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Alavi K, Thorsen AJ, Fang SH, Burgess PL, Trevisani G, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Evaluation and Management of Chronic Constipation. Dis Colon Rectum 2024; 67:1244-1257. [PMID: 39250791 DOI: 10.1097/dcr.0000000000003430] [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] [Indexed: 09/11/2024]
Affiliation(s)
- Karim Alavi
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Amy J Thorsen
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Sandy H Fang
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Sciences University, Portland, Oregon
| | - Pamela L Burgess
- Colon and Rectal Surgery, M Health Fairview Southdale Hospital, Minneapolis, Minnesota
| | - Gino Trevisani
- Colon and Rectal Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - Amy L Lightner
- Department of Surgery, Scripps Clinic Medical Group, La Jolla, California
| | - Daniel L Feingold
- Division of Colon and Rectal Surgery, Department of Surgery, Rutgers University, New Brunswick, New Jersey
| | - Ian M Paquette
- Department of Surgery Section of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
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Andreoli R, Zampieri N, Orlandi S, Geccherle A, Castellani RL. Long time consequences after STARR procedure: Report of 15 years experience and medico-legal perspective. Am J Surg 2024; 229:169-173. [PMID: 38042721 DOI: 10.1016/j.amjsurg.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/28/2023] [Accepted: 11/11/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Stapled transanal rectal resection is the most surgical procedure used for obstructed defecation syndrome, rectal prolapse, rectocele and rectal intussusception worldwide. The aim of this study is to report our experience and long time consequences and to offer a new medico-legal perspective. MATERIALS AND METHODS We retrospective review medical charts of patients treated between 2006 and 2021 b y the same team directed by the same senior surgeon. We consider major complications and long time sequelaeses as main object for the discussion. Inclusion and exclusion criteria were created. IRB approved the study. After revision a medico-legal perspective was done based on major complications. RESULTS During the study period 1726 patients, ages between 18 and 71 years old, were treated with 1280 STARR procedures and 446 "Longo" [was stopped on 2012]; all procedures were performed by the senior surgeon and visited by the team at the same control visit at 7days, 30 days and 12 and 18 months after surgery. All patients had 100 % compliance at 30 days, while 85 % had long time visit (more than 18 months). During the study period 6 % (104 subjects) of patients had minor complications while 1 patient (42 yrs female) reported total fecal incontinence after 18 months (0,05 %). This patient had mental disorder treated with drugs unknown before surgery and long time mental disorder after surgery. We focused on this last case to discuss long time complication DISCUSSION: This survey reports some interesting clinical data; respect to standard complications minor complications such as pain, bleeding and anal discomfort represent less than 10 % of procedures that is a good results in this perineal surgery. For those working with rectal mucosal prolapse, obstructed defecation syndrome, rectocele or rectal intussusception is essential to distinguish these diagnosis to have a good counselling with patient before surgery (at least 1 month before). It is essential to check these patients with a close follow-up especially after surgery, to avoid any other mental discomfort related to fecal incontinence; long time fecal incontinence, without anatomical disorders as our case, could be associated and related to drugs consumption or mental disorder, or perineal insensitivity due to surgical procedure. In conclusion it is essential to have good clinical practice to suggest STARR procedure, having idea about different diseases, different surgical approaches and different long time complications.
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Affiliation(s)
- Remo Andreoli
- Recto-intestinal Operative Unit, Sacro Cuore-Don Calabria Hospital, Scientific Institute of Research and Care - Negrar di Valpolicella, Verona, Italy
| | - Nicola Zampieri
- Woman and Child Hospital, University of Verona, Pediatric Surgical Unit, Department of Engineering for Innovation Medicine, Verona, Italy; Recto-intestinal Operative Unit, Sacro Cuore-Don Calabria Hospital, Scientific Institute of Research and Care - Negrar di Valpolicella, Verona, Italy.
| | - Simone Orlandi
- Recto-intestinal Operative Unit, Sacro Cuore-Don Calabria Hospital, Scientific Institute of Research and Care - Negrar di Valpolicella, Verona, Italy
| | - Andrea Geccherle
- Recto-intestinal Operative Unit, Sacro Cuore-Don Calabria Hospital, Scientific Institute of Research and Care - Negrar di Valpolicella, Verona, Italy
| | - Roberto L Castellani
- Surgical and Emergency Departement, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy; Recto-intestinal Operative Unit, Sacro Cuore-Don Calabria Hospital, Scientific Institute of Research and Care - Negrar di Valpolicella, Verona, 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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Oruc M, Erol T. Current diagnostic tools and treatment modalities for rectal prolapse. World J Clin Cases 2023; 11:3680-3693. [PMID: 37383136 PMCID: PMC10294152 DOI: 10.12998/wjcc.v11.i16.3680] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
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Affiliation(s)
- Mustafa Oruc
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Timucin Erol
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
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Ripamonti L, Guttadauro A, Lo Bianco G, Rennis M, Maternini M, Cioffi G, Chiarelli M, De Simone M, Cioffi U, Gabrielli F. Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review. Front Surg 2022; 9:790287. [PMID: 35237648 PMCID: PMC8882820 DOI: 10.3389/fsurg.2022.790287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo introduced a minimal invasive trans-anal approach known as Stapled Trans-Anal Rectal Resection (STARR) in order to correct mechanical disorders such as rectocele or rectal intussusception, two conditions present in more than 90% of patients with ODS. Considering the lack of a common view around ODS and STARR procedure. the aim of our study is to review the literature about preoperative assessment, operative features and outcomes of the STARR technique for the treatment of ODS. We performed a systematic search of literature, between January 2008 and December 2020 and 24 studies were included in this review. The total number of patients treated with STARR procedure was 4,464. In conclusion STARR surgical procedure has been proven to be safe and effective in treating symptoms of ODS and improving patients Quality of Life (QoL) and should be taken in consideration in the context of a holistic and multi modal approach to this complex condition. International guidelines are needed in order to optimize the diagnostic and therapeutic process and to improve outcomes.
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Affiliation(s)
- Lorenzo Ripamonti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
| | - Giulia Lo Bianco
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Maria Rennis
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Maternini
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, University of Sannio RCOST, Benevento, Italy
| | - Marco Chiarelli
- Department of Surgery, Ospedale Alessandro Manzoni, ASST Lecco, Lecco, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Francesco Gabrielli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
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Landolfi V, Brusciano L, Gambardella C, Tolone S, Del Genio G, Grossi U, Gualtieri G, Lucido FS, Docimo L. Long-Term Outcomes of Sectorial Longitudinal Augmented Prolapsectomy for Asymmetric Muco-hemorrhoidal Prolapse: An Observational Study of 433 Consecutive Patients. Surg Innov 2021; 29:27-34. [PMID: 33830810 DOI: 10.1177/15533506211007292] [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] [Indexed: 12/16/2022]
Abstract
PURPOSE Hemorrhoidal disease (HD) is a widespread condition severely influencing patients' quality of life. Recently, the large diffusion of stapled hemorrhoidopexy has revealed a new unexpected pathological entity: the asymmetric mucosal prolapse. We aimed to assess the outcomes of the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse, in terms of HD symptoms, prolapse recurrence, and rectal stenosis. METHODS Patients affected by III-IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP of 1 or 2 hemorrhoidal columns (SLAP1 or SLAP2) were retrospectively assessed. The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery. Mean outcome was evaluation of medium-long-term outcomes as the occurrence of recurrence and anal or rectal stenosis. Secondary outcome was the evaluation of postoperative bleeding, reoperation rate, length of hospitalization, fecal urgency, and time to return to work. RESULTS We enrolled 433 patients (277 SLAP1 and 156 SLAP2). Hemorrhoidal symptoms recurrence was reported in 9 patients undergone SLAP1 and 4 patients undergone SLAP2, while prolapse recurrence occurred, respectively, in 4 and 2 patients. No major intraoperative complications occurred. An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2. Fecal incontinence occurred in 8 and 4 cases of patients treated with SLAP1 and SLAP2. CONCLUSIONS The combination of a simple hemorrhoidectomy to a mucosal rectal prolapsectomy should be part of every coloproctologist background. Promising and satisfying results can be achieved using SLAP for HD associated with asymmetric prolapse.
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Affiliation(s)
- Vincenzo Landolfi
- Division of General Surgery, "Agostino Landolfi Hospital" of Solofra, Avellino, Italy
| | - Luigi Brusciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Gambardella
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Tolone
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianmattia Del Genio
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ugo Grossi
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgia Gualtieri
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Saverio Lucido
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ludovico Docimo
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
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Pagano C, Venturi M, Benegiamo G, Melada E, Vergani C. Mucopexy-Recto Anal Lifting (MuRAL) in managing obstructed defecation syndrome associated with prolapsed hemorrhoids and rectocele: preliminary results. Ann Surg Treat Res 2020; 98:277-282. [PMID: 32411633 PMCID: PMC7200604 DOI: 10.4174/astr.2020.98.5.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Treatment of rectocele associated with prolapsed hemorrhoids is a debated topic. Transanal stapling achieved good midterm results in patients with symptoms of obstructed defecation, nevertheless a number of severe complications have been reported. The aim of this study was to evaluate the safety and efficacy of a new endorectal manual technique in patients with obstructed defecation due to the combination of muco-hemorrhoidal prolapse and rectocele. Methods Patients enrolled after preoperative obstructed defecation syndrome (ODS) score, defecography and anoscopy were submitted to the novel Mucopexy-Recto Anal Lifting (MuRAL) combined with a modified Block procedure, and followed up by independent observers with digital exploration 3 weeks postoperatively, and digital exploration plus anoscopy at 3, 6, and 12 months. Operative time, hospital stay, numerating rating scale (NRS), ODS, satisfaction scores, and recurrence rate were recorded. Results Mean operative time was 35.7 minutes. Fifty-six patients completed 1-year follow-up: 7.1% had acute urinary retention, NRS score was < 3 from the third postoperative day, mean time of daily activity resumption was 12 days, none had persistent fecal urgency, 82% declared excellent/good satisfaction score, significant improvement of 6- and 12-month ODS score, no recurrence of rectocele, and 7.1% recurrence of prolapsed hemorrhoids were observed. Conclusion MuRAL associated with modified Block technique gave no severe complications and resulted in a safe and effective approach to symptomatic rectocele associated with muco-rectal prolapse. Further randomized studies, larger series, and longer follow-up are needed.
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Affiliation(s)
- Claudio Pagano
- General Surgery Unit, Vizzolo Predabissi Hospital, ASST Milano-Martesana, Vizzolo Predabissi (MI), Italy
| | - Marco Venturi
- Day/Week Surgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Guido Benegiamo
- General Surgery Unit, Vizzolo Predabissi Hospital, ASST Milano-Martesana, Vizzolo Predabissi (MI), Italy
| | - Ernesto Melada
- Day/Week Surgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Contardo Vergani
- Day/Week Surgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
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Ripamonti L, Maternini M, Guttadauro A. Non-operative management of intra-abdominal bleeding and retroperitoneal hematoma after stapling procedure for prolapsed hemorrhoids. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04935-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Grimes CL, Schimpf MO, Wieslander CK, Sleemi A, Doyle P, Wu YM, Singh R, Balk EM, Rahn DD. Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations. Int Urogynecol J 2019; 30:1433-1454. [PMID: 31256222 DOI: 10.1007/s00192-019-04001-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Several posterior compartment surgical approaches are used to address posterior vaginal wall prolapse and obstructed defecation. We aimed to compare outcomes for both conditions among different surgical approaches. METHODS A systematic review was performed comparing the impact of surgical interventions in the posterior compartment on prolapse and defecatory symptoms. MEDLINE, Embase, and ClinicalTrials.gov were searched from inception to 4 April 2018. Randomized controlled trials, prospective and retrospective comparative and single-group studies of women undergoing posterior vaginal compartment surgery for vaginal bulge or bowel symptoms were included. Studies had to include both anatomical and symptom outcomes both pre- and post-surgery. RESULTS Forty-six eligible studies reported on six surgery types. Prolapse and defecatory symptoms improved with native-tissue transvaginal rectocele repair, transanal rectocele repair, and stapled transanal rectocele repair (STARR) surgeries. Although prolapse was improved with sacrocolpoperineopexy, defecatory symptoms worsened. STARR caused high rates of fecal urgency postoperatively, but this symptom typically resolved with time. Site-specific posterior repairs improved prolapse stage and symptoms of obstructed defecation. Compared with the transanal route, native-tissue transvaginal repair resulted in greater improvement in anatomical outcomes, improved obstructed defecation symptoms, and lower chances of rectal injury, but higher rates of dyspareunia. CONCLUSIONS Surgery in the posterior vaginal compartment typically has a high rate of success for anatomical outcomes, obstructed defecation, and bulge symptoms, although these may not persist over time. Based on this evidence, to improve anatomical and symptomatic outcomes, a native-tissue transvaginal rectocele repair should be preferentially performed.
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Affiliation(s)
- Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA.
| | - Megan O Schimpf
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Cecilia K Wieslander
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Paula Doyle
- Department of Obstetrics and Gynecology, Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - You Maria Wu
- Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada
| | - Ruchira Singh
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Shao Y, Fu YX, Wang QF, Cheng ZQ, Zhang GY, Hu SY. Khubchandani’s procedure combined with stapled posterior rectal wall resection for rectocele. World J Gastroenterol 2019; 25:1421-1431. [PMID: 30918434 PMCID: PMC6429338 DOI: 10.3748/wjg.v25.i11.1421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/17/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obstructed defecation syndrome (ODS) is a widespread disease in the world. Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection (STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.
AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani’s procedure with stapled posterior rectal wall resection.
METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients (group A) underwent Khubchandani’s procedure with stapled posterior rectal wall resection and 51 patients (group B) underwent the STARR procedure. Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.
RESULTS In group A, 42 patients underwent Khubchandani’s procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min (group A) vs 39.24 ± 6.53 min (group B). Mean hospital stay was 3.15 ± 0.70 d (group A) vs 3.14 ± 0.54 d (group B). Mean blood loss was 10.91 ± 2.52 mL (group A) vs 10.14 ± 1.86 mL (group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was 17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm (group A) vs 4.18 ± 0.95 cm (group B) preoperatively to 1.19 ± 0.43 cm (group A) vs 1.54 ± 0.82 cm (group B) one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients’ (30/34, 88.2%) final outcomes were judged as effective and 4 (4/34, 11.8%) as moderate in group A, whereas in group B, 30 (30/37, 81.1%) patients’ outcomes were judged as effective, 5 (5/37, 13.5%) as moderate, and 2 (2/37, 5.4%) as poor.
CONCLUSION Khubchandani’s procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.
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Affiliation(s)
- Yi Shao
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yong-Xing Fu
- Department of Neonatal Medicine, Yidu Central Hospital of Weifang, Weifang 262500, Shandong Province, China
| | - Qing-Fa Wang
- Department of Neonatal Medicine, Yidu Central Hospital of Weifang, Weifang 262500, Shandong Province, China
| | - Zhi-Qiang Cheng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Guang-Yong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - San-Yuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
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11
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Giarratano G, Toscana C, Toscana E, Shalaby M, Sileri P. Stapled transanal rectal resection for the treatment of rectocele associated with obstructed defecation syndrome: a large series of 262 consecutive patients. Tech Coloproctol 2019; 23:231-237. [PMID: 30778786 DOI: 10.1007/s10151-019-01944-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aims to investigate functional results and recurrence rate after stapled transanal rectal resection (STARR) for rectocele associated with obstructive defection syndrome (ODS). METHODS A study was conducted on patients with ODS symptoms associated with symptomatic rectocele ≥ 3 cm on dynamic defecography who had STARR at our institution between 01/2007 and 12/2015. Data were prospectively collected and analyzed. ODS was evaluated using the Wexner constipation score. Primary outcomes were functional results, determined by the improvement in 6-month postoperative Wexner constipation score, and 1-year recurrence. Secondary outcomes were operative time, time to return to work, pain intensity measured using the visual analogue scale (VAS), patient satisfaction, and overall postoperative morbidity and mortality at 30 days. RESULTS Two-hundred-sixty-two consecutive female patients [median age 54 years (range 20-78)] were enrolled in the study. The median duration of follow-up was 79 months (range 30-138). Sixty (23%) patients experienced postoperative complications, but only 9 patients required reinterventions for surgical hemostasis (n = 7), fecal diversion for anastomotic leakage (n = 1), and recto-vaginal fistula repair (n = 1). Only 1 intraoperative complication (stapler misfire) was reported, and there were no deaths. There was a statistically significant (p < 0.001) reduction in the median (range) Wexner constipation score from 19 (14-24) preoperatively to 9 (5-15) 6 months postoperatively. Only 10 (4%) patients experienced recurrence and only 3 of them required additional reintervention. Patient satisfaction at 1 year was excellent in 86%, good in 13%, and poor in 1% of patients. CONCLUSIONS STARR is a safe, effective, and minimally invasive technique for the treatment of rectocele associated with ODS.
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Affiliation(s)
- G Giarratano
- Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy
| | - C Toscana
- Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy
| | - E Toscana
- Department of General Surgery, Villa Tiberia Hospital, Via Emilio Praga, 26, 00100, Rome, Italy.
| | - M Shalaby
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University, Mansoura, Dakahlia, Egypt.,Department of General Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
| | - P Sileri
- Department of General Surgery, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy
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Schiano di Visconte M, Nicolì F, Pasquali A, Bellio G. Clinical outcomes of stapled transanal rectal resection for obstructed defaecation syndrome at 10-year follow-up. Colorectal Dis 2018; 20:614-622. [PMID: 29363847 DOI: 10.1111/codi.14028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/15/2018] [Indexed: 01/06/2023]
Abstract
AIM The long-term efficacy of stapled transanal rectal resection (STARR) for surgical management of obstructed defaecation syndrome (ODS) has not been evaluated. Therefore, we investigated the long-term efficacy (> 10 years) of STARR for treatment of ODS related to rectocele or rectal intussusception and the factors that predict treatment outcome. METHOD This study was a retrospective cohort analysis conducted on prospectively collected data. Seventy-four consecutive patients who underwent STARR for ODS between January 2005 and December 2006 in two Italian hospitals were included. RESULTS Seventy-four patients [66 women; median age 61 (29-77) years] underwent STARR for ODS. No serious postoperative complications were recorded. Ten years postoperatively, 60 (81%) patients completed the expected follow-up. Twenty-three patients (38%) reported persistent perineal pain and 13 (22%) experienced the urge to defaecate. ODS symptoms recurred in 24 (40%) patients after 10 years. At the 10-year follow-up, 35% of patients were very satisfied and 28% would recommend STARR and undergo the same procedure again if necessary. In contrast, 21% of patients would not select STARR again. Previous uro-gynaecological or rectal surgery and high constipation scores were identified as risk factors for recurrence. CONCLUSIONS Stapled transanal rectal resection significantly improves the symptoms of ODS in the short term. In the long term STARR is less effective, however.
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Affiliation(s)
- M Schiano di Visconte
- Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, 'S. Maria dei Battuti' Hospital, Conegliano, Italy
| | - F Nicolì
- Department of General Surgery, 'S. Valentino' Hospital, Montebelluna, Italy
| | - A Pasquali
- Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, 'S. Maria dei Battuti' Hospital, Conegliano, Italy
| | - G Bellio
- Department of General Surgery, Colorectal and Pelvic Floor Diseases Center, 'S. Maria dei Battuti' Hospital, Conegliano, Italy
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