63 research outputs found
Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse : a randomized controlled trial
No full textPurpose A remarkable incidence of failures after stapled
axopexy (SA) for hemorrhoids has been recently reported
by several papers, with an incomplete resection of the
prolapsed tissue, due to the limited volume of the stapler
casing as possible cause. The stapled transanal rectal
resection (STARR) was demonstrated to successfully cure
the association of rectal prolapse and rectocele by using two
staplers. The aim of this randomized study was to evaluate
the incidence of residual disease after SA and STARR in
patients affected by prolapsed hemorrhoids associated with
rectal prolapse.
Methods Sixty-eight patients were selected on the basis of
validated constipation and continence scorings, clinical
examination, colonoscopy, anorectal manometry, and defecography
and randomized: 34 underwent a SA and 34 a
STARR operation. The operated patients were followed-up
with clinical examination, visual analog scale for postoperative
pain, a satisfaction index, and defecography.
Results At a mean follow-up of 8.1 +/− 2.0 and 7.9 +/−
1.8 months for the SA and STARR groups, respectively, the
incidence of residual disease was significantly higher in the
first group (29.4 vs 5.9 in the STARR group, p=0.007),
while a significantly lower incidence of residual skin-tags
was found after STARR (23.5% vs 58.8 after SA, p=0.03).
All patients with residual disease showed prolapsed tissue
over half the length of the anal dilator at the time of the
operation. Operative time and incidence of transient fecal
urgency were significantly higher in the STARR group
(with p=0.001 and 0.08, respectively), while SA was
followed by a significantly higher incidence of poor results
at the overall patient satisfaction index (p=0.04). No
significant differences were found in hospital stay, operative
complications, postoperative pain, time to return to
normal activity, continence, and constipation scores. All the
defecographic parameters significantly improved after
STARR, while SA was followed only by a trend to a
reduction of rectal prolapse.
Conclusions STARR provides a more complete resection of
the prolapsed tissue than SA in patients with association of
prolapsed hemorrhoids and rectal prolapse with equal
morbidity and significantly lower incidence of residual
disease and skin-tags. The anal dilator can be used for
selecting the surgical techniqu
What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial
No full textPURPOSE: A randomized study was conducted to compare the clinical and functional outcomes of the stapled transanal rectal resection, using the traditional 2 circular staplers and a new, curved stapler device in patients with obstructed defecation caused by rectal intussusception and rectocele. Stapled transanal rectal resection gives good midterm results in patients with obstructed defecation syndrome, but the limited capacity of the casing of the circular stapler and the impossibility to control the positioning of the rectal wall and the firing of staples may result in incomplete removal of the prolapsed tissues, or serious complications. The new curved multifire stapler could avoid these drawbacks.
METHODS: From January to December 2006, 100 women were selected, with clinical examination, constipation score, colonoscopy, anorectal manometry, and perineography, and randomly assigned to 2 groups: 50 patients underwent stapled transanal rectal resection with 2 traditional circular staplers (STARR group) and 50 had the same operation with a new, curved multifire stapler (TRANSTAR group). Patients were followed up with clinical examination, constipation score, and colpocystodefecography, with the recurrence rate as the primary outcome measure.
RESULTS: Recurrence rates at 3 years were 12.0% in STARR group and 0 in the TRANSTAR group (P = .035). Operating time was significantly shorter in the STARR group (P = .008). Complications were 2 bleeds (4%) in the STARR group and 1 tear of the vagina in the TRANSTAR group. The incidence of fecal urgency was 34.0% in the STARR group and 14.0% in the TRANSTAR group (P = .035). All symptoms and defecographic parameters significantly improved after the operation (P < .001) without differences between groups.
CONCLUSIONS: The curved Contour Transtar stapler device did not appear to offer significant advantages over the traditional PPH-01 device during the operation or in the clinical and functional outcomes. However, the lower incidence of fecal urgency and recurrences might justify the higher cost of the new stapler
La malattia diverticolare del colon : quando il trattamento chirurgico? Aspetti tecnici dell’approccio chirurgico
No full textImpact of new technologies on the clinical and functional outcome of Altemeier's procedure : a randomized, controlled trial
No full textPURPOSE: A randomized study was performed to assess whether new technologies offer advantages over the conventional technique on the clinical and functional outcome of patients with full-thickness rectal prolapse and fecal incontinence, submitted to Altemeier's procedure with levatorplasty. METHODS: Between January 1999 and December 2003, 58 patients (55 females; mean age, 70.9 +/- 11.3 years) with full-thickness rectal prolapse were evaluated with continence score, colonoscopy, anorectal manometry, anal electromyography, and sacral reflex latency; 40 of them were selected and randomly assigned to two groups: 20 patients (Group 1; 19 females, 73.4 +/- 10.4 years) were submitted to a conventional operation with monopolar electrocautery and handsewn anastomosis, and 20 (Group 2; 18 females, 71.5 +/- 12.2 years) using harmonic scalpel and circular stapler. Patients were followed up with clinical examination, anorectal manometry, and anal electromyography, with mean follow-up 29.3 +/- 8.5 and 27.5 +/- 9.2 months in Groups 1 and 2, respectively. RESULTS: Operative time, blood loss, and hospital stay were significantly reduced in Group 2 (P < 0.001), whereas no differences were found in pain score, time to return to normal activity, morbidity, and mortality. Complications were two (10 percent) stenosis in Group 1. Fecal continence score significantly improved in both groups (P < 0.01), whereas anorectal manometry and neurophysiologic data were not significantly modified by the operation. Recurrence rates were 15 and 10 percent in Groups 1 and 2, respectively (P= not significant). CONCLUSIONS: The clinical and functional long-term results of perineal rectosigmoidectomy with levatorplasty are not influenced by surgical instruments and type of coloanal anastomosis. The clinical relevance of the short-term results in high-risk patients should be specifically investigated
A new cure for pudendal neuralgia: preliminary results
No full textBackground Pudendal neuralgia is an increasing multifactorial condition, involving severe and chronic pain along the course of pudendal nerve, with heavy impact on patient’s quality of life. Current therapies include multianalgesic therapy, nerve blocks, surgery and neuromodulation, with controversial results, particu- larly in the long-term period, and possible side effects. With the aim of successfully treating pudendal neuralgia, avoiding a surgical decompression and the side effects of medical therapy we did a new operation, consisting of transperineal injection of adipose tis- sue with staminal cells in the Alcock’s channel. Methods Fifteen women with pudendal neuralgia not responsive to 3 monthsmedical therapy were examined clinically, with VAS score, vali- dated SF-36 Health Survey questionnaire, and pudendal nerve motor terminal latency (PNMTL). All patients were operated on by multiple transperineal injections of autologous adipose tissue with staminal cells, using the Coleman’s lipostructure technique. Clinical examinations with VAS, SF36 and PNMTL were scheduled during 12 months follow-up, with the incidence of pain recurrence (VAS [ 5) as primary outcome measure. Appropriate tests were used for statistics. Results All patients had preoperative signs of pudendal neuropathy with increase of nerve latency. Twelve patients completed the follow up protocol. There was no mortality and no complications. Two patients had no pain improvement and continued to use analgesic drugs. At 12 months VAS significantly improved (3.2 ± 0.9 vs 8.1 ± 1.2 preoperative, P \ 0.001) as well
as SF36 (75.5, with range 71–80, vs 85, with range 82–89, pre- operative, P \ 0.01), while PNMTL showed a not significant trend to a better nerve conduction (2.4 ± 0.04 vs 2.5 ± 0.03 preopera- tive, P = NS). Conclusions The new technique is easy and complication-free, with significant improvement of symptoms in the short period. A larger study with appropriate controls and longer follow-up is now needed to assess its real effectiveness. Reasons for the gap between clinical and functional results need further study
Stapoled anopexy VS double stapled transanal rectal resection in circular external recto.anal prolapse associated with non reducible prolapsed hemorrhoids and anoderma. Preliminary report
No full textStapled transanal rectal resection in solitary rectal ulcer associated with prolapse of the rectum: a prospective study
No full textPURPOSE : At present, none of the conventional surgical treatments of solitary rectal ulcer associated with internal rectal prolapse seems to be satisfactory because of the high incidence of recurrence. The stapled transanal rectal resection has been demostrated to successfully cure patients with internal rectal prolapse associated with rectocele, or prolapsed hemorrhoids. This prospective study was designed to evluate the short-term and long-term results of stapled transanal rectal resection in patients affected by solitary rectal ulcer associated with internal rectal prolapse and nonresponders to biofeedback therapy.
METHODS: Fourteen patients were selected on the basis of validated constipation and continence scorings, clinical examination, anorectal manometry, defecography, and colonoscopy and were submitted to biofeedback therapy. Ten nonresponders were operated on and followed up with incidence of failure, defined as no improvement of synptoms and/or recurrence of rectal ulceration, as the primary outcome measure. Operative time, hospital stay, postoperative pain, time to return to normal activity, overall patient satisfaction index, and presence of residual rectal prolapse also were evaluated.
RESULTS: At a mean follow-up of 27.2 (range, 24-34)months symptoms significantly improved, with 80 percent of excellent/good results and none of the ten operated patients showed a recurrence of rectal ulcer. Operative time, hospital stay, and time to return to normal activity were similar to those reported after stapled transanal rectal resection for obstructed defecation, whereas postoperative pain was slightly higher. One patient complained of perineal abscess,requiring surgery.
DISCUSSION: The stapled transanal rectal resection is safe and effective in the cure of solitary rectal ulcer associated with internal rectal prolapse, with minimal complications and no recurrences after two years. Randomized trials with sufficient number of patients are necessary to compare the efficacy of stapled transanal rectal resection with the traditional surgical treatments of this rare condition
[Treatment of acute symptoms of hemorrhoid disease with high-dose oral O-(beta-hydroxyethyl)-rutosides]
No full textThe pharmacological treatment is widely used in the therapy of haemorrhoids. An efficient treatment is particularly useful in case of haemorrhoids of 2nd, 3rd and 4th degree, when phlogosis, oedema and pain are present. Forty patients were treated with either O-(beta-hydroxyethyl)-rutosides (4 g/day orally) or placebo in a double blind randomized comparative trial. The groups of treatment were homogeneous. O-(beta-hydroxyethyl)-rutosides induced a statistically significant reduction of pain and bleeding; placebo did not induce any significant improvement. Tolerability was good and similar for both treatments. It has never been necessary to stop treatment for side effects. The results obtained in this study confirm the usefulness on administering an oral treatment, and not only a local treatment, to patients with acute symptoms of haemorrhoids, both in case of intermittent treatment and in case it is used to prepare quickly the patient for surgery
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