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Mari FS, Pezzatini M, Gasparrini M, Antonio B. STARR with Contour Transtar for Obstructed Defecation Syndrome: Long-Term Results. World J Surg 2018; 41:2906-2911. [PMID: 28600694 DOI: 10.1007/s00268-017-4084-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Obstructed defecation syndrome (ODS) is a widespread and disabling syndrome. With this study, we want to evaluate the long-term results of stapled transanal rectal resection (STARR) performed with Contour Transtar device in the treatment for ODS. A re-evaluation of 113 patients subjected to STARR from June 2007 to January 2010 was conducted. METHODS All the patients treated for symptomatic ODS with STARR with Contour Transtar were included in the study. We re-evaluate all patients treated in the study period with clinical examination and specific questionnaire to verify the stability of the functional results and the satisfaction at 5 years from surgery. Constipation was graded using the Agachan-Wexner constipation score; eventual use of aids to defecate and patient satisfaction were assessed preoperatively, 6 months and 5 years after surgery. Long-term complications were also investigated. RESULTS Constipation intensity decreased from the preoperative value of 15.8 (±4.9) to 5.2 (±3.9) (p < 0.0001) at 6 months and remained stable after 5 years (7.4 ± 4.1; p < 0.01). Patients who use laxatives and enema decrease from 74 (77%) and 27 (28%) to only 16 (17%; p < 0.001) and 5 (5%; p < 0.001), respectively, at 5-year follow-up. None continue to help themselves with digitations after surgery. Also the satisfaction rate remained stable (3.64 vs 3.81) during the 5 years of the study. CONCLUSION The long-term results have demonstrated the efficacy of the STARR with Contour Transtar in treating ODS and the stability over time of the defecatory improvements. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT02971332.
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Affiliation(s)
- Francesco Saverio Mari
- UO Week Day Surgery, St. Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
- Department of Medical and Surgical Sciences and Translational Medicine, University Sapienza of Rome, Rome, Italy.
| | - Massimo Pezzatini
- UO Week Day Surgery, St. Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
- Department of Medical and Surgical Sciences and Translational Medicine, University Sapienza of Rome, Rome, Italy
| | - Marcello Gasparrini
- UO Week Day Surgery, St. Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
- Department of Medical and Surgical Sciences and Translational Medicine, University Sapienza of Rome, Rome, Italy
| | - Brescia Antonio
- UO Week Day Surgery, St. Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
- Department of Medical and Surgical Sciences and Translational Medicine, University Sapienza of Rome, Rome, Italy
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Lee J, Lee K, Song C. Determining the Posture and Vibration Frequency that Maximize Pelvic Floor Muscle Activity During Whole-Body Vibration. Med Sci Monit 2016; 22:4030-4036. [PMID: 27787476 PMCID: PMC5087668 DOI: 10.12659/msm.898011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the electromyogram (EMG) response of pelvic floor muscle (PFM) to whole-body vibration (WBV) while using different body posture and vibration frequencies. Material/Methods Thirteen healthy adults (7 men, 6 women) voluntarily participated in this cross-sectional study in which EMG data from PFM were collected in a total of 12 trials for each subject (4 body postures, 3 vibration frequencies). Pelvic floor EMG activity was recorded using an anal probe. The rating of perceived exertion (RPE) was assessed with a modified Borg scale. Results We found that vibration frequency, body posture, and muscle stimulated had a significant effect on the EMG response. The PFM had high activation at 12 Hz and 26 Hz (p<0.05). PFM activation significantly increased with knee flexion (p<0.05). The RPE significantly increased with increased frequency (p<0.05). Conclusions The knee flexion angle of 40° at 12 Hz frequency can be readily promoted in improving muscle activation during WBV, and exercise would be performed effectively. Based on the results of the present investigation, sports trainers and physiotherapists may be able to optimize PFM training programs involving WBV.
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Affiliation(s)
- Juhyun Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea
| | - Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, Seoul, South Korea
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Liu WC, Wan SL, Yaseen SM, Ren XH, Tian CP, Ding Z, Zheng KY, Wu YH, Jiang CQ, Qian Q. Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience. World J Gastroenterol 2016; 22:7983-7998. [PMID: 27672293 PMCID: PMC5028812 DOI: 10.3748/wjg.v22.i35.7983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/23/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.
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Giannakaki V, Bordeianou L. Surgical management of severe constipation due to slow transit and obstructed defecation syndrome. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Alvarado M, Lara-García M, Cuevas E, Berbel P, Pacheco P. Denervation and Castration Effects on the Cross-Sectional Area of Pubococcygeus Muscle Fibers in Male Rats. Anat Rec (Hoboken) 2013; 296:1634-9. [DOI: 10.1002/ar.22760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 05/02/2013] [Accepted: 05/25/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Mayvi Alvarado
- Instituto de Neuroetología, Universidad Veracruzana; Xalapa Veracruz Mexico
| | - Miguel Lara-García
- Instituto de Neuroetología, Universidad Veracruzana; Xalapa Veracruz Mexico
| | - Estela Cuevas
- Centro Tlaxcala Biología de la Conducta, Universidad Autónoma de Tlaxcala; Tlaxcala Mexico
| | - Pere Berbel
- Instituto de Neurociencias; Universidad Miguel Hernández; Alicante Spain
| | - Pablo Pacheco
- Instituto de Neuroetología, Universidad Veracruzana; Xalapa Veracruz Mexico
- Instituto de Investigaciones Biomédicas; Universidad Nacional Autónoma de México; D.F. Mexico
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Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, Pucciani F, Altomare DF, Dodi G, Sciaudone G, Falletto E, Piloni V. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment). World J Gastroenterol 2013. [PMID: 23049207 DOI: 10.3748/wjg.v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotoninergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effective in the treatment of patients with chronic constipation. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation. Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.
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Affiliation(s)
- Antonio Bove
- Gastroenterology and Endoscopy Unit, Department of Gastroenterology, AORN "A. Cardarelli", 80131 Naples, Italy.
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Wang CP, Sung WH, Wang CC, Tsai PY. Early recognition of pelvic floor dyssynergia and colorectal assessment in Parkinson's disease associated with bowel dysfunction. Colorectal Dis 2013; 15:e130-7. [PMID: 23320499 DOI: 10.1111/codi.12105] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 10/14/2012] [Indexed: 12/14/2022]
Abstract
AIM Slow colonic transit time (CTT) and pelvic floor dyssynergia (PFD) are major contributors to constipation in patients with Parkinson's disease (PD). However, no symptom survey yet exists that effectively differentiates the contributing aetiologies. The significance of individual pelvic floor musculature behaviours and their relationship with colorectal dysmotility in constipated patients with PD are still controversial and need further clarification. We aimed to investigate how differentiated constipation-related symptoms of PD patients with constipation may identify constipation groupings and to register the pathophysiological features of the pelvic musculature. METHOD Our subjects undertook CTT, defaecography and the Knowles-Eccersley-Scott Symptom questionnaire. The pathological aetiologies were categorized as group 1 (slow CTT) and/or group 2 (puborectalis syndrome) and/or group 3 (pubococcygeus syndrome), in accordance with the CTT and defaecography results. RESULTS Constipation-related symptoms such as incomplete evacuation and defaecation difficulty yielded high post-test probabilities (81% and 88%, respectively) in groups 3 and 2, but a low post-test probability in group 1 (58%). Changes in the anorectal angle and perineum descent during straining were significantly correlated with CTT (r = 0.57 and r = 0.61, respectively) and with each other (r = 0.82). CONCLUSION Our findings that neural control of the puborectalis and pubococcygeus, along with colorectal peristalsis, were in a similar state of degeneration is key information that should assist physicians to instigate more effective management for colonic dysmotility or PFD.
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Affiliation(s)
- C-P Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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Masoni L, Mari FS, Favi F, Gasparrini M, Cosenza UM, Pindozzi F, Pancaldi A, Brescia A. Stapled transanal rectal resection with contour transtar for obstructed defecation syndrome: lessons learned after more than 3 years of single-center activity. Dis Colon Rectum 2013; 56:113-119. [PMID: 23222288 DOI: 10.1097/dcr.0b013e31826bda94] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obstructed defecation syndrome is a widespread and disabling disease. OBJECTIVE We aim to evaluate the safety and efficacy of stapled transanal rectal resection performed with a new dedicated curved device in the treatment of obstructed defecation syndrome. DESIGN A retrospective review of 187 stapled transanal rectal resections performed from June 2007 to February 2011 was conducted. SETTINGS The entire study was conducted at a university hospital. PATIENTS : All the patients with symptomatic obstructed defecation syndrome and the presence of a rectocele and/or a rectorectal or rectoanal intussusception, in the absence of sphincter contractile deficiency, were included in the treatment protocol. INTERVENTIONS All procedures were performed with the use of the Contour Transtar device. We analyzed the functional results of this technique, the incidence and features of the surgical and functional complications, and ways to prevent or treat them. MAIN OUTCOME MEASURES Constipation was graded by using the Agachan-Wexner constipation score; use of aids to defecate and patient satisfaction were assessed preoperatively and 6 months after surgery. Intraoperative and postoperative complications were also investigated. RESULTS The constipation intensity was statistically reduced from the preoperative mean value of 15.8 (± 4.9) to 5.2 (± 3.9) at 6 months after surgery (p < 0.0001). Of the 151 (80.3%) patients who took laxatives and the 49 (26.2%) who used enemas before treatment, only 25 (13.2%; p < 0.0001) and 7 (3.7%; p < 0.0001) continued to do so after surgery. None of the 17 (9.1%) patients who had previously helped themselves with digitations needed to continue this practice. Almost all patients showed a good satisfaction rate (3.87/5) after the procedure. LIMITATIONS Limitations are the short follow-up of 1 year and the design of the study that may introduce potential selection bias. CONCLUSIONS The results of this study show that stapled transanal rectal resection performed with the use of the Contour Transtar is a safe and effective procedure to treat obstructed defecation syndrome.
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Affiliation(s)
- Luigi Masoni
- Department of Medical-Surgical Sciences and Translational Medicine, St. Andrea Hospital, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy
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Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, Pucciani F, Altomare DF, Dodi G, Sciaudone G, Falletto E, Piloni V. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (Part II: Treatment). World J Gastroenterol 2012; 18:4994-5013. [PMID: 23049207 PMCID: PMC3460325 DOI: 10.3748/wjg.v18.i36.4994] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 11/17/2011] [Accepted: 08/15/2012] [Indexed: 02/06/2023] Open
Abstract
The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotoninergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effective in the treatment of patients with chronic constipation. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation. Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.
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Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, Pucciani F, Altomare DF, Dodi G, Sciaudone G, Falletto E, Piloni V. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment). World J Gastroenterol 2012. [PMID: 23049207 PMCID: PMC3460325 DOI: 10.3748/wjg.v18.i36.4994;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotoninergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effective in the treatment of patients with chronic constipation. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation. Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.
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Affiliation(s)
- Antonio Bove
- Gastroenterology and Endoscopy Unit, Department of Gastroenterology, AORN "A. Cardarelli", 80131 Naples, Italy.
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Martellucci J, Talento P, Carriero A. Early complications after stapled transanal rectal resection performed using the Contour® Transtar™ device. Colorectal Dis 2011; 13:1428-1431. [PMID: 20969712 DOI: 10.1111/j.1463-1318.2010.02466.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
AIM This study evaluated the early results (with particular reference to complications) of stapled transanal rectal resection (STARR) carried out using the CCS-30 Contour® Transtar™ device. The procedure was performed in a single centre on patients with obstucted defecation caused by rectocele or rectal intussusception. METHOD From July 2007 to February 2009, 133 patients were treated. Preoperatively, all underwent clinical examination, transanal ultrasonography, anorectal manometry and cinedefaecography. Obstructed defaecation syndrome was assessed using the Cleveland Clinic Constipation Score (CCC-S). Early postoperative complications and those occurring within 6 months were recorded. RESULTS The median follow-up period was 19 (range 12-30) months. The mean ± standard deviation preoperative CCC-S of 19.4 ± 7.1 decreased to 10.1 ± 9.0 postoperatively. The early complication rate was 15.7% and included rectovaginal fistula (n = 1), rectal perforation (n = 1), posterior dehiscence (n = 4), further surgery for retained staples (n = 2), postoperative bleeding (n = 2) and postoperative impaired continence (n = 11). CONCLUSIONS STARR using the Contour Transtar device seems to be effective for treating obstructed defaecation. However, serious complications may occur.
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Affiliation(s)
- J Martellucci
- General Surgery I, University of Siena, Siena, Italy.
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Cheng D. Relationship between Anorectal Pressure and Pelvic Floor Muscle Tension in Patients with Pelvic Floor Organ Prolapse Accompanied by Outlet Obstruction. Gynecol Obstet Invest 2011; 72:174-8. [DOI: 10.1159/000326678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 02/24/2011] [Indexed: 11/19/2022]
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Zehler O, Vashist YK, Bogoevski D, Bockhorn M, Yekebas EF, Izbicki JR, Kutup A. Quo vadis STARR? A prospective long-term follow-up of stapled transanal rectal resection for obstructed defecation syndrome. J Gastrointest Surg 2010; 14:1349-54. [PMID: 20596788 DOI: 10.1007/s11605-010-1261-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 06/07/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Functional and clinical long-term outcome after stapled transanal rectal resection (STARR) in patients with an isolated symptomatic rectocele are investigated. Short-term results after 1 year are comparable with the functional outcome even after 5 years. Eighty per cent of the patients were still satisfied. STARR is an alternative procedure to the conventional surgical approaches for patients with an obstructed defecation syndrome and rectocele. Several studies have reported short-term outcome after STARR, but long-term results are still missing. The objective of this study was to evaluate long-term clinical outcome after STARR with a follow-up of 5 years. MATERIALS AND METHODS Twenty patients with only an isolated symptomatic rectocele due to obstructed defecation syndrome were subjected to STARR. Functional and clinical outcome was assessed by Outlet Obstruction Syndrome score (OOS score), Wexner score (WS), and Symptom Severity score (SSS score). Data were prospectively collected over 7 years. RESULTS The perioperative morbidity after STARR accounted for 20% (n = 4). One patient was subjected to reoperation due to perforation, two postoperative bleedings occurred, and one patient developed an increasing local granulomatous reaction at the stapler line. The median follow-up accounted for 66 months (range 60-84). Sixteen patients (80%) were satisfied with the functional outcome. The median OOS, SSS and WS score improved significantly already after 1 year in these patients and remained stable at 5-year follow-up. In contrast, four patients were classified as treatment failures since the OOS score and the SSS score showed no improvement. At 5-year follow-up, these patients remained symptomatic without improvement in OOS and SSS scores. CONCLUSIONS The STARR procedure is an effective operation in isolated symptomatic rectoceles with regard to relief of the obstructed defecation syndrome. The short-term improvement after STARR predicts long-term outcome in obstructed defecation syndrome caused by a rectocele.
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Affiliation(s)
- Oliver Zehler
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
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Frascio M, Stabilini C, Ricci B, Marino P, Fornaro R, De Salvo L, Mandolfino F, Lazzara F, Gianetta E. Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up. World J Surg 2008; 32:1110-1115. [PMID: 18350243 DOI: 10.1007/s00268-008-9540-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS). METHODS Data were collected over a 3-year period (2004-2007), at the Department of Surgery of the University of Genoa, from 25 consecutive subjects (19 of them females) undergoing STARR because of OOS that had not responded to medical treatment,. RESULTS Preoperatively, patients were submitted to clinical examination, defecography, colonoscopy, manometry, and recto-anal reflexes determination. All patients had mucosal prolapse, 15 rectal intussusception, 15 rectocele. Postoperatively no deaths were observed; one patient had a hemorrhage requiring reintervention. Mean time to resumption of normal activity was 8.5 +/- 4.5 days. Patients were followed for a mean of 24.7 +/- 10.9 months (range: 6-42 months). Late specific complications included 3 cases of urge to defecate, 8 of incontinence to flatus. Functional outcome was positive for 22 patients (excellent in 4 cases, good in 15, fairly good in 3). Six months postoperatively (25 s), patients had improvement of the mean Constipation Score (p = 0.0002), less pain during evacuation (p = 0.0003), and reduced use of digital assistance to defecate (p < 0.0001). Continence Grading Scale and enema use remained stable after intervention. Patients had increase in basal sphincter pressure (p = 0.0078) and maximal squeeze pressure (p = 0.0051). Recto-anal reflex study showed increase in abdominal pain threshold (p < 0.0001); anal sphincter relaxation threshold and desire to defecate threshold did not change. CONCLUSIONS According to the present study, STARR seemed to be a safe and effective treatment for OOS associated with symptomatic rectocele and intussusception.
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Affiliation(s)
- Marco Frascio
- Department of Surgery, University of Genoa, Di.C.M.I., Largo Rosanna Benzi 8, Genoa 16132, Italy
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Andromanakos N, Skandalakis P, Troupis T, Filippou D. Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 2006; 21:638-46. [PMID: 16677147 DOI: 10.1111/j.1440-1746.2006.04333.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.
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Affiliation(s)
- Nikolaos Andromanakos
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, Athens, Greece
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Staumont G. [Diagnosis and treatment of dyschezia]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:427-38. [PMID: 16633309 DOI: 10.1016/s0399-8320(06)73198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, Laycock J, Lim PHC, van Lunsen R, á Nijeholt GL, Pemberton J, Wang A, Watier A, Van Kerrebroeck P. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 2005; 24:374-80. [PMID: 15977259 DOI: 10.1002/nau.20144] [Citation(s) in RCA: 313] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Bert Messelink
- Pelvic Care Center Prinsengracht, Onze Lieve Vrouwe Gasthuis, Amsterdam, Holland.
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Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. Int J Colorectal Dis 2004; 19:359-69. [PMID: 15024596 DOI: 10.1007/s00384-003-0572-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS A randomised trial was undertaken to compare the clinical and functional results of two novel transanal stapled techniques in patients with outlet obstruction syndrome. MATERIALS AND METHODS Ninety-six females with outlet obstruction were treated with medical therapy and biofeedback for 2 months; 67 non-responders were evaluated by the Constipation Scoring and Continence Grading Systems, clinical examination, endoscopy, dynamic defecography, anorectal manometry, transanal ultrasound and anal EMG, and 50 of them, all affected with descending perineum, intussusception and rectocele, were randomly assigned to two groups and operated on: 25 patients (mean age 53.2+/-15.3 years) underwent a single Stapled Trans-Anal Prolapsectomy, associated with Perineal Levatorplasty (STAPL Group), and the other 25 (mean 54.6+/-14.2 years) underwent a double Stapled Trans-Anal Rectal Resection (STARR Group). Patients were followed-up for a mean period of 23.4+/-5.1 months in STAPL Group and 22.3+/-4.8 in STARR Group. RESULTS STARR Group showed a significantly (p<0.0001) lower pattern of postoperative pain and a greater decrease (P=0.0117) of the rectal sensitivity threshold volume; otherwise, no differences were found in operative time, hospital stay, or time of inability to work. Complications included delayed healing of the perineal wound (ten), dyspareunia (five), urinary retention (two) and stenosis (one) in STAPL Group, and urge to defecate (four), transitory incontinence to flatus (two), urinary retention (two), bleeding (one) and stenosis (one) in STARR Group. All constipation symptoms significantly improved without worsening of anal continence and with excellent/good outcome at 20 months in 76 and 88% of patients of STAPL Group and STARR Group, respectively. Seven patients of STAPL Group had a little residual rectocele, while both intussusception and rectocele were corrected in all patients of STARR Group. Neither operation modified anal pressures or caused lesions of anal sphincters. CONCLUSIONS Both techniques are safe and effective in the treatment of outlet obstruction; nevertheless, the double Stapled Trans-Anal Rectal Resection seems to be preferable due to less pain, absence of dyspareunia, reduced rectal sensitivity threshold volume and absence of residual rectocele at defecography.
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Affiliation(s)
- Paolo Boccasanta
- 1st Department of General Surgery, Ospedale Maggiore di Milano, I.R.C.C.S. University of Milan, Milan, Italy.
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Yang LM, Lin JB, Zhao YL, Liang JL, Lin H, Zhong Z, Chen RW, Xie JF, Liu FY, Wu ZR. Effects of biofeedback training by EMG on patients with chronic functional constipation. Shijie Huaren Xiaohua Zazhi 2004; 12:730-733. [DOI: 10.11569/wcjd.v12.i3.730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study characteristics of anorectal pressure, EMG activity and effect of biofeedback training system on patient with chronic functional constipation (CFC).
METHODS: Anorectal manometry was carried out in 144 cases of CFC by a monitor system (liquid-phase type) and Biolab dynamics parameter before and after the biofeedback training. 20 healthy individuals were taken as control.
RESULTS: Compared with controls, CFC patients showed slightly lower anal quiesent pressure (P>0.05), lower anorectal sphincteric squeezing pressure (15.7±1.4 vs 12.7± 1.4) (P < 0.01), higher rectal defection volume thresholds and higher rectal maximum talerable volume thresholds (12±6.2 vs 14.9±6.6; 29.3±6.8 vs 36.0±7.3) (P < 0.01; P < 0.01); EMG assessments showed that 100% patients with CFC had the contradictory movement between the pelvic floor muscle (PFM) and abdominal anterior oblique muscle (AAOM). The movement extent of the PFM rose from 5.3±2.8 to 10.2±2.8 under quiet state (P < 0.01), and AAOM reduced from 34.4±5.2 to 30.8±4.9 (P < 0.01); All the abnormalities significantly improved with Orion PC/ 12 m EMG biofeedback training therapy. After biofeedback training therapy, symptoms of CFC patients were improved with efficient rate of 84.03%; With increase of the treatment time and shortenning of the interval and assistant training, the curative efficacy rose and the recurrence rate reduced (78.8% vs 91.7%; 69.2% vs 92.8%) (P < 0.05; P < 0.05).
CONCLUSION: CFC patients have abnormal anorectal pressure, sensation threshold and unusual anus electric activities. Biofeedback training therapy can improve the above-mentioned indexes and is effective in 84.03% of the patients. The relatively intensive long-time training can improve the curative rate in a short period, and family assistant training can reduce the recurrance rate of the disease.
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N/A, 林 济, 赵 延, 林 红, 钟 智, 陈 荣, 谢 俊, 吴 志. N/A. Shijie Huaren Xiaohua Zazhi 2004; 12:202-204. [DOI: 10.11569/wcjd.v12.i1.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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