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O'Donnell MT, Haviland SM. Functional Constipation and Obstructed Defecation. Surg Clin North Am 2024; 104:565-578. [PMID: 38677821 DOI: 10.1016/j.suc.2023.11.007] [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] [Indexed: 04/29/2024]
Abstract
Constipation encompasses symptoms of decreased colonic motility or difficulty with the defecation process. As a broad definition, this can be inclusive of functional constipation (FC) or colonic inertia, obstructed defecation (OD), and irritable bowel syndrome-constipation type (IBS-CS). After excluding IBS-C, FC and OD diagnosis and management require a multidisciplinary approach often involving nutritionists, pelvic floor therapists, urogynecologists, and colon and rectal surgeons. Differentiating the presence or absence of each can direct therapy and prognosticate chances for improvement in this often complex combination of disorders.
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Affiliation(s)
- Mary T O'Donnell
- Department of General Surgery Walter Reed National Military Medical Center, Colon and Rectal Surgery Division, 8901 Rockville Pike, Bethesda, MD 20889, USA.
| | - Sarah M Haviland
- Department of General Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
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2
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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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3
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Lukies M, Harisis G, Jarema A, Scicchitano M, MacLaurin W. Defecating proctography: A pictorial essay. Radiography (Lond) 2022; 28:628-633. [PMID: 35569315 DOI: 10.1016/j.radi.2022.04.012] [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: 02/26/2022] [Revised: 04/11/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To provide an illustrative description of the technique and spectrum of findings in defecating proctography. KEY FINDINGS Important findings on defecating proctography include rectocoele, enterocoele, sigmoidocoele, cystocoele, intussusception, rectal prolapse, descending perineum, incomplete emptying, anismus, and faecal incontinence. This review article illustrates these key findings with examples. CONCLUSION Defecating proctography is a well-established and cost-effective method of assessing disordered defecation. In conjunction with clinical information and other diagnostic tests, findings on defecating proctography can guide appropriate multidisciplinary management and may lead to improvement in embarrassing and debilitating symptoms in many patients. IMPLICATIONS FOR PRACTICE This review article provides a suggested technique and covers the spectrum of findings on defecating proctography.
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Affiliation(s)
- M Lukies
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia.
| | - G Harisis
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - A Jarema
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - M Scicchitano
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - W MacLaurin
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
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Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Female Pelvic Med Reconstr Surg 2021; 27:e645-e656. [PMID: 34506350 DOI: 10.1097/spv.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Mohan Paspulati R, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. Dis Colon Rectum 2021; 64:1184-1197. [PMID: 34516442 DOI: 10.1097/dcr.0000000000002155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, California
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, Ohio
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, Illinois
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, New York
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, California
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, New York
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, Virginia
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, Massachusetts
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6
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Paspulati RM, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons. Int Urogynecol J 2021; 32:2561-2574. [PMID: 34505921 DOI: 10.1007/s00192-021-04955-z] [citation(s)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, CA, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, OH, USA
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, IL, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Ok, USA
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, VA, USA
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
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Fathy M, Elfallal AH, Emile SH. Literature review of the outcome of and methods used to improve transperineal repair of rectocele. World J Gastrointest Surg 2021; 13:1063-1078. [PMID: 34621481 PMCID: PMC8462077 DOI: 10.4240/wjgs.v13.i9.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rectocele is commonly seen in parous women and sometimes associated with symptoms of obstructed defecation syndrome (ODS).
AIM To assess the current literature in regard to the outcome of the classical transperineal repair (TPR) of rectocele and its technical modifications.
METHODS An organized literature search for studies that assessed the outcome of TPR of rectocele was performed. PubMed/Medline and Google Scholar were queried in the period of January 1991 through December 2020. The main outcome measures were improvement in ODS symptoms, improvement in sexual functions and continence, changes in manometric parameters, and quality of life.
RESULTS After screening of 306 studies, 24 articles were found eligible for inclusion to the review. Nine studies (301 patients) assessed the classical TPR of rectocele. The median rate of postoperative improvement in ODS symptoms was 72.7% (range, 45.8%-83.3%) and reduction in rectocele size ranged from 41.4%-95.0%. Modifications of the classical repair entailed omission of levatorplasty, addition of implant, concomitant lateral internal sphincterotomy, changing the direction of plication of rectovaginal septum, and site-specific repair.
CONCLUSION The transperineal repair of rectocele is associated with satisfactory, yet variable, improvement in ODS symptoms with parallel increase in quality-of-life score. Several modifications of the classical TPR were described. These modifications include omission of levatorplasty, insertion of implants, performing lateral sphincterotomy, changing the direction of classical plication, and site-specific repair. The indications for these modifications are not yet fully clear and need further prospective studies to help tailor the technique to rectocele patients.
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Affiliation(s)
- Mohammad Fathy
- General Surgery, Mansoura University Faculty of Medicine, Mansoura 35516, Egypt
| | | | - Sameh Hany Emile
- General Surgery, Mansoura University Faculty of Medicine, Mansoura 35516, Egypt
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Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons. AJR Am J Roentgenol 2021; 217:800-812. [PMID: 34505543 DOI: 10.2214/ajr.21.26488] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.
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9
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Gurland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, El Sayed RF, Jambhekar KR, Chernyak V, Paspulati RM, Sheth VR, Steiner AM, Kamath A, Shobeiri SA, Weinstein MM, Bordeianou L. Consensus definitions and interpretation templates for magnetic resonance imaging of Defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the international continence society, the American Urogynecologic Society, the international Urogynecological association, and the Society of Gynecologic Surgeons. Int Urogynecol J 2021; 32:2561-2574. [PMID: 34505921 DOI: 10.1007/s00192-021-04955-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brooke H Gurland
- Division of Colorectal Surgery, Stanford University, Palo Alto, CA, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Cleveland Clinic Hospitals, Cleveland, OH, USA
| | - Ervin Kocjancic
- Department of Urology, College of Medicine University of Illinois, Chicago, IL, USA
| | - Lieschen H Quiroz
- Department of Obstetrics & Gynecology, University of Oklahoma, Oklahoma City, Ok, USA
| | - Rania F El Sayed
- Department of Radiology, Cairo University Pelvic Floor Centre of Excellency and Research Lab, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Kedar R Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Victoria Chernyak
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY, USA
| | - Raj Mohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vipul R Sheth
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Ari M Steiner
- Department of Radiology, Mount Sinai South Nassau Hospital, Oceanside, NY, USA
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, University of Virginia, INOVA Women's Hospital, Falls Church, VA, USA
| | - Milena M Weinstein
- Department of Obstetrics & Gynecology, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Liliana Bordeianou
- Department of Gastrointestinal Surgery, Massachusetts General Hospital Pelvic Floor Disorders Center, Harvard Medical School, Boston, MA, USA. .,Massachusetts General Hospital Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA.
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10
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Transvaginal Rectocele Augmented Repair with Mesh and Levatorplasty. Dis Colon Rectum 2020; 63:1168. [PMID: 32692078 DOI: 10.1097/dcr.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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11
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Shalaby M, Elfeki H, Omar W. Transvaginal repair for anterior rectocele - a video vignette. Colorectal Dis 2018; 20:647-648. [PMID: 29694693 DOI: 10.1111/codi.14235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Affiliation(s)
- M Shalaby
- General and Colorectal Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - H Elfeki
- General and Colorectal Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - W Omar
- General and Colorectal Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abstract
INTRODUCTION AND HYPOTHESIS A rectocele is the bulging of the anterior rectal wall into the posterior vaginal compartment. The route of surgical repair can be transvaginal, transrectal or abdominal. The aim of this retrospective study is to describe a novel transvaginal surgical procedure and investigate the associated subjective and objective clinical outcomes. METHODS Database records were retrieved for all women who underwent a rectocele plication for the period from January 2010 until December 2015 in a referral urogynecology unit with a minimum follow-up period of 12 months. This transvaginal technique entails a plication of the anterior rectal wall by suturing of the rectal muscularis layer. Clinical findings and quality of life (QOL) metrics were evaluated and reported on. RESULTS One hundred thirty-nine women met the initial inclusion criteria with full data available for 123. The presenting symptoms included a vaginal bulge in 73 (52.5%), overactive bladder (OAB) in 73 (52.5%), obstructed defecation (OD) in 49 (35.3%) and anal incontinence (AI) in 35 (25.2%). The majority of women (n = 72, 51.8%) had stage 3-4 posterior prolapse. The mean follow-up period was 27 ± 15 months. The postoperative symptoms were significantly improved for all, except AI (p = 0.43). There was a significant improvement in posterior prolapse (p < 0.001) with the majority of women noted to have a stage 0 or 1 (n = 109; 88.6%) posterior prolapse at follow-up. CONCLUSIONS The rectocele plication is a novel surgical technique with good subjective and objective clinical outcomes in the medium term.
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Treatment of obstructed defecation syndrome due to rectocele and rectal intussusception with a high volume stapler (TST STARR-plus). Tech Coloproctol 2017; 22:53-58. [PMID: 29063219 DOI: 10.1007/s10151-017-1696-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 09/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND In recent years, stapled transanal resection (STARR) has been adopted worldwide with convincing short-term results. However, due to the high recurrence rate and some major complications after STARR, there is still controversy about when the procedure is indicated. The aim of this study was to assess the safety, efficacy and feasibility of STARR performed with a new dedicated device for tailored transanal stapled surgery. METHODS All the consecutive patients affected by obstructed defecation syndrome (ODS) due to rectocele or/and rectal intussusception, who underwent STARR with the TST STARR-Plus stapler, were included in a prospective study. Pain, Cleveland Clinic Score for Constipation (CCCS) and incontinence, patient satisfaction, number of hemostatic stitches, operative time, hospital stay and perioperative complications were recorded. Postoperative complications and recurrence were also reported. RESULTS Forty-five consecutive patients (median age 50; range 24-79) were included in the study. Median resected volume was 15 cm3 (range 12-19 cm3) with a median height of surgical specimen of 5.6 cm (range 4.5-10 cm). The mean CCCS decreased from 17.26 (± 3.77) to 5.42 (± 2.78) postoperatively (p < 0.001). Patient satisfaction grade was excellent in 14 patients (31.1%), good in 25 (55.5%), sufficient in three (6.7%) and poor in three patients (6.7%). No major complications occurred. Five patients (11%) reported urgency after 30 days and two patients (4%) after 12 months. The Cleveland Clinic Incontinence score did not significantly change. At a median follow-up of 23 months (range 12-30 months), only three patients (6.7%) reported recurrent symptoms of obstructed defecation comparable to those reported at baseline. CONCLUSIONS TST STARR-Plus seems to be safe and effective for the treatment of ODS due to rectocele and rectal intussusception, and technical improvement could reduce the risk of some complications. However, careful patient selection is still the best means of preventing complications.
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Fabrizio AC, Alimi Y, Kumar AS. Methods of Evaluation of Anorectal Causes of Obstructed Defecation. Clin Colon Rectal Surg 2016; 30:46-56. [PMID: 28144212 DOI: 10.1055/s-0036-1593427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obstructed defecation is a complex disorder that results in impaired propagation of stool from the rectum. It is one of the major subtypes of functional constipation and can be secondary to either functional or anatomic etiologies. Patients with obstructed defecation typically present with symptoms of abdominal discomfort, a sensation of incomplete evacuation and rectal obstruction, passage of hard stools, the need for rectal or vaginal digitation, excessive straining, and reduced stool frequency. Evaluation of obstructed defecation is multimodal, starting with a thorough history and physical examination with focus on the abdominal, perineal, and rectal examination. Additional modalities to elicit the diagnosis of obstructed defecation include proctoscopy, colonic transit time studies, anorectal manometry, a rectal balloon expulsion test, defecography, electromyography, and ultrasound. The results from these studies should be taken in the context of each patient's clinical situation, as there is no single criterion standard for the diagnosis of obstructed defecation. Surgery is typically a last resort for these patients and the majority of patients will have good symptomatic management with diet and lifestyle changes. Patients who are found to have functional mechanisms behind their obstructed defecation also benefit from pelvic floor exercises and biofeedback therapy.
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Affiliation(s)
- Anne C Fabrizio
- Department of Surgery, Medstar Georgetown University Hospital, District of Columbia, Washington
| | - Yewande Alimi
- Department of Surgery, Medstar Georgetown University Hospital, District of Columbia, Washington
| | - Anjali S Kumar
- Colorectal Surgery Program, Virginia Mason Medical Center, Seattle, Washington
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Abstract
Rectoceles are a very common finding in patients, and symptoms most commonly include pelvic pain, pressure, or difficulty with passing stool. However, there are often other associated pelvic floor disorders that accompany rectoceles, making the clinical significance of it in an individual patient often hard to determine. When evaluating a patient with a rectocele, a thorough history and physical exam must be conducted to help delineate other causes of these symptoms. Treatment consists of addressing other defecatory disorders through various methods, with surgery reserved for select cases in which obstructed defecation is well documented.
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Affiliation(s)
- W Conan Mustain
- Division of Colon and Rectal Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Dimitriou N, Shah V, Stark D, Mathew R, Miller AS, Yeung JMC. Defecating Disorders: A Common Cause of Constipation in Women. WOMENS HEALTH 2015; 11:485-500. [DOI: 10.2217/whe.15.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Defecating disorders are a common and complex problem. There are a range of anatomical and functional bowel abnormalities that can lead to this condition. Treatment is difficult and needs a multidisciplinary approach. First line treatment for defecating disorders is conservative. For those that fail conservative treatment, some may respond to surgical therapy but with variable results. The aim of this review is to offer an overview of defecating disorders as well as provide an algorithm on how to diagnose and treat them with the help of a multidisciplinary and multimodal approach.
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Affiliation(s)
- Nikoletta Dimitriou
- 1st Department of Surgery, University of Athens, Medical School, Laiko Hospital, Athens, Greece
| | - Vikas Shah
- Department of Radiology, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Diane Stark
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Ronnie Mathew
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Andrew S Miller
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - Justin MC Yeung
- Pelvic Floor Unit, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
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