1,721,058 research outputs found
Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome.
No full textProspective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome (p.1521-1527) A. Arroyo, F. X. Gonzalez-Argente;, M. Garcia-Domingo, E. Espin-Basany, F. De-la-Portilla, F. Perez-Vicente, R. Calpena Published Online: Oct 21 2008 10:57AM DOI: 10.1002/bjs.6328 Sir, we would like to raise some points on the article by Arroyo et al. on stapled transanal rectal resection (STARR) for obstructive defaecation syndrome (ODS) (1). No psychiatric evaluation was performed, in spite of data showing that 66% of patients with ODS suffer from anxiety or depression (2). The authors operated on 59.1% of patients. This matches with operation rates on constipated patients by others, who also perform STARR, such as 58.1% (3), but contrasts with all the others, who consistently report lower operation rates for constipation, such as 7.3% (4) or 14% (2). Are surgeons who perform STARR, by any chance, over-treating their patients? While the authors state that they referred 75 patients for biofeedback, they did not take into any account, prior to operate on the remaining 104, conservative measures such as colonic irrigation, which has proven successful in a substantial number of constipated patients (5). Indeed, STARR can be effective, but, it is a worryingly invasive and irreversible procedure, bearing a number of complications (6). Sadly, STARR was recently passed off to the general Italian public as a panacea to magically solve a complex condition, such as constipation, ‘with no stitches’ (although, in reality, 56 titanium staples are fired), and ‘without opening’ (7). The authors are to be commended for reporting that in 30-72% of patients with ODS anatomical correction is fruitless (1). For those who consider patients with ODS to suffer more from bowel function than from its anatomy, STARR equals to ‘removing part of a lung to treat asthma or chopping off an arm to treat high blood pressure’ (8). Luigi Basso, Giuseppe Gagliardi*, Mario Pescatori*. University of Rome ‘Sapienza’ 1st Medical School, and * Coloproctology Unit, ‘Ars Medica’ Hospital, Rome, Italy. References 1. Arroyo A, González-Argenté FX, García-Domingo M, Espin-Basany E, De-la-Portilla F, Pérez- Vicente F, Calpena R. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome. Br J Surg 2008; 95: 1521-7. 2. Pescatori M, Spyrou M, Pulvirenti d'Urso A. A prospective evaluation of occult disorders in obstructed defecation using the ¿iceberg diagram¿. Colorectal Dis 2006; 8: 785-9. 3. Boccasanta P, Venturi M, Roviaro G. Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse. A randomized controlled trial. Int J Colorectal Dis 2007; 22: 245-51. 4. Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum 1997; 40: 273-9. 5. Prospective study of colonic irrigation for the treatment of defaecation disorders. Koch SM, Melenhorst J, van Gemert WG, Baeten CG. Br J Surg 2008; 95: 1273-9. 6. Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 2008; 12: 7-19. 7. Pappagallo M. La giungla dei rimborsi. ‘E io opero in Austria’ [The jungle of reimbursements. ‘Hence, I operate in Austria’]. Corriere della Sera (Milan, Italy). 2008 Sep 8: 11. Italian. 8. Phillips RKS. Invited Commentary. Dis Colon Rectum 2004; 47: 1296
Endoanal/endovaginal ultrasound-assisted bilateral partial miotomy of the puborectalis for anismus
No full textAnismus, or non-relaxing puborectalis muscle (PRM), affects 44 % of the patients suffering from obstructed defecation [1]. Biofeedback is considered the first therapeutic option in our unit, but it takes time and the patient needs to be compliant [2, 3]. Partial bilateral myotomy of the PRM is a safe and effective procedure for obstructed defecation due to anismus in selected patients [4]. Our modified minimally invasive approach with two small perianal incisions consists in “blindly” hooking the PRM prior to the myotomy [5]. Concern may arise whether the correct muscle is hooked and divided.
We investigated whether intraoperative ultrasound may help to better identify the PRM, thus avoiding accidental division of the adjacent deep part of the external anal sphincter
Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation
No full textBackground: The STARR double stapling procedure (DSP), i.e. transanal anteroposterior rectotomy, has been recently reported as a low-morbidity and effective operation for the treatment of rectocele and internal rectal mucosal prolapse (R-IMP) causing obstructed defecation. We report the postoperative complications and recurrence of symptoms following this novel operation. Patients and methods: Fourteen chronically constipated women with R-IMP, aged 36-72 years, presented with either severe complications or recurrence of symptoms following DSP performed by means of two circular staplers. All were followed for a median period of 12 months (range, 2-24) after DPS. Results: Severe rectal bleeding occurred in two cases postoperatively. Persistent severe anal pain was reported by seven patients, all presenting with anxiety. Four of them were multiparous. Three patients had fecal incontinence, both had vaginal deliveries. R-IMP recurred in six, obstructed defecation in seven cases. Four patients needed reintervention, one for suturing the bleeding area, one excising the recurrent prolapse, one for colpocele and one for rectal stricture. Four patients required biofeedback training for non-relaxing puborectalis and two needed psychotherapy. Conclusion: Parity, spastic floor syndrome and psychoneurosis seem to be the risk factors predisposing to failure of DSP, which may be followed by severe complications and early recurrence of symptoms requiring reoperation
Intestinal obstruction requiring fecal diversion due to rectal hematoma following a hemorrhoid laser procedure (HeLP)
No full text35-year-old man had undergone a procedure for prolapse and hemorrhoids (PPH) for advanced hemorrhoids at age 20 and a hemorrhoid laser procedure (HeLP) 18 months prior to presenting with a large bowel obstruction. On examination, the rectum was closed at 6 cm from the anal verge by an extramucosal mass causing stenosis. The patient underwent a Hartmann’s procedure without complications
Rectovaginal fistula after double-stapled transanal rectotomy (STARR) for obstructed defaecation.
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