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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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Mercer-Jones M, Grossi U, Pares D, Vollebregt PF, Mason J, Knowles CH. Surgery for constipation: systematic review and practice recommendations: Results III: Rectal wall excisional procedures (Rectal Excision). Colorectal Dis 2017; 19 Suppl 3:49-72. [PMID: 28960928 DOI: 10.1111/codi.13772] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To assess the outcomes of rectal excisional procedures in adults with chronic constipation. METHOD Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level. RESULTS Forty-seven studies were identified, providing data on outcomes in 8340 patients. Average length of procedures was 44 min and length of stay (LOS) was 3 days. There was inadequate evidence to determine variations in procedural duration or LOS by type of procedure. Overall morbidity rate was 16.9% (0-61%), with lower rates observed after Contour Transtar procedure (8.9%). No mortality was reported after any procedures in a total of 5896 patients. Although inconsistently reported, good or satisfactory outcome occurred in 73-80% of patients; a reduction of 53-91% in Longo scoring system for obstructive defecation syndrome (ODS) occurred in about 68-76% of patients. The most common long-term adverse outcome is faecal urgency, typically occurring in up to 10% of patients. Recurrent prolapse occurred in 4.3% of patients. Patients with at least 3 ODS symptoms together with a rectocoele with or without an intussusception, who have failed conservative management, may benefit from a rectal excisional procedure. CONCLUSION Rectal excisional procedures are safe with little major morbidity. It is not possible to advise which excisional technique is superior from the point of view of efficacy, peri-operative variables, or harms. Future study is required.
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Affiliation(s)
- M Mercer-Jones
- Queen Elizabeth Hospital, Gateshead NHS Trust, Gateshead, UK
| | - U Grossi
- National Bowel Research Centre, Blizard Institute, Queen Mary, University London, London, UK
| | - D Pares
- Hospital Germans Trías i Pujol, Barcelona, Spain
| | - P F Vollebregt
- National Bowel Research Centre, Blizard Institute, Queen Mary, University London, London, UK
| | - J Mason
- University of Warwick, Coventry, UK
| | - C H Knowles
- National Bowel Research Centre, Blizard Institute, Queen Mary, University London, London, UK
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- National Institute for Health Research: Chronic Constipation Treatment Pathway, London, UK
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- Affiliate section of the Association of Coloproctology of Great Britain and Ireland
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Liu W, Sturiale A, Fabiani B, Giani I, Menconi C, Naldini G. Internal Delorme's Procedure for Treating ODS Associated With Impaired Anal Continence. Surg Innov 2017; 24:566-573. [PMID: 28778136 DOI: 10.1177/1553350617723771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the medium-term outcomes of internal Delorme's procedure for treating obstructed defecation syndrome (ODS) patients with impaired anal continence. PATIENTS AND METHODS In a retrospective study, 41 ODS patients who underwent internal Delorme's procedure between 2011 and 2015 were divided into 3 subgroups according to their associated symptoms of impaired continence, as urgency, passive fecal incontinence and both, before study. Then the patients' preoperative statuses, perioperative complications, and postoperative outcomes were investigated and collected from standardized questionnaires, including Altomare ODS score, Fecal Incontinence Severity Index (FISI), Patient Assessment of Constipation-Quality of Life Questionnaire (PAC-QoL), and Fecal Incontinence Quality of Life Scale (FIQLS). All results with a 2-tailed P < .05 were considered statistically significant. RESULTS At an average 2.8 years of follow-up, there were significant improvements ( P < .01) in Altomare ODS score, FISI, PAC-QoL, and FIQLS in all patients when comparing scores from before the operation with those at the final follow-up. Similar results were also observed in both the urgency subgroup and passive fecal incontinence subgroup, but there were no statistically significant improvements ( P > .05) in Altomare ODS score, FISI, PAC-QoL, or FIQLS in the urgency and passive fecal incontinence subgroups. Anorectal manometry showed the mean value of anal resting pressure increased 20%. Additionally, no major complications occurred. CONCLUSION Internal Delorme's procedure is effective without major morbidity for treating ODS associated with urgency or passive fecal incontinence, but it may be less effective for treating ODS associated with both urgency and passive fecal incontinence.
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Affiliation(s)
- Weicheng Liu
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
| | | | | | - Iacopo Giani
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Claudia Menconi
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Gabriele Naldini
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
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Leo CA, Campennì P, Hodgkinson JD, Rossitti P, Digito F, De Carli G, D'Ambrosi L, Carducci P, Seriau L, Terrosu G. Long-Term Functional Outcome after Internal Delorme's Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation. J INVEST SURG 2017; 31:256-262. [PMID: 28362517 DOI: 10.1080/08941939.2017.1300714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate long-term functional outcomes of Internal Delorme's Procedure (IDP) in patients refractory to conservative treatment for Obstructed Defecation Syndrome (ODS), and to compare those who received postoperative rehabilitation with those who did not. MATERIALS AND METHODS All patients with ODS refractory to nonoperative therapy were identified across three regional pelvic floor referral hospitals, and IDP was performed. Postoperatively selected patients received biofeedback therapy. Functional outcomes were established using the Cleveland Clinic Constipation (CCC) score and obstructed defecation score (OD score) preoperatively at 12 months and at the last available follow-up. Patient satisfaction was assessed with a visual analogue score. RESULTS From October 2006 to September 2013, IDP was performed in 170 patients: 77 received postoperative biofeedback and 93 did not. Mean follow-up was 6.3 years (range 1-8 years). CCC and OD scores improved significantly in both groups after 12 months and at the last follow-up (p > 0.05). When comparing two groups while there was no significant difference between CCC and OD scores at 12 months, score was significantly better in the group that received rehabilitation at the last follow-up (p = 0.001). Patient satisfaction was higher in the rehabilitation group (67%) compared with those without rehabilitation (55%). Clinical recurrence was recorded in nine patients who did not have postoperative rehabilitation. CONCLUSIONS It has been demonstrated that IDP is associated with good long-term functional outcomes. Patients receiving rehabilitation had a better long-term follow-up, a higher overall satisfaction, and lower recurrence rate when compared with the patients who did not receive postoperative rehabilitation.
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Affiliation(s)
- C A Leo
- a North West London NHS Trust, St Mark's Hospital Academic Institute , Middlesex , Harrow , UK
| | - P Campennì
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - J D Hodgkinson
- a North West London NHS Trust, St Mark's Hospital Academic Institute , Middlesex , Harrow , UK
| | - P Rossitti
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - F Digito
- c Department of Surgery , S. Antonio Hospital, S. Daniele del Friuli, Udine , Italy
| | - G De Carli
- d Department of Surgery , S. Maria del Prato Hospital , Feltre , Italy
| | - L D'Ambrosi
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - P Carducci
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - L Seriau
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
| | - G Terrosu
- b Department of Surgery , S. Maria della Misericordia Hospital, Università degli Studi di Udine , Udine , Italy
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Abstract
Rectoanal intussusception is an invagination of the rectal wall into the lumen of the rectum. Patients may present with constipation, incomplete evacuation, incontinence, or may be asymptomatic. Defecography has been the gold standard for detection. Magnetic resonance imaging defecography and dynamic anal endosonography are alternatives to conventional defecography. However, both methods are not as sensitive as conventional defecography. Treatment options range from conservative/medical treatment such as biofeedback to surgical procedures such as Delorme, rectopexy, and stapled transanal rectal resection. Recent studies conducted after a trial of failed nonoperative management show adequate results with operations performed for rectal intussusception with or without rectocele if other causes of constipation are not present.
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Affiliation(s)
- Kristen Blaker
- Department of Surgery, Division of General Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joselin L Anandam
- Department of Surgery, Division of General Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Liu WC, Wan SL, Yaseen SM, Ren XH, Tian CP, Ding Z, Zheng KY, Wu YH, Jiang CQ, Qian Q. Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience. World J Gastroenterol 2016; 22:7983-7998. [PMID: 27672293 PMCID: PMC5028812 DOI: 10.3748/wjg.v22.i35.7983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/23/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented.
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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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The translation and validation of the Japanese version of the patient assessment of constipation quality of life scale. Surg Today 2015; 46:414-21. [DOI: 10.1007/s00595-015-1179-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/11/2015] [Indexed: 02/06/2023]
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Wagenlehner FME, Del Amo E, Santoro GA, Petros P. Perineal body repair in patients with third degree rectocele: a critical analysis of the tissue fixation system. Colorectal Dis 2013; 15:e760-5. [PMID: 24118694 DOI: 10.1111/codi.12453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/30/2013] [Indexed: 02/08/2023]
Abstract
AIM We describe the technique of tissue fixation system (TFS) perineal body repair in patients presenting with symptomatic third degree rectocele. METHOD The single sling TFS perineal body repair is performed in three surgical steps: (i) dissection of the rectum off the vagina and laterally displaced perineal body; (ii) identification of the deep transverse perineii muscles beyond their insertion point behind the descending pubic ramus; (iii) elevation and approximation of the separated and laterally displaced perineal bodies by insertion, without tension, of non-stretch 7 mm polypropylene tape into the bodies of the deep transverse perineii muscles. RESULTS From January 2007 to December 2009 we performed the TFS operation for 30 women, median age 61 (range 47-87) years, mean parity 2.6 (range 1-5), with third degree symptomatic low rectocele (median obstructive defaecation syndrome score 19; range 11-24). Median hospital stay was 24 (range 12-96) h. The median visual analogue scale for postoperative pain was 1 (range 1-7). Complications occurred in three cases (10%) and included a surfaced tape that was partly resected (repair maintained), a recurrence of the rectocele due to incorrect placement (failed repair) and a foreign body abscess requiring tape removal. At 12-month follow-up, 27 patients (90%) reported normal defaecation and the median obstructive defaecation syndrome score was significantly reduced to 4 (range 1-6; P < 0.001). CONCLUSION The TFS perineal body repair is an effective, safe, minimally invasive treatment in women with symptomatic low rectocele.
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Affiliation(s)
- F M E Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
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