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Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders

World Journal of Gastroenterology 2011年第37期17卷 4199-4205页

作者： Ivano Biviano Danilo Badiali Laura Candeloro Fortunée Irene Irene Habib Massimo Mongardini Angelo Caviglia Fiorella Anzini Enrico S Corazziari Department of Medicine and Medical Specialties SAPIENZA RomeUniversity 00161 Rome Italy Department of Surgical Sciences Division of General Surgery L SAPIENZA Rome University 00161Rome Italy Departmental Operative Unit of Colonproctology Hospital San Camillo-Forlanini 00161 Rome Italy

AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of ***:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for *** comparable patients(Female,30;age 53 ± 13 years),who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol,were *** were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment.A responder was def ined as an absence of the Rome Ⅲ diagnostic criteria for functional *** and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients,***:After STARR,53% of patients were responders;during conservative treatment,75% were *** STARR,30% of the patients reported the use of laxatives,17% had intermittent anal pain,13% had anal leakage,13% required digital facilitation,6% experienced defecatory urgency,6% experienced fecal incontinence,and 6% required *** macrogol therapy,23% of the patients complained of abdominal bloating and 13% of borborygmi,and 3% required digital *** preoperative symptom,defecographic,or manometric finding predicted the outcome of ***-operative defecography showed a statistically significant reduction(P rectal diameter and *** postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified,and that rectal compliance was reduced(P = 0.01).CONCLUSION:STARR is not better and is less safe than macrogol in the treatment of defecation *** could be considered as an alternative therapy in patien

关键词： Constipation Obstructed defecation Rectocele rectal intussusception stapled trans-anal rectal resection

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Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation(Part Ⅱ:Treatment)

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World Journal of Gastroenterology 2012年第14期18卷 4994-5013页

作者： Antonio Bove Massimo Bellini Edda Battaglia Renato Bocchini Dario Gambaccini Vincenzo Bove Filippo Pucciani Donato Francesco Altomare Giuseppe Dodi Guido Sciaudone Ezio Falletto Vittorio Piloni Gastroenterology and Endoscopy Unit Department of GastroenterologyAORN "A.Cardarelli"80131 NaplesItaly Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa56100 PisaItaly Gastroenterology and Endoscopy Unit Cardinal Massaja Hospital14100 AstiItaly Gastroenterology Unit M.Bufalini Hospital47023 CesenaItaly Department of Medical and Surgical Critical Care University of Florence50141 FlorenceItaly Department of Emergency and Organ transplantation University of Bari70124 BariItaly Department of Oncological and Surgical Sciences University of Padua35126 PaduaItaly Division of General and Geriatric Surgery Second University of Naples80131 NaplesItaly Sixth Division of University Surgery Department of General SurgerySan Giovanni Battista Hospital10126 TurinItaly Diagnostic Imaging Centre "N.Aliotta" Villa Silvia-SenigalliaI-60100 AnconaItaly

The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-rectal Surgery reports on the treatment of chronic constipation and obstructed defecation. There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation. Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre. Osmotic laxatives may be effective in patients who do not respond to fibre supplements. Stimulant laxatives should be re- served for patients who do not respond to osmotic laxatives. Controlled trials have shown that serotonin- ergic enterokinetic agents, such as prucalopride, and prosecretory agents, such as lubiprostone, are effec- tive in the treatment of patients with chronic constipa- tion. Surgery is sometimes necessary. Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coil who are resistant to medical therapy and who do not have defecatory disorders, generalised motility disorders or psychological disorders. Randomised controlled trials have established the efficacy of rehabilitative treat- ment in dys-synergic defecation. Many surgical proce- dures may be used to treat obstructed defecation in patients with acquired anatomical defects, but none is considered to be the gold standard. Surgery should be reserved for selected patients with an impaired quality of life. Obstructed defecation is often associated with pelvic organ prolapse. Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse, but the efficacy and safety of such procedures have not yet been established.

关键词： Laxatives Prokinetics Biofeedback Pelvicfloor rehabilitation Outlet obstruction stapled trans-anal rectal resection Delorme operation Colectomy Pelvic organ prolapse Mesh

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