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Sakata S, McKenna NP, Allawi A, D'Angelo ALD, Chua HK, Dozois EJ. How to do an Altemeier perineal rectosigmoidectomy for full-thickness rectal prolapse. ANZ J Surg 2021; 91:1019-1020. [PMID: 33458932 DOI: 10.1111/ans.16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
Here, we offer a step-by-step description of the technique for an Altemeier perineal rectosigmoidectomy, which is our institution's preferred perineal approach for patients with full-thickness rectal prolapse. This article is supplemented by a series of high-quality clinical images that are available in Figs S1-S11. The principles of this technique are to excise the rectal prolapse and improve structural support of the pelvic floor.
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Affiliation(s)
- Shinichiro Sakata
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas P McKenna
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed Allawi
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anne-Lise D D'Angelo
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi K Chua
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Dozois
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Giannakaki V, Bordeianou L. Surgical management of severe constipation due to slow transit and obstructed defecation syndrome. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Descending perineum syndrome: a review of the presentation, diagnosis, and management. Int Urogynecol J 2016; 27:1149-56. [PMID: 26755058 DOI: 10.1007/s00192-015-2889-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/02/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Defecatory dysfunction is a relatively common and challenging problem among women and one that practicing pelvic reconstructive surgeons and gynecologists deal with frequently. A subset of defecatory dysfunction includes obstructed defecation, which can have multiple causes, one of which is descending perineum syndrome (DPS). METHODS A literature search was performed to identify the pathophysiology, diagnosis, and management of DPS. RESULTS Although DPS has been described in the literature for many decades, it is still uncommonly diagnosed and difficult to manage. A high index of suspicion combined with physical examination consistent with excess perineal descent, patient symptom assessment, and imaging in the form of defecography are required for the diagnosis to be accurately made. Primary management options of DPS include conservative measures consisting of bowel regimens and biofeedback. Although various surgical approaches have been described in limited case series, no compelling evidence can be demonstrated at this point to support surgical intervention. CONCLUSIONS Knowledge of DPS is essential for the practicing pelvic reconstructive surgeon to make a timely diagnosis, avoid harmful treatments, and initiate therapy early on.
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Design and Evaluation of an Intelligent Artificial Anal Sphincter System Powered by an Adaptive Transcutaneous Energy Transfer System. Int J Artif Organs 2015; 38:154-60. [DOI: 10.5301/ijao.5000386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 11/20/2022]
Abstract
Objectives The aim of this study was to optimize an intelligent artificial anal sphincter system (AASS) II for patients with severe fecal incontinence. Methods Redesigning and integrating a pressure sensor into the sphincter prosthesis allows us to reduce the sensor volume and makes it suitable for a chronic, ambulatory application. Furthermore, a close-loop frequency control method was designed for the transcutaneous energy transfer system. Finally, a longer working time of the implanted device was obtained by the low-power design of the hardware and software. The new model was implanted in 2 dogs and studied for periods of up to 5 weeks. Results The output voltage induced on the load of 30 Ω, for a variation range in k of 0.12 ~ 0.42, was maintained at approximately 6.8 V with a frequency control range of the 270 ~ 320 kHz. The minimum and maximum output voltages of the pressure sensor were found to be 1.7 V and 2.34 V, respectively, which corresponded to a pressure range of 90 ~ 120 kPa with maximum change rate of approximately 3.7% caused by the temperature variations. Moreover, compared with AASS I, the low-power design resulting in 94% reduction in power consumption. Conclusions The efficacy of the device in achieving continence and sensing the need to defecate was assessed in an animal model. The technical concept and the design of the AASS II turned out to be capable of fulfilling the medical requirements.
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Iantorno G, Cinquetti M, Mazzocchi A, Morelli A, Bassotti G. Audit of constipation in a gastroenterology referral center. Dig Dis Sci 2007; 52:317-20. [PMID: 17211706 DOI: 10.1007/s10620-006-9486-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 06/13/2006] [Indexed: 12/18/2022]
Abstract
This study was designed to assess the various subtypes of functional constipation in a referral gastrointestinal center of a Latino-American country. All patients referred for evaluation of constipation during a 10-year period were audited, and those with functional constipation according to Rome I criteria classified by physiologic tests of colonic transit, as well as tests of anorectal and pelvic floor function. More than 70% of patients with functional constipation had evidence of pelvic floor dysfunction, whereas those with slow transit and constipation-predominant irritable bowel syndrome subtypes were less frequently represented. Even in a setting different from those most frequently reported in the literature, pelvic floor dysfunction represents the most common cause of functional constipation. Simple, physiologic testing is needed and useful for the diagnosis. This fact has therapeutic implications, especially because many such patients may benefit from biofeedback.
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Affiliation(s)
- Guido Iantorno
- Unidad de Motilidad Digestiva, Hospital de Gastroenterologia Dr C Bonorino Udaondo, Buenos Aires, Argentina
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Andromanakos N, Skandalakis P, Troupis T, Filippou D. Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 2006; 21:638-46. [PMID: 16677147 DOI: 10.1111/j.1440-1746.2006.04333.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.
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Affiliation(s)
- Nikolaos Andromanakos
- Second Department of Propedeutic Surgery, Athens University Medical School, Laiko General Hospital, Athens, Greece
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Abstract
This article outlines the normal physiology of the female pelvic floor, including normal urinary storage and voiding, normal colorectal storage, and defecation. Physiologic changes during a woman's lifetime that may affect bladder and bowel function are also considered. An important framework for understanding the normal physiology of the female pelvic floor is provided, so the reader may gain a more thoughtful approach to the recognition and treatment of pelvic floor pathophysiology.
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Affiliation(s)
- C Wester
- Department of Obstetrics and Gynecology, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois, USA
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Ho YH, Tan M, Eu KW, Leong A, Choen FS. Laparoscopic-assisted compared with open total colectomy in treating slow transit constipation. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1997; 67:562-5. [PMID: 9287926 DOI: 10.1111/j.1445-2197.1997.tb02039.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Total colectomy is the procedure of choice when slow transit constipation (STC) can be confidently diagnosed. A laparoscopic-assisted technique (LTC) may be potentially advantageous over traditional open technique (OTC) in the treatment of this benign condition. METHODS A historical control (non-randomized) study was performed on patients diagnosed to have STC after clinical, anorectal physiologic and transit marker studies. All earlier consecutive patients underwent OTC and the latter consecutive patients underwent LTC. The intra-operative time, blood loss, postoperative ileus recovery, duration of hospitalization and complications were recorded. A bowel function and patient satisfaction questionnaire was administered on follow-up. RESULTS Twenty-four of 411 patients were found to have STC; 17 (2 men, 15 women; mean age, 40 (standard error of mean [SEM] 5) years) underwent OTC and 7 (2 men, 5 women; mean age, 39.5 (SEM 6) years) underwent LTC. There were significant improvements in the stool frequency, need for assisted evacuation and abdominal distension (P < 0.05) after both procedures; 96% were fully satisfied with the resulting bowel function. However, OTC patients were less satisfied with the cosmetic outcome (P < 0.05). Intra-operative time for LTC was longer by a mean 74 min (P < 0.05). Postoperative blood loss, recovery of ileus and hospitalization time were the same in both groups. There were no deaths. The complication rates were 43% for LTC and 24% for OTC. The predominant complication was bowel obstruction for which two patients (both OTC) required adhesiolysis. CONCLUSIONS Both OTC and LTC improve bowel function for STC;LTC gives a better cosmetic result, but takes longer to perform.
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Affiliation(s)
- Y H Ho
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Abstract
Chronic constipation is common in the general population, especially in women, in its idiopathic form. However, confusion still surrounds its definition, despite recent efforts to standardize it. Constipation can be divided in two large subgroups-normal transit and slow transit. The have different pathophysiological bases still not completely understood. Most patients respond to simple therapeutic measures aimed at correcting dietary fiber intake and lifestyle. Others, however, need more aggressive treatment, including laxatives, psychological therapy, and biofeedback. In a few patients with intractable constipation, surgery might be indicated to give relief.
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Affiliation(s)
- P Velio
- Cattedra di Gastroenterologia, Università degli Studi di Milano, IRCSS-Ospedale Maggiore di Milano, Italy
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Fink RL, Roberts LJ, Scott M. The role of manometry, electromyography and radiology in the assessment of intractable constipation. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1992; 62:959-64. [PMID: 1456907 DOI: 10.1111/j.1445-2197.1992.tb07654.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An analysis is made of functional studies performed in 96 constipated patients to see how these studies influenced the choice of surgical treatment. All patients underwent anal manometry, and other investigations included colonic transit studies (56), anal sphincter electromyography (42) and defaecatory proctography (34). Additionally nine patients underwent full thickness rectal biopsy. The resting anal canal pressures of the patients studied were lower than controls, and fibre density studies on electromyography were abnormal in half the patients studied suggesting a degree of denervation of the sphincter muscles, which possibly related to chronic straining on the toilet. There was evidence of reduced rectal sensation as shown by an increase in the least perceived volume on balloon distension of the rectum, and in those with megarectum and/or megacolon an increase in maximum tolerated volume. The recto-anal inhibitory reflex was used to screen for adult Hirschsprung's disease, but in one patient the reflex was present despite absence of ganglia on full thickness rectal biopsy indicating the need for biopsy as the definitive diagnostic procedure. Delayed colonic transit using radio opaque markers was a necessary requirement before recommending colectomy, and delayed transit was demonstrated in 34% of the patients studied. Anismus on electromyography was found in 20% of the patients but there was poor correlation with failure of the anorectal angle to widen when bearing down on proctography. The investigations helped in the choice of treatment, but were difficult to interpret. They should be used in severe constipation when surgery is being contemplated.
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Affiliation(s)
- R L Fink
- University Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Bazzocchi G, Difalco A, Bensi G, Lanfranchi GA. The effect of muscarinic blockade on anorectal function in patients with constipation-predominant irritable bowel syndrome. Curr Ther Res Clin Exp 1992. [DOI: 10.1016/s0011-393x(05)80445-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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