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Lambiase C, Bellini M, Chiarioni G. Postinfectious Disorders of Gut-Brain Interaction: A Brainstorming Story. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00441-5. [PMID: 38750868 DOI: 10.1016/j.cgh.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Christian Lambiase
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; National Institute of Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health System Trust, University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Chiarioni
- University of North Carolina at Chapel Hill Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Medicine, Gastrointestinal Unit, Il Cerchio Med HealthCare, Verona Center, Verona, Italy
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Tutino R, Pata F. Editorial: Pelvic floor disorders: a multidisciplinary issue. Front Surg 2024; 11:1400636. [PMID: 38586240 PMCID: PMC10995366 DOI: 10.3389/fsurg.2024.1400636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Roberta Tutino
- Department of General and Emergency Surgery, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
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Sun D, Lo KM, Chen SC, Leung WW, Wong C, Mak T, Ng S, Futaba K, Gregersen H. The rectum, anal sphincter and puborectalis muscle show different contraction wave forms during prolonged measurement with a simulated feces. Sci Rep 2024; 14:432. [PMID: 38172283 PMCID: PMC10764324 DOI: 10.1038/s41598-023-50655-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
Contractile patterns in rectum, puborectalis muscle and anal sphincter must be studied to understand defecation. Six subjects had contractile waveforms studied with Fecobionics. Symptom questionnaires, balloon expulsion test and anorectal manometry were done for reference. The Fecobionics bag was filled in rectum to urge-to-defecate volume and measurements were done for 4 h before the subjects attempted to evacuate the device. Pressures and bend angle (BA) variations were analyzed with Fast Fourier Transformation. Four normal subjects exhibited low frequency waves (< 0.06 Hz) for pressures and BA. The waves were uncoordinated between recordings, except for rear and bag pressures. Peak wave amplitudes occurred at 0.02-0.04 Hz. Pressures and the BA differed for peak 1 (p < 0.001) and peak 2 amplitudes (p < 0.005). The front pressure amplitude was bigger than the others (rear and BA, p < 0.05; bag, p < 0.005) for peak 1, and bigger than bag pressure (p < 0.005) and BA (p < 0.05) for peak 2. One subject was considered constipated with lower front pressure amplitudes compared to normal subjects and increased amplitudes for other parameters. The sixth subject was hyperreactive and differed from the other subjects. In conclusion, the rectum, anal sphincter and puborectalis muscle showed different contraction waves during prolonged measurements. The data call for larger studies to better understand normal defecation, feces-withholding patterns, and the implications on anorectal disorders.
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Affiliation(s)
- Daming Sun
- Chongqing Engineering Research Center of Medical Electronics and Information Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Kar Man Lo
- California Medical Innovations Institute, 11107 Roselle St., San Diego, CA, 92121, USA
| | - Ssu-Chi Chen
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing Wa Leung
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cherry Wong
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tony Mak
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon Ng
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kaori Futaba
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hans Gregersen
- California Medical Innovations Institute, 11107 Roselle St., San Diego, CA, 92121, USA.
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Balci B, Leventoglu S, Osmanov I, Erkan B, Irkilata Y, Mentes B. Laparoscopic ventral mesh rectopexy vs. transperineal mesh repair for obstructed defecation syndrome associated with rectocele: comparison of selectively distributed patients. BMC Surg 2023; 23:359. [PMID: 38001430 PMCID: PMC10675873 DOI: 10.1186/s12893-023-02206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/24/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Obstructed defecation syndrome represents 50-60% of patients with symptoms of constipation. We aimed to compare the two frequently performed surgical methods, laparoscopic ventral mesh rectopexy and transperineal mesh repair, for this condition in terms of functional and surgical outcomes. METHODS This study is a retrospective review of 131 female patients who were diagnosed with obstructed defecation syndrome, attributed to rectocele with or without rectal intussusception, enterocele, hysterocele or cystocele, and who underwent either laparoscopic ventral mesh rectopexy or transperineal mesh repair. Patients were evaluated for surgical outcomes based on the operative time, the length of hospital stay, operative complications, using prospectively designed charts. Functional outcome was assessed by using the Initial Measurement of Patient-Reported Pelvic Floor Complaints Tool. RESULTS Fifty-one patients diagnosed with complex rectocele underwent laparoscopic ventral mesh rectopexy, and 80 patients diagnosed with simple rectocele underwent transperineal mesh repair. Mean age was found to be 50.35 ± 13.51 years, and mean parity 2.14 ± 1.47. Obstructed defecation symptoms significantly improved in both study groups, as measured by the Colorectal Anal Distress Inventory, Constipation Severity Instrument and Patient Assessment of Constipation-Symptoms scores. Minor postoperative complications including wound dehiscence (n = 3) and wound infection (n = 2) occurred in the transperineal mesh repair group. CONCLUSION Laparoscopic ventral mesh rectopexy and transperineal mesh repair are efficient and comparable techniques in terms of improvement in constipation symptoms related to obstructed defecation syndrome. A selective distribution of patients with or without multicompartmental prolapse to one of the treatment arms might be the preferred strategy.
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Affiliation(s)
- Bengi Balci
- Department of Surgery, Memorial Ankara Hospital, Proctology Unit, Ankara, Turkey
| | - Sezai Leventoglu
- Department of Surgery, Faculty of Medicine, Gazi University Hospital, Ankara, Turkey.
| | - Igbal Osmanov
- Department of Surgery, Memorial Ankara Hospital, Proctology Unit, Ankara, Turkey
| | - Beyza Erkan
- Department of Surgery, Faculty of Medicine, Gazi University Hospital, Ankara, Turkey
| | | | - Bulent Mentes
- Department of Surgery, Memorial Ankara Hospital, Proctology Unit, Ankara, Turkey
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Brillantino A, Iacobellis F, Maglio M, Grillo M, Vicenzo L, Monaco L, Romano L, Renzi A. The Relevance of the Excessive Perineal Descent in the Obstructed Defecation Syndrome: A Prospective Study of 141 Patients. Dis Colon Rectum 2023; 66:1508-1515. [PMID: 36952567 DOI: 10.1097/dcr.0000000000002526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Despite the widely accepted association between excessive straining and perineal descent, the clinical significance of perineal descent in patients with obstructed defecation syndrome is still unclear. OBJECTIVE This study aimed to evaluate the prevalence of pathological perineal descent in patients with obstructed defecation syndrome and the impact of perineal descent on symptoms severity. DESIGN This was a prospective multicenter uncontrolled study. SETTINGS The study involved 3 hospital pelvic-care centers and was conducted from January 2018 to January 2022. PATIENTS The study included 141 consecutive adult patients with an obstructed defecation syndrome score of 9 or more and no evidence of organic GI pathology. All the patients underwent dynamic pelvic MRI and, in case of suspected paradoxical puborectalis contraction, anal manometry. MAIN OUTCOME MEASURES Main outcome measures were the prevalence of excessive perineal descent and the correlation between perineal descent and obstructed defecation syndrome score. RESULTS One hundred twenty-eight patients (90.7%) completed magnetic resonance examination and were included in the analysis. Of these, 18 patients (14.1%) had a physiological perineal descent and 110 (85.9%) had an excessive perineal descent. Excessive perineal descent was found in 46.1% of patients (12/26) with MRI signs of paradoxical puborectalis contraction and in 96% of patients (98/102) with normal puborectalis relaxation. In this latter group of patients, a good correlation between obstructed defecation syndrome score and maximum perineal descent during straining was found (Spearman r test: 0.68; p < 0.0001). LIMITATIONS The study was limited by the small sample size and by the strong selection of the study population. CONCLUSIONS Excessive perineal descent is a common finding in patients with obstructed defecation syndrome and high symptoms score, occurring almost consistently in patients without paradoxical puborectalis contraction. In these patients, the maximum perineal descent seems to be well correlated with symptoms severity. See Video Abstract at http://links.lww.com/DCR/C135 . LA RELEVANCIA DEL DESCENSO PERINEAL EXCESIVO EN EL SNDROME DE DEFECACIN OBSTRUIDA UN ESTUDIO PROSPECTIVO DE PACIENTES ANTECEDENTES:A pesar de la asociación ampliamente aceptada entre el esfuerzo excesivo y el descenso perineal, la importancia clínica del descenso perineal en pacientes con síndrome de defecación obstruida aún no está clara.OBJETIVO:Evaluar la prevalencia del descenso perineal patológico en pacientes con síndrome de defecación obstruida y el impacto del descenso perineal en la severidad de los síntomas.DISEÑO:Este fue un estudio prospectivo multicéntrico no controladoENTORNO CLINICO:El estudio involucró a tres centros hospitalarios de atención pélvica y se llevó a cabo entre enero de 2018 y enero de 2022.PACIENTES:El estudio incluyó a 141 pacientes adultos consecutivos con puntuación del síndrome de defecación obstruida ≥ 9 y sin evidencia de patología gastrointestinal orgánica. A todas las pacientes se les realizó resonancia magnética pélvica dinámica y, en caso de sospecha de contracción puborrectal paradójica, manometría anal.PRINCIPALES MEDIDAS DE RESULTADO:Las principales medidas de resultado fueron la prevalencia del descenso perineal excesivo y la correlación entre el descenso perineal y la puntuación del síndrome de defecación obstruida.RESULTADOS:Ciento veintiocho (90,7%) pacientes completaron el examen de resonancia magnética y fueron incluidos en el análisis. De estos, 18 (14,1%) presentaron descenso perineal fisiológico y 110 (85,9%) descenso perineal excesivo. Se encontró descenso perineal excesivo en el 46,1% (12/26) de los pacientes con signos de contracción puborrectal paradójica en la resonancia magnética y en el 96% (98/102) de los pacientes con relajación puborrectal normal. En estos últimos pacientes se encontró una buena correlación entre la puntuación del síndrome de defecación obstruida y el descenso perineal máximo durante el esfuerzo (prueba r de Spearman: 0,68; p < 0,0001).LIMITACIONES:El estudio estuvo limitado por el pequeño tamaño de la muestra y por la fuerte selección de la población de estudio.CONCLUSIONES:El descenso perineal excesivo es un hallazgo común en pacientes con síndrome de defecación obstruida y alto puntaje de síntomas, ocurriendo casi constantemente en pacientes sin contracción puborrectal paradójica. En estos últimos pacientes el descenso perineal máximo parece estar bien correlacionado con la severidad de los síntomas. Consulte Video Resumen en http://links.lww.com/DCRC135 . (Traducción- Dr. Francisco M. Abarca-Rendon ).
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Affiliation(s)
- Antonio Brillantino
- Surgery Department, "A. Cardarelli" Hospital, Via A. Cardarelli, Naples, Italy
| | - Francesca Iacobellis
- Radiology Department, "A. Cardarelli" Hospital, Via A. Cardarelli, Naples, Italy
| | - Mauro Maglio
- Surgery Department, "A. Cardarelli" Hospital, Via A. Cardarelli, Naples, Italy
| | - Maurizio Grillo
- Surgery Department, "A. Cardarelli" Hospital, Via A. Cardarelli, Naples, Italy
| | - Luciano Vicenzo
- Surgery Department, "A. Cardarelli" Hospital, Via A. Cardarelli, Naples, Italy
| | - Luigi Monaco
- Surgery Department, "Villa Esther" Hospital, Via Due Principati, Avellino, Italy
| | - Luigia Romano
- Radiology Department, "A. Cardarelli" Hospital, Via A. Cardarelli, Naples, Italy
| | - Adolfo Renzi
- Surgery Department, Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy
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Mazor Y, Schnitzler M, Jones M, Ejova A, Malcolm A. The patient with obstructed defecatory symptoms: Management differs considerably between physicians and surgeons. Neurogastroenterol Motil 2023; 35:e14592. [PMID: 37036403 DOI: 10.1111/nmo.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/19/2023] [Accepted: 03/23/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patients with obstructed defecatory symptoms (ODS) are commonly referred to either gastroenterologists (GE) or colorectal surgeons (CS). Further management of these patients may be impacted by this choice of referral. METHODS An online survey of specialist practice was disseminated to GE and CS in Australia and New Zealand. A case vignette of a patient presenting with ODS was described, with multiple subsequent scenarios designed to delineate the responder's preferred approach to management of this patient. KEY RESULTS A total of 107 responders participated in the study, 62 CS and 45 GE. For a female patient with ODS not responding to pharmacological treatment, GE were more likely than CS to refer patients for anorectal manometry, while CS were more likely to refer for dynamic imaging. A quarter of CS and GE referred patients directly to pelvic floor physiotherapy, without any pre-treatment testing. Knowing the result of dynamic imaging, especially if a rectocele was demonstrated, substantially influenced management for both of the specialties: GE became more likely to refer the patients for CS consultation and less likely to refer directly for biofeedback or physiotherapy and CS were more likely to opt for an operative pathway over conservative management than they were prior to knowledge of the imaging findings. The majority (>75%) of GE and CS did not find it necessary to obtain a gynecological consultation, even in the presence of a rectocele. CONCLUSIONS & INFERENCES Practice variation across medical specialties affects diagnostic and management recommendations for patients with ODS, impacting treatment pathways. Our findings provide an incentive toward establishing interdisciplinary, uniform, management guidelines.
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Affiliation(s)
- Yoav Mazor
- Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Margaret Schnitzler
- Department of Colorectal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Head of Northern Clinical School, University of Sydney, New South Wales, Australia
| | - Michael Jones
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anastasia Ejova
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Allison Malcolm
- Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Bassotti G. Relief from behind: enemas, the back door enforcement to help treating chronic constipation in adults. Expert Rev Gastroenterol Hepatol 2023; 17:1081-1087. [PMID: 37804131 DOI: 10.1080/17474124.2023.2267968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Chronic constipation is a frequent symptom encountered in the daily clinical practice. The treatment of this condition mainly relies on the use of laxatives. However, patients' satisfaction with this approach is limited, and alternative measures are often added to the treatment. Among these, particularly frequent worldwide is the use of enemas, even though literature data on its scientific validity are scarce. AREAS COVERED In this article, by an extensive online search of Medline (through PubMed), Scopus, Cochrane CENTRAL, EMBASE, and the Science Citation Index, the available literature data on the use of enemas in adult patients with chronic constipation, also in the perspective of available guidelines on treatment of this pathological condition, were analyzed. EXPERT OPINION Although the use of enemas remains a frequently employed method and it is considered as useful by many physicians as an adjunctive support for the treatment of chronic constipation in adults, this practice is not substantiated by rigorous scientific data, and some studies are available only for specific instances (fecal impaction, transanal irrigation). Thus, waiting for more robust scientific data, enemas treatment should be carried out on an individual patient's basis, according to the experience of the caring physicians.
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Affiliation(s)
- Gabrio Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Gastroenterology Unit, Perugia General Hospital, Perugia, Italy
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Barbara G, Cremon C, Bellini M, Corsetti M, Di Nardo G, Falangone F, Fuccio L, Galeazzi F, Iovino P, Sarnelli G, Savarino EV, Stanghellini V, Staiano A, Stasi C, Tosetti C, Turco R, Ubaldi E, Zagari RM, Zenzeri L, Marasco G. Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP). Dig Liver Dis 2023; 55:187-207. [PMID: 36517261 DOI: 10.1016/j.dld.2022.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 01/29/2023]
Abstract
The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements. In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C-reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants.
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Affiliation(s)
- Giovanni Barbara
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy.
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010 Pisa, Italy
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham, United Kingdom
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesca Falangone
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, University Sapienza, Rome, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy
| | - Francesca Galeazzi
- Gastroenterology Unit, Azienda Ospedale Università di Padova, 35128 Padua, Italy
| | - Paola Iovino
- Gastrointestinal Unit Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | | | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences-Section of Pediatric, University Federico II, 80100 Naples, Italy
| | - Cristina Stasi
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | | | - Rossella Turco
- Department of Translational Medical Sciences-Section of Pediatric, University Federico II, 80100 Naples, Italy
| | - Enzo Ubaldi
- Primary Care, Health Care Agency of Ascoli Piceno, Ascoli Piceno, Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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Ferrari L, Cuinas K, Igbedioh C, Hainsworth A, Solanki D, Williams A, Sahai A, Kelleher C, Schizas A. Patient pathway in a tertiary referral pelvic floor unit: Telephone triage assessment clinic. Neurourol Urodyn 2023; 42:168-176. [PMID: 36317396 DOI: 10.1002/nau.25063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/31/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND To meet the increasing demands for colorectal pelvic floor services, a dedicated telephone triage assessment clinic (TTAC) was set up to establish a more efficient pathway, and reduce waiting times and patient's visits to the hospital. The primary aim of this study was to review TTAC in patients suffering from pelvic floor dysfunction and assess its feasibility. Secondary aims include measurement of waiting times for TTAC, main presenting complaints, and main treatment outcomes, including the need for review by a consultant surgeon. METHODS Review of data collected retrospectively in a single tertiary referral center collected from an institutional database. KEY RESULTS Between January 2016 and October 2017, 1192 patients referred to our pelvic floor unit were suitable for TTAC. Of these, 694 patients had complete records. There were 66 without follow-up after the initial TTAC, leaving 628 patients for analysis. In all, 86% were females and 14% were males, with a mean age of 52 years (range: 18-89). The median waiting time for TTAC was 31 days (range: 0-184). The main presenting complaint during the TTAC was obstructive defecation in 69.4%, fecal incontinence in 28.5%, and rectal prolapse in 2.1%. In our study, 611 patients had conservative management (97.3%), with a median of three sessions per patient (range: 1-16), while 82 patients (13.1%) needed a surgical intervention. Only 223 patients (35.5%) were reviewed by a consultant at some stage during the study period. CONCLUSIONS AND INFERENCES To optimize resources, an adequate triage system allowed us to streamline the pathway for each individual patient with pelvic floor dysfunction according to their symptoms and/or test results with the aim of reducing waiting times and expediting treatment.
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Affiliation(s)
- Linda Ferrari
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Karina Cuinas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Carlene Igbedioh
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Alison Hainsworth
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Deepa Solanki
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Andrew Williams
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Arun Sahai
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | | | - Alexis Schizas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
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Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF trial): quality of life outcome. Tech Coloproctol 2023; 27:125-133. [PMID: 36520243 PMCID: PMC9753858 DOI: 10.1007/s10151-022-02741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic anal fissure is one of the most common anorectal diseases and is associated with reduced quality of life. The aim of this study was to investigate the effects of pelvic floor physical therapy on quality of life in patients with chronic anal fissure using the Short-Form 36 Health Survey (RAND-36). METHODS Adult patients, with chronic anal fissure and concomitant pelvic floor dysfunction, such as dyssynergia and increased pelvic floor muscle tone, were recruited at the Proctos Clinic in the Netherlands, between December 2018 and July 2021 and randomly assigned to an intervention group, receiving 8 weeks of pelvic floor physical therapy or assigned to a control group receiving postponed pelvic floor physical therapy (PAF trial). Quality of life and pain ratings were outcomes of the study and were measured at 8- and 20-week follow-up. RESULTS One hundred patients (50 women and 50 men, median age 44.6 years [range 19-68 years]), completed the RAND-36 questionnaire and visual analog (VAS) pain scale score at admission. A significant improvement was found at 20-week follow-up in all domains of the RAND-36; physical functioning, pain, health change (p < 0.001); physical role, vitality, general health, social functioning, emotional role, mental health (p < 0.05). VAS pain was significantly reduced at 8 weeks (mean estimated difference 1.98; 95% CI 1.55-2.42, p < 0.001) and remained significant at 20-week follow-up (p < 0.001). The difference between the groups as regards change in the mean pain intensity scores at 8 weeks was 2.48 (95% CI - 3.20 to - 1.75; p < 0.001). Compared to the reference values of the general Dutch population, the patients in our study with a chronic anal fissure and pelvic floor dysfunction reported an impaired quality of life in 8 of 9 domains of the RAND-36. After treatment, significant lower scores were found in 2 out of 9 domains. CONCLUSIONS The results of this study provide evidence that treatment by pelvic floor physical therapy improves quality of life and reduces pain, making it an important tool in management of chronic anal fissure and concomitant pelvic floor dysfunction.
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van Reijn-Baggen DA, Elzevier HW, Putter H, Pelger RCM, Han-Geurts IJM. Pelvic floor physical therapy in patients with chronic anal fissure: a randomized controlled trial. Tech Coloproctol 2022; 26:571-582. [PMID: 35511322 PMCID: PMC9069957 DOI: 10.1007/s10151-022-02618-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/16/2022] [Indexed: 12/12/2022]
Abstract
Background A chronic anal fissure is a common, painful condition with great impact on daily life. The exact pathogenesis has not been fully elucidated and treatment varies. A large percentage of patients experience pelvic floor dysfunction (dyssynergia and increased pelvic floor muscle tone). The aim of our study was to investigate the effect of pelvic floor physical therapy in patients with chronic anal fissure. Methods Between December 2018 and July 2021, at the Proctos Clinic in the Netherlands, patients with chronic anal fissure and pelvic floor dysfunction were randomly assigned to an intervention group, receiving 8 weeks of pelvic floor physical therapy including electromyographic biofeedback or assigned to a control group receiving postponed pelvic floor physical therapy. The primary outcome was muscle tone at rest during electromyographic registration of the pelvic floor before and after pelvic floor physical therapy. Secondary outcomes contained healing of the fissure, pain ratings, improvement of pelvic floor function, and complaint reduction measured with a proctology-specific patient-reported outcome measurement. Endpoints were measured at 8- and 20-week follow-up. Results One hundred forty patients were included in the study, 68 men (48.6%) and 72 women (51.4%) with a mean age of 44.5 ± 11.1 (range 19–79) years. Mean resting electromyographic values of the pelvic floor in the intervention group significantly improved from pre- to post-treatment (p < 0.001) and relative to controls (mean estimated difference between groups − 1.88 µV; 95% CI, − 2.49 to − 1.27 (p < 0.001) at first follow-up and remained significant from baseline at 20-week follow-up (p < 0.001). The intervention group performed better compared to the control group on all secondary outcomes, i.e., healing of the fissure (55.7% of the patients vs 21.4% in control, pain ratings (p < 0.001), diminished dyssynergia (p < 0.001), complaint reduction (p < 0.001), and decrease of pelvic floor muscle tone (p < 0.05) at first follow-up. Conclusions The findings of this study provide strong evidence that pelvic floor physical therapy is effective in patients with chronic anal fissure and pelvic floor dysfunction and supports its recommendation as adjuvant treatment besides regular conservative treatment.
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Affiliation(s)
- Daniëlle A van Reijn-Baggen
- Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands. .,Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Henk W Elzevier
- Department of Urology and Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - H Putter
- Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
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Malcolm A. Enhanced Understanding of Normal and Abnormal Evacuation: A Potential Pathway to Improved and Individualized Therapy for Defecatory Disorders. Gastroenterology 2022; 162:1028-1030. [PMID: 35149025 DOI: 10.1053/j.gastro.2022.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Allison Malcolm
- Neurogastroenterology Unit, Department of Gastroenterology, Royal North Shore Hospital and, University of Sydney, Sydney, New South Wales, Australia.
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Bellini M, Chiarioni G. Staying in HRAM's Way: Tweaking the London Classification for Disorders of Anorectal Function. Dig Dis Sci 2022; 67:748-749. [PMID: 33939155 DOI: 10.1007/s10620-021-06995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Massimo Bellini
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Chiarioni
- Division of Gastroenterology of the University of Verona, AOUI Verona, Verona, Italy.
- Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Divisione di Gastroenterologia B, Ospedale Policlinico GB Rossi, Piazzale LA Scuro, 10, 37134, Verona, Italy.
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van Reijn-Baggen DA, Dekker L, Elzevier HW, Pelger RCM, Han-Geurts IJM. Management of chronic anal fissure: results of a national survey among gastrointestinal surgeons in the Netherlands. Int J Colorectal Dis 2022; 37:973-978. [PMID: 35194670 PMCID: PMC8976773 DOI: 10.1007/s00384-022-04115-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic anal fissure (CAF) is a common, bothersome condition frequently accompanied by pelvic floor complaints. Despite current guidelines, optimal management is challenging. The aim of this study is to evaluate current management of CAF among gastrointestinal surgeons in the Netherlands. METHODS Dutch gastrointestinal surgeons and residents were sent a survey invitation by email, which was available online between June 2021 and September 2021. The questionnaire consisted of 21 questions concerning work experience, physical examination, diagnostic and surgical techniques, and follow-up. RESULTS Overall, 106 (33%) respondents completed the survey. Most respondents (59%) had at least 10 years of experience in treating CAF. Only 23% always addressed pelvic floor complaints. Fifty-one percent performed digital rectal examination and 22% always, or almost always, examined the pelvic floor muscles. Most respondents started treatment with fibers and/or laxatives and ointment (96%). Diltiazem was in 90% the preferred ointment. Twenty-two percent referred patients for pelvic floor physical therapy. Botulinum toxin was in 54% performed under general or spinal anesthesia or sedation. The surgical procedure of choice was fissurectomy (71%) followed by lateral internal sphincterotomy (27%). Fissurectomy was in 51% always combined with botulinum toxin. Fifty-seven percent of the respondents preferred a physical follow-up appointment. CONCLUSION Guideline recommendations are largely followed in the Netherlands, starting with conservative measures followed by surgical procedures. Surgeons do not consistently assess pelvic floor complaints, nor do they routinely examine the pelvic floor muscles. Awareness of pelvic floor dysfunctions is important to refer patients for pelvic floor physical therapy.
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Affiliation(s)
- Danielle A. van Reijn-Baggen
- Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands ,Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisette Dekker
- Department of Surgery, Proctos Clinic, Bilthoven, The Netherlands ,Department of Surgery, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Henk W. Elzevier
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands ,Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob C. M. Pelger
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
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A novel wireless, smartphone-based biofeedback training device for functional defecatory disorders: a pilot study. Tech Coloproctol 2021; 26:61-65. [PMID: 34796435 DOI: 10.1007/s10151-021-02540-6] [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] [Received: 04/20/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Functional defecatory disorders (FDDs) are highly prevalent around the world. Biofeedback is an effective treatment for FDDs. Traditionally, this treatment is performed by clinicians in a limited number of hospitals because of procedure-related expenses and a need for a dedicated procedure room. To make the biofeedback therapy more widely available, we have designed a novel wireless, smartphone-based biofeedback device, with the ultimate goal of performing the therapy at home. The aim of this pilot study was to investigate whether the developed device can be employed to treat patients with FDDs in a clinical setting, prior to employing it in a home setting. METHODS From March 2018 to July 2018, we performed the biofeedback therapy using the newly developed wireless, smartphone-based device in patients with FDDs 30 min daily during weekdays for 2 weeks. A Visual Analogue Scale (VAS) for bowel satisfaction, Patient Assessment of Constipation-Symptoms (PAC-SYM), Patient Assessment of Constipation Quality of Life (PAC-QOL), and a balloon expulsion test were assessed at baseline and after the therapy. RESULTS Thirteen patients were recruited and ten of them (mean age 70.3 ± 8.9 years, female:male ratio: 3:7) completed the study. Spontaneous bowel movements, complete spontaneous bowel movements, and VAS were all significantly increased after the therapy compared with baseline, respectively (6.5 ± 4.3 vs. 1.5 ± 2.2, p = 0.006; 3.1 ± 2.2 vs. 0.2 ± 0.6, p = 0.002; 49.5 ± 31.0 vs. 12.0 ± 9.2, p = 0.003). There was a significant decrease in the PAC-SYM and PAC-QoL after the biofeedback therapy (0.7 ± 0.6 vs. 1.4 ± 0.3, p = 0.001; 0.7 ± 0. 6 vs. 1.5 ± 0.4, p = 0.001). The therapy reduced the balloon expulsion time significantly (83.9 ± 68.8 s vs. 160.0 ± 36.7 s, p = 0.002). No obvious adverse events related to the procedure itself occurred. CONCLUSIONS Biofeedback training using the newly developed wireless, smartphone-based device is feasible in the clinic setting, and it seems to be a promising method for improving constipation and related symptoms in patients with FDDs. These findings could be used to develop a much-needed, home-based, suitably powered, randomized, controlled clinical trial.
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An Age-Old Problem: The Surgical Treatment of Complete Rectal Prolapse. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12030032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dear Editor, [...]
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Trigui A, Rejab H, Akrout A, Trabelsi J, Zouari A, Majdoub Y, Amar MB, Mzali R. Laser utility in the treatment of hemorrhoidal pathology: a review of literature. Lasers Med Sci 2021; 37:693-699. [PMID: 34331606 DOI: 10.1007/s10103-021-03333-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/03/2021] [Indexed: 10/20/2022]
Abstract
Hemorrhoidal disease is a common reason for consultation in proctology. It can be treated in several ways (medical, endoscopic, and surgical). Laser treatment has been described since 1960 and has developed in recent years. The purpose of this literature review was to study the results of laser treatment of hemorrhoids and to compare them with those of surgical methods. We performed a systematic search of the literature by querying the Medline, Google Scholar, and Cochrane Library databases. Retrospective studies and case reports were excluded. We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure). The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies. The age of the patients varies between 18 and 74 years old. HeLP laser treatment was significantly superior to surgical treatment in terms of postoperative pain (p < 0.001), hemorrhoidal disease downgrading (p < 0.001), and postoperative satisfaction (p < 0.001). Similarly, LHP laser treatment was significantly superior to surgical treatment in terms of operative duration (p < 0.00001), intraoperative bleeding (p < 0.00001), postoperative pain at H12 and H24 (p < 0.00001 and p = 0.0003), and postoperative bleeding rate (p < 0.001). The laser represents a revolution in the field of proctology mainly in the treatment of hemorrhoidal pathology. It is a safe, effective, and less painful mini-invasive technique. More rigorous studies will be needed to better evaluate this technique.
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Affiliation(s)
- Aymen Trigui
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia.
| | - Haithem Rejab
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Amira Akrout
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Jihen Trabelsi
- Department of Epidemiology, Hedi Cheker Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Amine Zouari
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Youssef Majdoub
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Mohamed Ben Amar
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Rafik Mzali
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
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Zheng Y, Yang H, Yin X, Ma X, Guo L. Acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e25511. [PMID: 34114980 PMCID: PMC8202566 DOI: 10.1097/md.0000000000025511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Female pelvic floor dysfunction is one of the common chronic diseases affecting women's physical and mental health. Pregnancy and delivery are one of the main causes. Pelvic floor rehabilitation is a common method for the treatment of postpartum pelvic floor dysfunction, but it has some defects. Acupoint injection has advantages in the treatment of postpartum pelvic floor dysfunction, but there is a lack of standard clinical research to verify it. Therefore, the purpose of this randomized controlled trial is to evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders. METHODS This is a prospective randomized controlled trial to study the efficacy and safety of acupoints injection combined with pelvic floor rehabilitation. And it is approved by the Ethics Committee of Clinical Research of our hospital. Patients were randomly divided into observation group (acupoint injection combined with pelvic floor rehabilitation group) or control group (pelvic floor rehabilitation group alone). The patients were followed up for 8 weeks after 12 weeks of treatment. The observation indexes included: pelvic organ prolapse degree, pelvic floor muscle strength, urinary incontinence score, adverse reactions, among others. Data were analyzed using the statistical software package SPSS version 18.0. CONCLUSIONS This study will evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor dysfunction, and provide reliable reference for the clinical application of this project. TRIAL REGISTRATION OSF Registration number: DOI 10.17605/OSF.IO/VC65Z.
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Affiliation(s)
| | | | - Xunfu Yin
- College of Artificial Intelligence, Southwest University, Chongqing, China
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A step-by-step approach to endorectal proctopexy (ERPP): how we do it. Tech Coloproctol 2021; 25:879-886. [PMID: 34046758 DOI: 10.1007/s10151-021-02467-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
There are many surgical treatments aimed at correcting internal mucosal prolapse and rectocele associated with obstructed defecation syndrome (ODS). Perineal procedures can be considered as first options in young men in whom an abdominal approach poses risks of sexual dysfunction and in selected women with isolated posterior compartment prolapse who failed conservative treatment. About 20 years ago, we described endorectal proctopexy (ERPP) also known as internal Delorme procedure. The aim of the present study was to describe, with attention to technical details and the aid of a video, the different steps of ERPP for the treatment of ODS. A retrospective analysis of our last 100 cases confirms our initial good results. Complications included suture line dehiscence with consequent stricture in four patients (4%). Bleeding occurred in four (4%) patients and was conservatively treated. Transient anal continence impairment consisting of urgency and soiling occurred in 12 (12%) and 6 (6%) patients, respectively. At 6-month follow-up the Cleveland Clinic Constipation Score and ODS score improved from a median preoperative value of 18.9 and 18.5 to 5 and 5, respectively (p < 0.0001). The mean follow-up was 36.05 ± 13.3 (range 12-58) months and anatomical recurrence rate was 6 (%). Due to its excellent safety profile and the ability to tailor the procedure to different disease presentations, we think that ERPP should be part of the basic armamentarium of all colorectal surgeons operating on the pelvic floor.
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Pucciani F, Trafeli M. Sampling reflex: pathogenic role in functional defecation disorder. Tech Coloproctol 2021; 25:521-530. [PMID: 33587211 DOI: 10.1007/s10151-020-02393-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The sampling reflex is necessary to begin defecation or flatulence. It consists of a simultaneous rectoanal inhibitory reflex (RAIR) mediated by relaxation of the internal anal sphincter and rectoanal excitatory reflex (RAER) mediated by contraction of the external anal sphincter. The aim of this study was to evaluate the sampling reflex in patients with functional defecation disorder (FDD). METHODS A prospective cohort study was conducted on 58 obstructed defecation syndrome (ODS) patients with FDD. All 58 patients and 20 controls were evaluated with anorectal manometry to study the sampling reflex. Quantitative RAIR (total duration of reflex; maximal amplitude of relaxation; residual pressure at the lowest point of the RAIR) and RAER data (maximal amplitude of contraction; duration) were obtained. The straining test on manometry was considered positive for FDD if there was a muscle contraction/lack of relaxation or an insufficient pressure gradient for the passage of feces. Defecography was performed on all the patients with assessment of the anorectal angle and persistence or increase of puborectalis indentation. RESULTS Fifty (86.2%) FDD patients had an altered sampling reflex, showing incomplete/short duration of RAIR and excessive contraction/duration of RAER. More specifically, there was a correlation between a positive straining test and a short total duration of RAIR (ρ 0.92) as well as with excessive duration of RAER (ρ 0.89). There was also a correlation between lack of muscle relaxation on defecography and short total duration of RAIR ((ρ 0.79) and between lack of muscle relaxation on defecography and excessive duration of RAER (ρ 0.83). Altered maximal amplitude relaxation had the highest sensitivity in detecting impairment of RAIR (87.9) while maximal amplitude contraction had the highest sensitivity in detecting impairment of RAER (89.6). High residual pressure at the lowest point of RAIR had the highest specificity in detecting impairment of RAIR (80.0) while RAER duration had the highest specificity in detecting impairment of RAER (77.7). CONCLUSION The sampling reflex is impaired in patients with FDD. This finding provides an important insight into the pathogenesis of obstructed functional defecation.
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Affiliation(s)
- F Pucciani
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Florence, Italy.
| | - M Trafeli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Florence, Italy
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Shao W, Wang H, Chen Q, Zhao W, Gu Y, Feng G. Enhanced recovery after surgery nursing program, a protective factor for stoma-related complications in patients with low rectal cancer. BMC Surg 2020; 20:316. [PMID: 33276751 PMCID: PMC7716511 DOI: 10.1186/s12893-020-00978-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/22/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study aimed to investigate the association between enhanced recovery after surgery (ERAS) nursing program and stoma-related complications (SRCs) and prognosis in patients with low rectal cancer (LRC) undergoing abdominoperineal resection with sigmoidostomy. METHODS LRC patients who underwent elective abdominoperineal resection with sigmoidostomy between May 2016 and May 2019 were retrospectively enrolled. The occurrence of early major or minor SRCs (within postoperative 30 days) was set as the primary end-point. Clinicopathological variables and laboratory tests were compared between patients with or without SRCs. The univariate and multivariate logistic regression analyses were performed to investigate risk factors for SRCs. Hospitalization satisfaction-related and prognosis-related variables were compared between LRC patients with or without ERAS nursing program. RESULTS A total of 288 patients were enrolled and the incidence of SRCs was 26.7% (77/288). ERAS nursing program was the only independent risk factor for SRCs in LRC patients (OR 2.04, 95%CI 1.31-3.12, P = 0.016) by the multivariate logistic regression analysis. Moreover, ERAS nursing program was associated with higher hospitalization satisfaction rate, faster bowel function recovery, better psychological status, and higher quality of life. CONCLUSIONS ERAS nursing program was a protective factor for SRCs and associated with improved prognosis in LRC patients undergoing elective abdominoperineal resection with sigmoidostomy.
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Affiliation(s)
- Weiling Shao
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Honggang Wang
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Qun Chen
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Wen Zhao
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Yulian Gu
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Guoqin Feng
- Department of Nursing, Taizhou People's Hospital, No. 366 Taihu Road, Taizhou, 225300, Jiangsu Province, China.
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Brusciano L, Gambardella C, Del Genio G, Tolone S, Lucido FS, Terracciano G, Gualtieri G, Docimo L. OUTLET OBSTRUCTED CONSTIPATION AND FECAL INCONTINENCE: IS REHABILITATION TREATMENT THE WAY? MYTH OR REALITY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 5757:198-202. [PMID: 32401951 DOI: 10.1590/s0004-2803.202000000-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 12/15/2022]
Abstract
Pelvic floor rehabilitation aims to address perineal functional and anatomic alterations as well as thoraco-abdominal mechanic dysfunctions leading to procto-urologic diseases like constipation, fecal and urinary incontinence, and pelvic pain. They require a multidimensional approach, with a significant impact on patients quality of life. An exhaustive clinical and instrumental protocol to assess defecation disorders should include clinical and instrumental evaluation as well as several clinical/physiatric parameters. All these parameters must be considered in order to recognize and define any potential factor playing a role in the functional aspects of incontinence, constipation and pelvic pain. After such evaluation, having precisely identified any thoraco-abdomino-perineal anatomic and functional alterations, a pelvi-perineal rehabilitation program can be carried out to correct the abovementioned alterations and to obtain clinical improvement. The success of the rehabilitative process is linked to several factors such as a careful evaluation of the patient, aimed to select the most appropriate and specific targeted rehabilitative therapy, the therapist's scrupulous hard work, especially as regards the patient's emotional and psychic state, and finally the patient's compliance in undertaking the therapy itself, especially at home. These factors may deeply influence the overall outcomes of the rehabilitative therapies, ranging from "real" success to illusion "myth".
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Affiliation(s)
- Luigi Brusciano
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy
| | - Claudio Gambardella
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy.,University of Campania "Luigi Vanvitelli", School of Medicine, Department of Cardiothoracic Sciences, Naples, Italy
| | - Gianmattia Del Genio
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy
| | - Salvatore Tolone
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy
| | - Francesco Saverio Lucido
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy
| | - Gianmattia Terracciano
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy
| | - Giorgia Gualtieri
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy
| | - Ludovico Docimo
- University of Campania "Luigi Vanvitelli", Division of General, Mininvasive and Bariatric Surgery, Naples, Italy
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Battaglia E, Boano V, Sguazzini CE, Elia CM, Grassini M. Gastrointestinal physiopathological testing: what's new? MINERVA GASTROENTERO 2019; 66:1-3. [PMID: 31760734 DOI: 10.23736/s1121-421x.19.02629-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Edda Battaglia
- Section of Physiopatology, Department of Gastroenterology and Endoscopy, Cardinal Massaia Hospital, Asti, Italy -
| | - Valentina Boano
- Section of Physiopatology, Department of Gastroenterology and Endoscopy, Cardinal Massaia Hospital, Asti, Italy
| | - Carlo E Sguazzini
- Section of Physiopatology, Department of Gastroenterology and Endoscopy, Cardinal Massaia Hospital, Asti, Italy
| | - Chiara M Elia
- Section of Physiopatology, Department of Gastroenterology and Endoscopy, Cardinal Massaia Hospital, Asti, Italy
| | - Mario Grassini
- Section of Physiopatology, Department of Gastroenterology and Endoscopy, Cardinal Massaia Hospital, Asti, Italy
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A comprehensive physical therapy evaluation for Male Chronic Pelvic Pain Syndrome: A case series exploring common findings. J Bodyw Mov Ther 2019; 23:825-834. [PMID: 31733768 DOI: 10.1016/j.jbmt.2019.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Male Chronic Pelvic Pain Syndrome (MCPPS) is a complex condition and difficult to decipher due to the multifactorial etiologies and system interrelationships. No studies to date have described a movement-based, multisystem assessment including the musculoskeletal, visceral, nervous, lymphatic and vascular systems, as well as manual prostate mobility testing. The purpose of this paper is to demonstrate the importance of a comprehensive physical therapy evaluation to identify predominant mechanical and movement-based dysfunctions related to multiple anatomical structures and their interrelationships. Furthermore, symptoms and potentially confounding psychosocial, and environmental factors linked to MCPPS will be presented, and an overview of prospective treatment will be provided. METHOD A retrospective analysis of evaluative findings for ten men was performed. The men, with an average age 35 (range 24-46) were referred to physical therapy for MCPPS. RESULTS This retrospective analysis of ten patients identifies potential contributing pain factors associated with MCPPS. Similarities in clinical presentation among men suffering from MCPPS were identified to include predominant mechanical dysfunctions of the thoraco-lumbar spine, the liver, the kidney, the femoral nerve, the bladder, the prostate, and the pelvic floor. CONCLUSION The observations in this retrospective study demonstrate that the use of a multisystem assessment approach in patients with MCPPS is critical for their more effective treatment. On the basis of these findings, and the close mechanical interrelationships of the anatomical elements involved and multisystem MCPPS etiologies, larger-scale research is warranted.
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Brusciano L, Gambardella C, Tolone S, Del Genio G, Terracciano G, Gualtieri G, Schiano di Visconte M, Docimo L. An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the same whole in the harmonic functioning of the pelvic floor. Tech Coloproctol 2019; 23:603-605. [PMID: 31065825 DOI: 10.1007/s10151-019-01996-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/02/2019] [Indexed: 01/29/2023]
Affiliation(s)
- L Brusciano
- XI Division of General, Minimally Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy.
| | - C Gambardella
- XI Division of General, Minimally Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy.,Department of Cardiothoracic Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Tolone
- XI Division of General, Minimally Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - G Del Genio
- XI Division of General, Minimally Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - G Terracciano
- XI Division of General, Minimally Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | - G Gualtieri
- XI Division of General, Minimally Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
| | | | - L Docimo
- XI Division of General, Minimally Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini n° 5, 80131, Naples, Italy
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