favorable outcome of laparoscopic TME as regards postoperative complications, postoperative pain, hospital stay, the return of bowel functions and cosmetic results.

Evaluation of Male Sexual Dysfunction Associated with Laparoscopic versus Open Resection in Rectal Cancer in Different Age Groups