1
|
Drezdzon MK, Peterson CY. Anorectal Emergencies. Surg Clin North Am 2023; 103:1153-1170. [PMID: 37838461 DOI: 10.1016/j.suc.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Anorectal emergencies are rare presentations of common anorectal disorders, and surgeons are often called on to assist in their diagnosis and management. Although most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure, surgeons must also be able to identify surgical anorectal emergencies, such as gangrenous rectal prolapse. This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess and unique situations including rectal foreign body and anorectal sexually transmitted infections.
Collapse
Affiliation(s)
- Melissa K Drezdzon
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin
| | - Carrie Y Peterson
- Division of Colorectal Surgery, Medical College of Wisconsin, HCM A6303, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| |
Collapse
|
2
|
Haberal E, Yarbuğ Karakayalı F, Karakaya E. Concurrence of rectocoele and anal incontinence, and outcome of their simultaneous surgical correction. Trop Doct 2021; 51:573-577. [PMID: 34334007 DOI: 10.1177/00494755211032497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rectocoele and faecal incontinence coexist in most patients. We determined an excellent one-year outcome of simultaneous repair of the former and correction of the latter can be achieved.
Collapse
Affiliation(s)
- Elifcan Haberal
- MD, Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Feza Yarbuğ Karakayalı
- MD Professor, Department of General Surgery, School of Medicine, Başkent University, İstanbul, Turkey
| | - Emre Karakaya
- MD, Assistant Professor, Department of General Surgery, School of Medicine, Başkent University, Ankara, Turkey
| |
Collapse
|
3
|
Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2018.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractThe aim of this study was to evaluate the published professional association guidelines regarding the current diagnosis and treatment of functional intestinal constipation in adults and to compare those guidelines with the authors’ experience to standardize actions that aid clinical reasoning and decision-making for medical professionals. A literature search was conducted in the Medline/PubMed, Scielo, EMBASE and Cochrane online databases using the following terms: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Conclusively, chronic intestinal constipation is a common condition in adults and occurs most frequently in the elderly and in women. Establishing a precise diagnosis of the physiopathology of functional chronic constipation is complex and requires many functional tests in refractory cases. An understanding of intestinal motility and the defecatory process is critical for the appropriate management of chronic functional intestinal constipation, with surgery reserved for cases in which pharmacologic intervention has failed. The information contained in this review article is subject to the critical evaluation of the medical specialist responsible for determining the action plan to be followed within the context of the conditions and clinical status of each individual patient.
Collapse
|
4
|
Alashmali S. Diarrhea/Constipation. CASES ON MEDICAL NUTRITION THERAPY FOR GASTROINTESTINAL DISORDERS 2021. [DOI: 10.4018/978-1-7998-3802-9.ch004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter will discuss a case of diarrhea/constipation. Diarrhea and constipation are functional bowel disorders (FBDs) of the mid or lower gastrointestinal (GI) tract. These FBDs result from intestinal motility dysfunction and/or changes in intestinal fluid absorption, which in turn leads to bloating, discomfort, and occasionally, abdominal pain. Certain dietary choices aggravate these conditions, leading to serious complications. Management of diarrhea/constipation usually requires the use of medications and/or lifestyle modifications. The presently discussed case involved factors that exacerbated the conditions of diarrhea/constipation. This case serves as an example of the role of medical nutrition therapy in managing FBDs (particularly diarrhea and constipation). Moreover, this case will allow the dietetic professional to assess the causes of diarrhea/constipation in order to plan for the nutrition intervention and educate the patient about the dietary manipulations required to reduce their symptoms.
Collapse
|
5
|
Comparative Efficacy of Drugs for the Treatment of Chronic Constipation: Quantitative Information for Medication Guidelines. J Clin Gastroenterol 2020; 54:e93-e102. [PMID: 31904680 DOI: 10.1097/mcg.0000000000001303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Quantitative information is scarce with regard to guidelines for currently prescribed medications for constipation. Furthermore, these guidelines do not reflect the differences in the number of bowel movements caused by each drug. GOALS In this study, we used a model-based meta-analysis to quantitatively estimate the deviations from the baseline number of spontaneous bowel movements (SBMs) and complete spontaneous bowel movements (CSBMs) associated with pharmacotherapy for chronic constipation to bridge the knowledge gap in the guidelines for current medications. STUDY A comprehensive survey was conducted using literature databases. In this study, we also included randomized placebo-controlled trials on chronic constipation. Pharmacodynamic models were established to describe the time course of the numbers of SBMs and CSBMs produced by each drug. RESULTS Data from 20 studies (comprising 9998 participants and 8 drugs) were used to build this model. The results showed that bisacodyl had the greatest effect on increasing the frequency of bowel movements, whereas plecanatide yielded the lowest increase in the number of SBMs and CSBMs. After eliminating the placebo effect, the maximal increase in bowel movement frequency associated with bisacodyl was 6.8 for SBMs (95% confidence interval: 6.1-7.6) and 4.7 for CSBMs (95% confidence interval: 4.3-5.1) per week. These numbers are ∼4 times higher than the number of bowel movements produced by plecanatide. The change in the frequency of SBMs and CSBMs for other drugs, such as sodium picosulfate, velusetrag, linaclotide, elobixibat, lubiprostone, and prucalopride, was similar. The highest increases in the frequency of SBM and CSBM were 2.5 to 4 and 1 to 2.1 per week, respectively. Bisacodyl had the most noticeable loss of efficacy between week 1 and week 4; it reduced the frequencies of SBMs and CSBMs by 2.3 and 2.2, respectively. By contrast, the changes in the frequencies of SBMs and CSBMs were not as great with other drugs. CONCLUSIONS The data provided in this study may be a valuable supplement to the medication guidelines for the treatment of chronic constipation.
Collapse
|
6
|
Yang YP, Shi J, Zhao ZY, Yu LY, Liu TJ. Subtotal colectomy with antiperistaltic cecosigmoidal anastomosis may be another suitable option for slow transit constipation: Experiences from Chinese people. Medicine (Baltimore) 2020; 99:e19065. [PMID: 32049806 PMCID: PMC7035066 DOI: 10.1097/md.0000000000019065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/20/2019] [Accepted: 01/08/2020] [Indexed: 11/26/2022] Open
Abstract
The objective of this paper is to demonstrate, considering the experiences from Chinese people, if slow transit constipation (STC) can be accurately diagnosed, choosing patients qualifying for surgery, subtotal colectomy with antiperistaltic cecosigmoidal anastomosis (STC-Anti-CSA) may come with more acceptable short and long-term outcomes.A retrospective study was performed at a department of colorectal and anal surgery. A cohort of 29 patients were coming with up to 5 years' follow-up care, who were in a diverse range of age, BMI, laxative medicine histories, including both males and females. Pre-surgery work-up strictly followed a protocol designed to rule out the patients who were not suitable for surgery treatments. Classification of STC was followed after diagnosis. STC-Anti-CSA was performed in all cases. The operative time, blood loss, average post-operative length of stay (LOS), frequency of BMs, stool consistency and patients satisfaction, by using Wexner constipation score (WCS), numerical rating scale (NRS), and abdominal bloating score (ABS), over the study period were recorded.In this study, there were 14 males and 15 females, with mean age 51, and BMI from 20.14 to 31.62 kg/m. The period of laxative medicine history was 4.8 years (2-13 years). The mean operative time was 152 ± 34 min, and the mean perioperative blood loss was 123 ± 51 mL. Average post-operative LOS (LOS) was 8 days. There were no severe post-operative complications, peri-operative mortality, anastomotic leaks, or revisions of the original surgery. Initial post-operative BMs averaged 6 times/day. During the period of 1 month to 12 months follow-up care, BMs fell down to 2 or 3 times/day. By the 1st to 3rd year follow-up care, BMs averaged 5 to 7 times/week. However, from the 4th year to 5th year, constipations recurred somehow. However, most patients were satisfied with their bowel patterns.STC-Anti-CSA can receive acceptable postoperative outcomes as long as the patients can be accurately diagnosed and classified as severe STC. Among the surgical procedures for STC, this procedure may be another suitable option, especially for Chinese people.
Collapse
Affiliation(s)
- Yong-Ping Yang
- Department of General Surgery, The Second Hospital of Jilin University
| | - Jian Shi
- Department of General Surgery, The Second Hospital of Jilin University
| | - Ze-Yun Zhao
- Department of General Surgery, The Second Hospital of Jilin University
| | - Ling-Yun Yu
- Department of General Surgery, The Second Hospital of Jilin University
- Department of Ear Nose and Throat Surgery, The First Hospital of Jilin University, Changchun, China
| | - Tong-Jun Liu
- Department of General Surgery, The Second Hospital of Jilin University
| |
Collapse
|
7
|
Yang Y, Cao YL, Wang WH, Zhang YY, Zhao N, Wei D. Subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy for the treatment of slow transit constipation in an aged population: A retrospective control study. World J Gastroenterol 2018; 24:2491-2500. [PMID: 29930470 PMCID: PMC6010946 DOI: 10.3748/wjg.v24.i23.2491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/05/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the efficacy, improved quality of life, and prognosis in patients undergoing either subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC) or subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) for the treatment of slow transit constipation.
METHODS Between October 2010 and October 2014, aged patients with slow transit constipation who were hospitalized and underwent laparoscopic surgery in our institute were divided into two groups: the bypass group, 15 patients underwent SCBAC, and the bypass plus colostomy group, 14 patients underwent SCBCAC. The following preoperative and postoperative clinical data were collected: gender, age, body mass index, operative time, first flatus time, length of hospital stay, bowel movements (BMs), Wexner fecal incontinence scale, Wexner constipation scale (WCS), gastrointestinal quality of life index (GIQLI), numerical rating scale for pain intensity (NRS), abdominal bloating score (ABS), and Clavien-Dindo classification of surgical complications (CD) before surgery and at 3, 6, 12, and 24 mo after surgery.
RESULTS All patients successfully underwent laparoscopic surgery without open surgery conversion or surgery-related death. The operative time and blood loss were significantly less in the bypass group than in the bypass plus colostomy group (P = 0.007). No significant differences were observed in first flatus time, length of hospital stay, or complications with CD > 1 between the two groups. No patients had fecal incontinence after surgery. At 3, 6, and 12 mo after surgery, the number of BMs was significantly less in the bypass plus colostomy group than in the bypass group. The parameters at 3, 6, 12, and 24 mo after surgery in both groups significantly improved compared with the preoperative conditions (P < 0.05), except NRS at 3, 6 mo after surgery in both groups, ABS at 12, 24 mo after surgery and NRS at 12, 24 mo after surgery in the bypass group. WCS, GIQLI, NRS, and ABS significantly improved in the bypass plus colostomy group compared with the bypass group at 3, 6, 12, and 24 mo after surgery (P < 0.05) except WCS, NRS at 3, 6 mo after surgery and ABS at 3 mo after surgery. At 1 year after surgery, a barium enema examination showed that the emptying time was significantly better in the bypass plus colostomy group than in the bypass group (P = 0.007).
CONCLUSION Laparoscopic SCBCAC is an effective and safe procedure for the treatment of slow transit constipation in an aged population and can significantly improve the prognosis. Its clinical efficacy is more favorable compared with that of SCBAC. Laparoscopic SCBCAC is a better procedure for the treatment of slow transit constipation in an aged population.
Collapse
Affiliation(s)
- Yang Yang
- Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Yong-Li Cao
- Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Wen-Hang Wang
- Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Yuan-Yao Zhang
- Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Nan Zhao
- Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Luoyang 471000, Henan Province, China
| | - Dong Wei
- Institute of Anal-Colorectal Surgery, No. 150 Central Hospital of PLA, Luoyang 471000, Henan Province, China
| |
Collapse
|
8
|
Al-Mozany N, Wright C, O'Grady G, Young CJ, Solomon MJ. Barriers to the management of obstructed defaecation according to colorectal surgeons. Colorectal Dis 2017; 19:649-655. [PMID: 28319316 DOI: 10.1111/codi.13665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022]
Abstract
AIM Obstructed defaecation (OD) has a high prevalence and high disease impact; however, patients often experience suboptimal management. This problem reflects the complex pathophysiology of OD as well as health service delivery factors. This study aimed to identify the factors that act as a barrier to effective management of OD as perceived by specialist colorectal surgeons treating this disorder. METHOD A postal questionnaire was administered to a bi-national sampling of colorectal specialists in Australia and New Zealand who were registered with their specialty society. Questions addressed variables relevant in OD management, including clinical access, decision-making, patient factors and surgeon experience and perceptions, and used Likert scales. Statistical analyses compared surgeon practice variables. RESULTS The response rate was 68.5% (n = 113). Most surgeons managed OD (94%), and preferred to treat OD patients themselves (87%); however, 33% of these respondents were dissatisfied with their management, 46% felt they lacked management expertise and 33% stated they had inadequate expertise in OD investigations. Clinical investigation services were more limited in private than public practice, and many surgeons lacked access to biofeedback (31%). Other barriers included heterogeneity in decision-making by surgeon age and practice location (P < 0.05), dual pathologies (e.g. irritable bowel syndrome) and psychological factors, and limited uptake of multidisciplinary services and standardized (Rome) diagnostic criteria. CONCLUSION Barriers to OD management include surgeon-specific factors, patient-specific factors and healthcare access factors. Increased utilization of pelvic floor and multidisciplinary services, increased training and standardization of OD investigations and improved access to specialist investigations and allied-health management services could improve outcomes for OD.
Collapse
Affiliation(s)
- N Al-Mozany
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - C Wright
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - G O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
9
|
Mearin F, Ciriza C, Mínguez M, Rey E, Mascort JJ, Peña E, Cañones P, Júdez J. Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:332-63. [PMID: 27230827 DOI: 10.17235/reed.2016.4389/2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.
Collapse
Affiliation(s)
| | - Constanza Ciriza
- Aparato Digestivo, Hospital Universitario Doce de Octubre, España
| | | | - Enrique Rey
- Aparato Digestivo, Hospital Clínico San Carlos, España
| | | | | | | | | |
Collapse
|
10
|
Mearin F, Ciriza C, Mínguez M, Rey E, Mascort JJ, Peña E, Cañones P, Júdez J. [Irritable bowel syndrome with constipation and functional constipation in adults: Treatment (Part 2 of 2)]. Aten Primaria 2017; 49:177-194. [PMID: 28238460 PMCID: PMC6875999 DOI: 10.1016/j.aprim.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/12/2017] [Indexed: 12/14/2022] Open
Abstract
In this Clinical practice guide we examine the diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, at the confluence of the spectrum of irritable bowel syndrome and functional constipation. Both fall within the framework of functional intestinal disorders and have major personal, health and social impact, altering the quality of life of the patients affected. The former is a subtype of irritable bowel syndrome in which constipation and altered bowel habit predominate, often along with recurring abdominal pain, bloating and abdominal distension. Constipation is characterised by infrequent or hard-to-pass bowel movements, often accompanied by straining during defecation or the sensation of incomplete evacuation. There is no underlying organic cause in the majority of cases; it being considered a functional bowel disorder. There are many clinical and pathophysiological similarities between the two conditions, the constipation responds in a similar way to commonly used drugs, the fundamental difference being the presence or absence of pain, but not in an "all or nothing" way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, degree of involvement, forms of perception and behaviour. Functional bowel disorders are diagnosed using the Rome criteria. This Clinical practice guide adapts to the Rome IV criteria published at the end of May 2016. The first part (96, 97, 98) examined the conceptual and pathophysiological aspects, alarm criteria, diagnostic test and referral criteria between Primary Care and Gastroenterology. This second part reviews all the available treatment alternatives (exercise, fluid ingestion, diet with soluble fibre-rich foods, fibre supplements, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antdepressants, psychological treatment, acupuncture, enemas, sacral root neurostimulation and surgery), and practical recommendations are made for each.
Collapse
Affiliation(s)
- F Mearin
- Coordinación de la GPC, Comité Roma de Trastornos Funcionales Intestinales, Asociación Española de Gastroenterología (AEG), Centro Médico Teknon, Barcelona, España
| | - C Ciriza
- Grupo de Trastornos Funcionales, Sociedad Española de Patología Digestiva (SEPD), Hospital Universitario Doce de Octubre, Madrid, España
| | - M Mínguez
- AEG y SEPD, Hospital Clínico Universitario, Universitat de Valencia, Valencia, España
| | - E Rey
- SEPD, Hospital Clínico Universitario San Carlos, Madrid, España
| | - J J Mascort
- Secretaría Científica, Sociedad Española de Medicina de Familia y Comunitaria (semFYC), España.
| | - E Peña
- Coordinación de Digestivo, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), España
| | - P Cañones
- Coordinación de Digestivo, Sociedad Española de Médicos Generales y de Familia (SEMG), España
| | - J Júdez
- Departamento de Gestión del Conocimiento, SEPD, España
| |
Collapse
|
11
|
Mearin F, Ciriza C, Mínguez M, Rey E, Mascort J, Peña E, Cañones P, Júdez J. Guía de práctica clínica del síndrome del intestino irritable con estreñimiento y estreñimiento funcional en adultos: tratamiento. (Parte 2 de 2). Semergen 2017; 43:123-140. [DOI: 10.1016/j.semerg.2017.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 12/14/2022]
|
12
|
Serra J, Mascort-Roca J, Marzo-Castillejo M, Delgado Aros S, Ferrándiz Santos J, Rey Diaz Rubio E, Mearin Manrique F. Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.gastre.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
13
|
Thompson JS, Langenfeld SJ, Hewlett A, Chiruvella A, Crawford C, Armijo P, Oleynikov D. Surgical treatment of gastrointestinal motility disorders. Curr Probl Surg 2016; 53:503-549. [PMID: 27765162 DOI: 10.1067/j.cpsurg.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Jon S Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
| | - Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Alexander Hewlett
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | - Dmitry Oleynikov
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
14
|
Shi Y, Chen Q, Huang Y, Ni L, Liu J, Jiang J, Li N. Function and clinical implications of short-chain fatty acids in patients with mixed refractory constipation. Colorectal Dis 2016; 18:803-10. [PMID: 26921846 DOI: 10.1111/codi.13314] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
AIM The present study was designed to investigate the function and clinical implications of stool short-chain fatty acids (SCFAs) in patients with mixed refractory constipation. METHOD Ascending colon specimens obtained from 30 patients with ascending colon cancer were regarded as the control group. Ascending colon specimens obtained from patients with mixed refractory constipation were regarded as the experimental group and were divided into three subgroups, according to Wexner scores [A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996; 39: 681-5] of 16-20, 21-25 and 26-30, with 30 patients in each group. The stool SCFAs were extracted and quantitatively analysed using gas chromatography-mass spectrometry (GC-MS). The expression of G protein-coupled receptor 43 (GPR43) and of choline acetyltransferase (ChAT) were detected by immunofluorescence, reverse transcription-polymerase chain reaction (RT-PCR) and western blotting of colon samples. RESULTS The levels of acetate, propionate and butyrate were significantly lower in the experimental group than in the control group (P < 0.05). Compared with the control group, the densitometric quantification and mean density of GPR43 and ChAT proteins, and expression of GPR43 and CHAT genes, were significantly decreased in the patients with mixed refractory constipation (P < 0.05). CONCLUSION In the patients with mixed refractory constipation, the levels of stool SCFAs, including acetate, propionate and butyrate, as well as the levels of GPR43 and ChAT expressed in the colon, which were all negatively correlated with the Wexner score, were decreased and may be associated with the pathogenesis of mixed refractory constipation.
Collapse
Affiliation(s)
- Y Shi
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Q Chen
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Y Huang
- Research Institute of General Surgery, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing, Jiangsu, China
| | - L Ni
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - J Liu
- Research Institute of General Surgery, Jinling Hospital, Clinical School of Nanjing, Second Military Medical University, Nanjing, Jiangsu, China
| | - J Jiang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - N Li
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| |
Collapse
|
15
|
Clark K, Lam LT, Talley NJ, Quinn J, Blight A, Byfieldt N, Currow DC. Assessing the Presence and Severity of Constipation with Plain Radiographs in Constipated Palliative Care Patients. J Palliat Med 2016; 19:617-21. [DOI: 10.1089/jpm.2015.0451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Katherine Clark
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Lawrence T. Lam
- Discipline of Paediatrics and Child Health, The Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Health and Physical Education, The Hong Kong Institute of Education, Hong Kong, China
| | - Nicholas J. Talley
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Jessica Quinn
- School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Alison Blight
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
| | - Naomi Byfieldt
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
| | - David C. Currow
- Palliative and Supportive Services, Flinders University, Adelaide, Australia
| |
Collapse
|
16
|
Paquette IM, Varma M, Ternent C, Melton-Meaux G, Rafferty JF, Feingold D, Steele SR. The American Society of Colon and Rectal Surgeons' Clinical Practice Guideline for the Evaluation and Management of Constipation. Dis Colon Rectum 2016; 59:479-92. [PMID: 27145304 DOI: 10.1097/dcr.0000000000000599] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
17
|
Serra J, Mascort-Roca J, Marzo-Castillejo M, Delgado Aros S, Ferrándiz Santos J, Rey Diaz Rubio E, Mearin Manrique F. Clinical practice guidelines for the management of constipation in adults. Part 1: Definition, aetiology and clinical manifestations. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:132-141. [PMID: 27048918 DOI: 10.1016/j.gastrohep.2016.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/05/2016] [Indexed: 02/07/2023]
Abstract
Clinical practice guidelines for the management of constipation in adults aim to generate recommendations on the optimal approach to chronic constipation in the primary care and specialized outpatient setting. Their main objective is to provide healthcare professionals who care for patients with chronic constipation with a tool that allows them to make the best decisions about the prevention, diagnosis and treatment of this condition. They are intended for family physicians, primary care and specialist nurses, gastroenterologists and other health professionals involved in the treatment of these patients, as well as patients themselves. The guidelines have been developed in response to the high prevalence of chronic constipation, its impact on patient quality of life and recent advances in pharmacological management. The Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) system has been used to classify the scientific evidence and strengthen the recommendations.
Collapse
Affiliation(s)
- Jordi Serra
- Unitat de Motilitat i Trastorns Funcionals Digestius, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Juanjo Mascort-Roca
- Centro de Asitencia Primaria (CAP) Florida Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, España; Departament de Ciències Clíniques, Campus Bellvitge, Facultat de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Mercè Marzo-Castillejo
- Unitat de Suport a la Recerca- Institut d'Investigació d'Atenció Primària (IDIAP) Jordi Gol Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut; Científico de semFYC, Barcelona, España
| | - Silvia Delgado Aros
- Neuro-Enteric Translational Science (NETS) group coordinator, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-Parc de Salut Mar. Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, España
| | | | - Enrique Rey Diaz Rubio
- Hospital Clínico San Carlos, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Fermín Mearin Manrique
- Servicio de Aparato Digestivo, Instituto de Trastornos Funcionales y Motores Digestivos, Barcelona, España
| |
Collapse
|
18
|
Brown H, Grimes C. Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016; 5:165-171. [PMID: 27547494 DOI: 10.1007/s13669-016-0148-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While it would be our hope to report that there have been significant gains in the understanding of the correlation between the posterior vaginal compartment and defecatory dysfunction in the last year, this is not the case. Instead, we review the highlights of management of posterior vaginal compartment and defecatory dysfunction including 1) defining and understanding the patient's symptoms; 2) considering systemic disorders, motility dysfunction, and mechanical causes that may be contributing; 3) encouraging conservative management as first-line therapy; and 4) recognizing which surgical options are likely to improve specific symptoms. This is then followed by an update on treatment options for fecal incontinence, which we now prefer to refer to as accidental bowel leakage. We are able to report on five exciting and innovative treatment approaches for accidental bowel leakage. As the scientific community increases focus on patient-centered outcomes, we are likely on the verge of having a greater understanding of how treatment options for posterior compartment prolapse and defecatory dysfunction can improve patient symptoms. This year, we can report that strong evidence based recommendations simply do not exist, and this area is ripe for future investigation.
Collapse
Affiliation(s)
- Heidi Brown
- University of Wisconsin-Madison School of Medicine & Public Health, Departments of Obstetrics & Gynecology and Urology, Female Pelvic Medicine & Reconstructive Surgery Section, 600 Highland Avenue, Box 6188 (H4/656), Madison, WI 53792, , Fax:
| | - Cara Grimes
- Columbia University Medical Cnter, Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, 622 West 168 Street, PH 16, Room 127, New York, NY 10032, Phone:212-305-0189
| |
Collapse
|
19
|
Grant MP, Cardin A, O'Connor N, Eastman P. Examining Clinical Utility of Imaging for Inpatient Palliative Care. Am J Hosp Palliat Care 2016; 34:632-636. [PMID: 27006392 DOI: 10.1177/1049909116640524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Medicine in the final months of life is increasingly interventional, both in the manner by which life may be prolonged and symptoms may be reduced. Radiology is frequently utilized to provide diagnostic clarity and improve symptom control. As with any intervention, examining the benefit and potential harms of a procedure is required to establish its role in ongoing clinical care. METHODS This retrospective cohort study involved patients admitted to an inpatient palliative care unit between October 2013 and September 2014. Data were collected using clinical databases manually searched by the researchers. RESULTS Of 388 admissions, there were a total of 154 imaging events completed in 85 patients. Patients who had imaging performed had longer mean length of stays, more likely to be discharged home, and male. Very few imaging events (4%) occurred in the 3 days prior to death and none on the day of death. In total, 43% of imaging confirmed the clinical suspicion and management changed 42% of times. Limbs X-rays and computed tomography brain had low rates of confirming clinical suspicion (21% and 17%) and changing management (21% and 33%). There were a total of 7 complications resulting from imaging, the majority due to interventional procedures. CONCLUSION The use of imaging in inpatient palliative care seems to be of substantive utility, prompting alterations in management in >40% of instances. The majority of imaging occurred prior to the terminal phase of the disease and with few complications.
Collapse
Affiliation(s)
- Matthew Paul Grant
- 1 Department of Medicine, Monash University, Clayton, Victoria, Australia.,2 Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Anthony Cardin
- 3 Department of Palliative Medicine and Radiology, Barwon Health, Geelong, Victoria, Australia
| | - Niamh O'Connor
- 4 Department of Palliative Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Peter Eastman
- 3 Department of Palliative Medicine and Radiology, Barwon Health, Geelong, Victoria, Australia
| |
Collapse
|
20
|
Chahdoura H, Morales P, Barreira JC, Barros L, Fernández-Ruiz V, Ferreira IC, Achour L. Dietary fiber, mineral elements profile and macronutrients composition in different edible parts of Opuntia microdasys (Lehm.) Pfeiff and Opuntia macrorhiza (Engelm.). Lebensm Wiss Technol 2015. [DOI: 10.1016/j.lwt.2015.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
21
|
A prospective comparison of short term results and functional recovery after laparoscopic subtotal colectomy and antiperistaltic cecorectal anastomosis with short colonic reservoir vs. long colonic reservoir. BMC Gastroenterol 2015; 15:30. [PMID: 25887580 PMCID: PMC4367911 DOI: 10.1186/s12876-015-0257-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/26/2015] [Indexed: 12/12/2022] Open
Abstract
Background To observe and compare the short term results and functional recovery of laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSCACRA) in the treatment of Adult slow transit constipation (STC) with two different reservoir length: short colonic reservoir and long colonic reservoir. Methods All STC patients treated with LSCACRA between April 2007 and December 2011 at our institution were followed up. Patients with 2 cm to 3 cm ascending colon preserved above the ileocecal junction were designated as observation group, whereas those preserved by 10 cm to 15 cm were classified as control group. 41 cases in the observation group and 40 cases in the control group were enrolled. Preoperative and outcome parameters of patients were collected, including gender, age, body mass index, operative time , blood loss, first flatus time, hospital stay, postoperative complications, Wexner constipation scale(WCS), Wexner incontinence scale, gastrointestinal quality of life index(GIQLI), abdominal pain intensity scale(APIS), abdominal pain frequency scale(APFS) and abdominal bloating scale(ABS). Results Laparoscopic surgeries were successfully carried out for all patients, without any case transferred to laparotomy or death related to surgery. The operative time, blood loss, first flatus time, and days of hospital stay of the two groups did not show significant differences. We found no significant differences on complications (Clavien–Dindo grade > I) between the two groups. No patient exhibited anastomotic leak. No fecal incontinence occurred in both groups. On the 3rd, 6th and 12th month after operation, the parameters of both groups significantly improved compared with the preoperative conditions (P < 0.05) except the APIS at 3rd and 6th month in control group. On the 3rd, 6th and 12th month after operation, the Functional Recovery outcomes of WCS、GIQLI、APIS、APFS and ABS in the observation group were superior to those in the control group (P < 0.05). Conclusion LSCACRA has a significant effect in the treatment of STC in adult. Postoperative outcomes can be optimized by shortening the length of the preserved ascending colon above the ileocecal junction, which promise better life quality of patients. Trial registration: Chinese Clinical Trial Registry ChiCTR-OPC-14005280, 2014-09-29. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0257-7) contains supplementary material, which is available to authorized users.
Collapse
|
22
|
Chronic severe constipation: current pathophysiological aspects, new diagnostic approaches, and therapeutic options. Eur J Gastroenterol Hepatol 2015; 27:204-14. [PMID: 25629565 DOI: 10.1097/meg.0000000000000288] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic constipation is a considerable problem because it significantly affects the quality of a patient's life. Constipation can be diagnosed at every age and is more frequent in women and among the elderly. In epidemiological studies, its incidence is estimated at 2-27% in the general population. Chronic constipation may be primary or secondary. However, primary constipation (functional or idiopathic) can be classified into normal transit constipation, slow transit constipation, and pelvic outlet obstruction. In this review we make an attempt to present the current pathophysiological aspects and new therapeutic options for chronic idiopathic constipation, particularly highlighting the value of patient assessment for accurate diagnosis of the cause of the problem, thus helping in the choice of appropriate treatment.
Collapse
|
23
|
Ding W, Jiang J, Feng X, Yao A, Wang L, Li J, Li N. Novel surgery for refractory mixed constipation: Jinling procedure - technical notes and early outcome. Arch Med Sci 2014; 10:1129-34. [PMID: 25624849 PMCID: PMC4296070 DOI: 10.5114/aoms.2014.47824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/15/2013] [Accepted: 05/28/2013] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The treatment of slow-transit constipation combined with outlet obstruction is controversial. This study introduced a new surgical strategy, subtotal colectomy combined with a modified Duhamel procedure (Jinling procedure), of which the safety and satisfactory rate were examined. MATERIAL AND METHODS Ninety patients with refractory slow-transit constipation associated with outlet obstruction were consecutively included between Jan 2010 and Dec 2010. All underwent the laparoscopic-assisted Jinling procedure, which added a new side-to-side anastomosis to the colorectal posterior anastomosis after subtotal colectomy. The pre- and post-operative data were collected. RESULTS There was no surgery-related death. A total of 39 complications and adverse events were reported in 22 patients (morbidity rate of 24.4%). Most complications were managed conservatively without significant events. The satisfactory rate was 93.1% at 6-month follow-up. CONCLUSIONS The Jinling procedure is safe for refractory slow-transit constipation associated with outlet obstruction, with minimal major complications and a high satisfaction rate. However, this procedure requires rigorous preoperative examination, exquisite surgical and laparoscopic techniques and excellent perioperative management. The pelvic floor, especially the presacral space, is damaged, and therefore it may be unsalvageable if severe complications, such as anastomosis leakage or ischemia, occur.
Collapse
Affiliation(s)
- Weiwei Ding
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Jun Jiang
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Xiaobo Feng
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Anlong Yao
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Lin Wang
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Jieshou Li
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Ning Li
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| |
Collapse
|
24
|
Cosentino M, Beati C, Fornari S, Capalbo E, Peli M, Lovisatti M, Cariati M, Cornalba G. Defaecography and colonic transit time for the evaluation of female patients with obstructed defaecation. Radiol Med 2014; 119:813-9. [PMID: 24846080 DOI: 10.1007/s11547-014-0405-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 02/10/2014] [Indexed: 01/07/2023]
Abstract
PURPOSE Colonic transit time and defaecography are well known, commonly used studies for evaluating patients with chronic constipation. The aim of this study was to compare colonic transit time with radiopaque markers and defaecography in female patients with obstructed defaecation. MATERIALS AND METHODS In a prospective observational study, between January 2010 and December 2012, a total of 30 female patients, mean age 60 years, with symptoms of obstructed defaecation were subjected to colonic transit time and defaecography, and divided into two groups: normal or abnormal colon transit time. The results were statistically compared using the Chi-square test. RESULTS The comparison of data between colonic transit time and defaecography showed the following groups: group 1 (6/30 = 20 %) with normal colonic transit time but abnormal defaecography, and group 2 (24/30 = 80 %) with abnormal colonic transit time; the latter was further divided into two subgroups: group 2a (4/24 = 17 %), patients with inertia coli; group 2b (20/24 = 83 %), patients with impaired defaecation demonstrated at defaecography. There was a significant statistical difference between the radiological findings in these groups. CONCLUSIONS This study confirmed the value of both defaecography and colonic transit time in assessing clinically obstructed women. Obstructed defaecation might not always be associated with abnormal colonic transit time. Likewise, not all constipated patients had signs of obstructed defaecation. The differential diagnosis between colonic slow transit constipation and constipation due to pelvic floor disorders is essential for an adequate strategy of care.
Collapse
Affiliation(s)
- Maria Cosentino
- Dipartimento di Scienze Diagnostiche, Unità Operativa Complessa di Radiologia, Ospedale San Carlo Borromeo, Via Pio II, 3, 20153, Milan, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE. Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies. J Gastrointest Surg 2014; 18:1059-69. [PMID: 24352613 DOI: 10.1007/s11605-013-2427-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/27/2013] [Indexed: 02/07/2023]
Abstract
Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangulation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to understand each patient's symptoms, bowel habits, anatomy, and pre-operative expectations. Preoperative workup includes physical exam, colonoscopy, anoscopy, and, in some patients, anal manometry and defecography. With this information, a tailored surgical approach (abdominal versus perineal, minimally invasive versus open) and technique (posterior versus ventral rectopexy +/- sigmoidectomy, for example) can then be chosen. We propose an algorithm based on available outcomes data in the literature, an understanding of anorectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients.
Collapse
Affiliation(s)
- Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA,
| | | | | | | | | | | |
Collapse
|
26
|
Rauck RL. Treatment of opioid-induced constipation: focus on the peripheral μ-opioid receptor antagonist methylnaltrexone. Drugs 2014; 73:1297-306. [PMID: 23881667 DOI: 10.1007/s40265-013-0084-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Most prescribed opioids exert their analgesic effects via activation of central μ-opioid receptors. However, μ-opioid receptors are also located in the gastrointestinal (GI) tract, and activation of these receptors by opioids can lead to GI-related adverse effects, in particular opioid-induced constipation (OIC). OIC has been associated with increased use of healthcare resources, increased healthcare costs, and decreased quality of life for patients. Nonpharmacologic (e.g., increased fiber uptake) and pharmacologic agents (e.g., laxatives) may be considered for the treatment and prevention of OIC. However, many interventions, such as laxatives alone, are generally insufficient to reverse OIC because they do not target the underlying cause of OIC, opioid activation of μ-opioid receptors in the GI tract. Therefore, there has been keen interest in antagonism of the μ-opioid receptor in the periphery to inhibit the effects of opioids in the GI tract. In this review, currently available pharmacologic therapies for the treatment and prevention of OIC are summarized briefly, with a primary focus on the administration of the peripheral μ-opioid receptor antagonist methylnaltrexone bromide in patients with OIC and advanced illness who are receiving palliative care. Also, clinical trial data of methylnaltrexone treatment in patients with OIC and other pain conditions (i.e., chronic noncancer pain and pain after orthopedic surgery) are reviewed. Data support that methylnaltrexone is efficacious for the treatment of OIC and has a favorable tolerability profile.
Collapse
|
27
|
Abstract
OBJECTIVES Through evidence review and the consensus of an expert panel, we developed recommendations for the clinical management of gastroesophageal reflux disease, constipation, and abdominal bloating in Rett syndrome. METHODS Based on review of the literature and family concerns expressed on RettNet, initial draft recommendations were created. Wherein the literature was lacking, 25 open-ended questions were included. Input from an international, multidisciplinary panel of clinicians was sought using a 2-stage modified Delphi process to reach consensus agreement. Items related to the clinical assessment and management of gastroesophageal reflux disease, constipation, and abdominal bloating. RESULTS Consensus was achieved on 78 of 85 statements. A comprehensive approach to the assessment of gastroesophageal reflux and reflux disease, constipation, and abdominal bloating was recommended, taking into account impairment of communication skills in Rett syndrome. A stepwise approach to the management was identified with initial use of conservative strategies, escalating to pharmacological measures and surgery, if necessary. CONCLUSIONS Gastrointestinal dysmotility occurs commonly in Rett syndrome. These evidence- and consensus-based recommendations have the potential to improve care of dysmotility issues in a rare condition and stimulate research to improve the present limited evidence base.
Collapse
|
28
|
A modified total colonic exclusion for elderly patients with severe slow transit constipation. Tech Coloproctol 2014; 18:629-34. [PMID: 24435473 DOI: 10.1007/s10151-013-1108-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 12/09/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to evaluate outcomes of total colonic exclusion with antiperistaltic ileorectal anastomosis (TCE-AIA) for elderly patients with slow transit constipation (STC). METHODS Elderly patients (defined as age >65) who underwent TCE-AIA for severe idiopathic STC between 2009 and 2012 at our institution were identified. Postoperative outcomes and routine follow-up were assessed using the Wexner constipation score (WCS), gastrointestinal quality of life index (GIQLI) and four-point postoperative satisfaction scales. RESULTS A total of 13 elderly patients were met the inclusion criteria. Five patients (38.5%) were male, and eight patients (61.5%) were female. The mean age of this population was 74 years (range 63-82 years). The mean operative time was 55 min (range 28-32), and blood loss was minimal. The mean postoperative hospital stay was 6.7 days (range 5-12 days). The mean time until the first postoperative bowel movement was 4 days (range 2-8 days). There was no procedure-related mortality and no major in-hospital complications. The median duration of follow-up was 12.4 months (range 6-29 months). None of the 13 patients had fecal incontinence or recurrence of constipation at the follow-up end point. However, eight patients underwent colonoscopy during follow-up, and four patients presented with diversion colitis. The patients' preoperative WCS was 22.8 ± 3.3, and it had significantly improved to 5.4 ± 2.1 on 6 months after operation (p < 0.05). The preoperative GIQLI of 93.6 ± 20.5 had significantly increased to 120.8 ± 13.0 on 6 months after surgery (p < 0.05). Patient satisfaction at 6 months was very high in 11 patients and high in two patients. CONCLUSIONS TCE-AIA is a relatively simple procedure. It might be an effective surgical intervention for the selected elderly patients with STC.
Collapse
|
29
|
Abstract
Rectal prolapse continues to be problematic for both patients and surgeons alike, in part because of increased recurrence rates despite several well-described operations. Patients should be aware that although the prolapse will resolve with operative therapy, functional results may continue to be problematic. This article describes the recommended evaluation, role of adjunctive testing, and outcomes associated with both perineal and abdominal approaches.
Collapse
|
30
|
Ayaz S, Hisar F. The efficacy of education programme for preventing constipation in women. Int J Nurs Pract 2013; 20:275-82. [DOI: 10.1111/ijn.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sultan Ayaz
- Nursing Department; Faculty of Health Sciences; Gazi University; Ankara Turkey
| | - Filiz Hisar
- Nursing Department; Faculty of Health Sciences; Gazi University; Ankara Turkey
| |
Collapse
|
31
|
Seong MK, Kim TW. Significance of defecographic parameters in diagnosing pelvic floor dyssynergia. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:225-30. [PMID: 23577317 PMCID: PMC3616276 DOI: 10.4174/jkss.2013.84.4.225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Defecography is known to be a sensitive and specific measurement of pelvic floor dyssynergia (PFD). However, its standardized parameter for diagnostic analysis is still incomplete. We attempted to determine which defecographic findings are most significant for PFD, and how closely they match other physiologic tests and clinical symptoms of functional pelvic outlet obstruction. METHODS Ninety-six patients with constipation who completed work-up of their symptoms with defecography, anorectal manometry and electromyography (EMG) were included in the study. Internal consistency of defecographic findings, and agreements between defecographic findings and results of other tests were statistically analyzed (Crohnbach's α, Cohen's κ, respectively). RESULTS Of the 96 patients evaluated, obstructive symptoms of constipation were obvious in 35 (36.5%) by obstructive symptom score. As known defecographic findings for PFD, poor opening of the anal canal was found in 33 (34.4%), persistent posterior angulation of the rectum in 33 (34.4%), and poor emptying of the rectum in 61 (63.5%). Manometric defecation index, manometric evacuation index, and EMG findings compatible with PFD were in 81 (84.4%), 72 (75%), and 73 (76%), respectively. Internal consistency of three defecographic findings was good (α = 0.78). Agreements between each defecographic findings and each result of other tests were all poor. CONCLUSION Among known defecographic findings for PFD, one specific finding cannot be considered more important than the others for its diagnosis. It is hard to expect consistent results of various diagnostic tests and to predict the presence of defecographic PFD by use of anorectal manometry, EMG, or even by clinical symptoms.
Collapse
Affiliation(s)
- Moo-Kyung Seong
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | | |
Collapse
|
32
|
|
33
|
Gélinas P. Preventing constipation: a review of the laxative potential of food ingredients. Int J Food Sci Technol 2012. [DOI: 10.1111/j.1365-2621.2012.03207.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Pierre Gélinas
- Food Research and Development Centre; Agriculture and Agri-Food Canada; 3600 Casavant Blvd. West; Saint-Hyacinthe; Quebec; J2S 8E3; Canada
| |
Collapse
|
34
|
The Association Between Stage II or Greater Posterior Prolapse and Bothersome Obstructive Bowel Symptoms. Female Pelvic Med Reconstr Surg 2012; 16:59-64. [PMID: 22453088 DOI: 10.1097/spv.0b013e3181ce958a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE : The primary objective of this study was to estimate the association between stage II or greater posterior prolapse and individual obstructive bowel symptoms. METHODS : We conducted a cross-sectional study of all women presenting for initial visit at a tertiary center for pelvic floor disorders. Exposure was defined as stage II or greater posterior vaginal prolapse as measured by pelvic organ prolapse quantification measurements. Outcomes included the separate bothersome obstructive bowel symptoms of splinting, straining, or incomplete bowel emptying. RESULTS : Our study included 721 women. Univariate analysis did not show an association between stage II or greater posterior prolapse and the bothersome symptoms of straining or incomplete emptying. Stage II or greater posterior prolapse was associated with bothersome splinting (adjusted OR, 1.63; 95% CI, 1.06-2.53). CONCLUSIONS : Stage II or greater posterior prolapse was associated with the bothersome symptom of splinting, but not bothersome straining or the sensation of incomplete evacuation.
Collapse
|
35
|
|
36
|
Abstract
BACKGROUND Constipation is common and distressing in palliative care. Despite this, approaches to assessment and subsequent treatment are most remarkable for the numbers who fail adequate palliation. AIM The primary aim of this paper is to summarise the current approaches to assessing constipation in palliative care, contrasting these approaches with those recommended by gastroenterologists in the assessment of resistant constipation in non-palliative care. The secondary aim is to suggest ways that the approaches used by gastroenterologist could be modified to be tolerable to palliative care. DESIGN A non-systematic review of the literature was undertaken. DATA SOURCES The electronic databases (MEDLINE, CINHAL) were searched for English language articles that explored assessment of constipation in palliative care and evidence-based gastroenterology guidelines that summarised assessment and management of constipation. RESULTS Currently, the assessment of constipation in palliative care is predominantly based on people's reports, physical examination and if further imaging is deemed necessary, a plain abdominal radiograph. However, data in non-palliative care patients refutes the usefulness of self-reported symptoms to localise whether problems are due to colon dysfunction or structures of defaecation. Plain radiographs are most useful to exclude a bowel obstruction only. In cases of resistant constipation, gastroenterology guidelines recommend an assessment approach that includes measuring colon transit time and an assessment of the structures that facilitate defaecation. CONCLUSIONS Current approaches to assessing constipation in palliative care are very different to those recommended by gastroenterology guidelines. However, modified approaches may be tolerable to palliative care patients and offer the chance of developing targeted palliation.
Collapse
Affiliation(s)
- Katherine Clark
- Department of Palliative Care, Calvary Mater Hospital and The University of Newcastle, New South Wales, Australia.
| | | |
Collapse
|
37
|
Kim JH, Lee HJ, Lee HS, Lim EJ, Imm JY, Suh HJ. Physical and sensory characteristics of fibre-enriched sponge cakes made with Opuntia humifusa. Lebensm Wiss Technol 2012. [DOI: 10.1016/j.lwt.2012.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
38
|
Riezzo G, Orlando A, D'Attoma B, Guerra V, Valerio F, Lavermicocca P, De Candia S, Russo F. Randomised clinical trial: efficacy of Lactobacillus paracasei-enriched artichokes in the treatment of patients with functional constipation--a double-blind, controlled, crossover study. Aliment Pharmacol Ther 2012; 35:441-50. [PMID: 22225544 DOI: 10.1111/j.1365-2036.2011.04970.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 06/07/2011] [Accepted: 12/12/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of probiotics in the management of constipation is uncertain. AIMS To evaluate the effects of probiotic-enriched artichokes on treatment preference, symptom profile and short-chain fatty acid (SCFA) production in constipated subjects when compared with ordinary artichokes. METHODS Twenty constipated patients (3M/17F; 38.8 ± 14.4 years) were studied using a double-blind method and a computer-generated randomisation list. Each patient consumed 180 g per day of ordinary artichokes or artichokes enriched with Lactobacillus paracasei IMPC 2.1 for 15 days (daily dose of 2 × 10(10) CFU). Relief of symptoms was evaluated using a visual analogue scale. The stool consistency and symptom profile of patients were investigated using the Bristol stool form chart and the Gastrointestinal Symptom Rating Scale questionnaire (GSRS). SCFA production in faecal samples was evaluated using HPLC. RESULTS Eighty per cent of patients preferred probiotic-enriched artichokes to ordinary ones (P = 0.011). Satisfactory relief of symptoms was significantly higher (P = 0.0014) during the probiotic-enriched artichoke period. Bristol chart cluster scores were significantly higher (3.3 ± 1.2, 2.9 ± 1.3 2.2 ± 1.2, baseline, ordinary artichokes and probiotic-enriched ones, respectively; P = 0.009) and GSRS constipation was significantly lower (13.9 ± 0.9, 10.2 ± 0.8, 8.3 ± 0.9; P = 0.032) in the probiotic group compared with the baseline. As for SCFA production, propionic acid was significantly higher (2.2 ± 1.4, 2.1 ± 1.53, 1.5 ± 1.2; P = 0.035) in the probiotic group compared with baseline. CONCLUSION This trial shows a positive effect on symptoms in constipated patients after intake of probiotic-enriched artichokes.
Collapse
Affiliation(s)
- G Riezzo
- Laboratory of Experimental Pathophysiology, I.R.C.C.S. Saverio de Bellis, National Institute of Digestive Diseases, Castellana Grotte, Bari, Italy
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Grimes CL, Lukacz ES. Posterior vaginal compartment prolapse and defecatory dysfunction: are they related? Int Urogynecol J 2012; 23:537-51. [PMID: 22222672 DOI: 10.1007/s00192-011-1629-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/06/2011] [Indexed: 02/07/2023]
Abstract
While posterior vaginal compartment prolapse and defecatory dysfunction are highly prevalent conditions in women with pelvic floor disorders, the relationship between anatomy and symptoms, specifically obstructed defecation, is incompletely understood. This review discusses the anatomy of the posterior vaginal compartment and definitions of defecatory dysfunction and obstructed defecation. A clinically useful classification system for defecatory dysfunction is highlighted. Available tools for the measurement of symptoms, physical findings, and imaging in women with posterior compartment prolapse are discussed. Based on a critical review of the literature, we investigate and summarize whether posterior compartment anatomy correlates with function. Definitions of obstructed defecation and significant posterior compartment prolapse are proposed for future exploration.
Collapse
Affiliation(s)
- Cara L Grimes
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Reproductive Medicine, University of California-San Diego, La Jolla, CA, USA.
| | | |
Collapse
|
40
|
|
41
|
Tack J, Müller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, Fried M. Diagnosis and treatment of chronic constipation--a European perspective. Neurogastroenterol Motil 2011; 23:697-710. [PMID: 21605282 PMCID: PMC3170709 DOI: 10.1111/j.1365-2982.2011.01709.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe. PURPOSE We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.
Collapse
Affiliation(s)
- J Tack
- Division of Gastroenterology, University Hospital LeuvenLeuven, Belgium
| | - S Müller-Lissner
- Department of Internal MedicinePark-Klinik Weissensee, Berlin, Germany
| | - V Stanghellini
- Department of Clinical Medicine, University of BolognaBologna, Italy
| | - G Boeckxstaens
- Division of Gastroenterology, University Hospital LeuvenLeuven, Belgium
| | - M A Kamm
- Departments of Medicine and Gastroenterology, St Vincent's HospitalMelbourne, Australia and Imperial CollegeLondon, UK
| | - M Simren
- Department of Internal Medicine, Sahlgrenska University HospitalGöteborg, Sweden
| | - J-P Galmiche
- Department of Liver and Gastroenterology, Institute of Diseases of the Digestive System NantesCHU Nantes, France
| | - M Fried
- Division of Gastroenterology and Hepatology, University Hospital ZurichZurich, Switzerland
| |
Collapse
|
42
|
Stanghellini V, Cogliandro RF. Dried plums vs. psyllium. Aliment Pharmacol Ther 2011; 33:1180-1; author reply 1181-2. [PMID: 21488922 DOI: 10.1111/j.1365-2036.2011.04639.x] [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: 12/12/2022]
|
43
|
Kopelman Y, Triadafilopoulos G. Endoscopy in the diagnosis and management of motility disorders. Dig Dis Sci 2011; 56:635-54. [PMID: 21286936 DOI: 10.1007/s10620-011-1584-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/14/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastrointestinal illness may result from either an underlying structural abnormality (e.g. neoplastic obstruction), or a functional disorder (e.g. motor diarrhea), or both (e.g. achalasia with squamous esophageal cancer). AIMS The purpose of this study was to highlight the potential value and role of endoscopy in the recognition and management of patients with functional and motility disorders. METHODS We performed a literature review in PubMed. RESULTS Diagnostic and therapeutic endoscopy may be under-used by motility-oriented gastroenterologists; in contrast, motility and other functional studies may be under-used by endoscopists. Yet, many areas of cross-exchange exist. CONCLUSIONS This review aims to guide the appropriate indications for the use of endoscopy in diagnosing and treating functional GI and motility disorders and serve as a bridge and a forum of exchange between endoscopists and motility specialists.
Collapse
Affiliation(s)
- Yael Kopelman
- Stanford University School of Medicine, Stanford, CA, USA
| | | |
Collapse
|
44
|
Farid M, Madbouly KM, Hussein A, Mahdy T, Moneim HA, Omar W. Randomized controlled trial between perineal and anal repairs of rectocele in obstructed defecation. World J Surg 2010; 34:822-9. [PMID: 20091310 DOI: 10.1007/s00268-010-0390-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The present study was designed to evaluate functional outcome of perineal repair with and without levatorplasty versus transanal repair of rectocele in obstructed defecation. METHODS AND PATIENTS A total of 48 multiparous women with obstructed defecation caused by a rectocele were randomly allocated to three groups: transperineal repair with levatorplasty (TPR-LP; n = 16); transperineal repair without levatorplasty (TPR; n = 16); and transanal repair (TAR; n = 16). The study included defecographic assessment, anal manometry, symptom improvement, sexual function, and score on a function questionnaire. Assessments were done preoperatively and 6 months postoperatively. RESULTS Defecography showed significant reduction in size of rectocele in all groups. Constipation improved significantly in both groups with transperineal repair but not in the group with transanal repair. Significant reductions in mean anal resting pressure, maximum reflex volume, and urge-to-defecate volume were observed only with the transperineal approach (with and without levatorplasty). Functional score improved significantly in the transperineal groups (with levatorplasty, P < 0.001; without levatorplasty, P < 0.01), but not in the transanal group (P = 0.142). Levatorplasty added to transperineal repair significantly improved the overall functional score compared with transperineal repair alone (P < 0.01) and transanal repair TAR (P < 0.001). CONCLUSIONS Rectocele repair appears to improve anorectal function by improving rectal urge sensitivity. Transperineal repair of rectocele is superior to transanal repair in both structural and functional outcome. Levatorplasty improves functional outcome, but potential effects on dyspareunia should be discussed with the patient.
Collapse
Affiliation(s)
- Mohamed Farid
- Department of Surgery, University of Mansoura, Mansoura, Egypt
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
OBJECTIVE This study evaluated the type of colectomy, postoperative complications, functional results, and satisfaction in patients with constipation refractory to conservative therapy. Further, colonic transit time (CTT), faecal load (coprostasis), and colon length (redundancies) were compared between operated and non-operated patients. MATERIAL AND METHODS Out of 281 patients, 30 women and 5 men underwent surgery. All patients were evaluated by clinical and physiological investigations. Forty-four randomly selected healthy persons constituted the control group. RESULTS Twenty-one patients had at hemicolectomy, 11 patients a subtotal colectomy and 3 patients an ileostomy. Two patients had an anastomotic leak and one died. In 11 patients, further surgery was necessary, because of recurrent constipation. Abdominal pain disappeared and defecation patterns improved significantly to 1-4 per day after a colectomy with no uncontrolled diarrhoea. The mean CTT was 65.0 h for patients operated, 37.9 h in non-operated patients and 24.75 h in controls (p < 0.05). Abdominal bloating and pain and defecation parameters correlated significantly positively with CTT and faecal loading, which were significantly increased in operated patients (p < 0.05). The colon was significantly longer in operated patients compared to non-operated, which significantly increased CTT and aggravated symptoms. The histology of the removed colon revealed degenerative changes. CONCLUSIONS A segmental or a subtotal colectomy reduced bloating and pain and improved defecation patterns significantly. Although patient satisfaction was rather high, there are significant risks of postoperative complications and future operations. The operated patients had a significant increased CTT, faecal load and colon length, compared to non-operated patients.
Collapse
Affiliation(s)
- Dennis Raahave
- Department of Surgery, Copenhagen University North Sealand Hospital, Helsingore, Denmark.
| | | | | | | |
Collapse
|
46
|
Holma R, Hongisto SM, Saxelin M, Korpela R. Constipation is relieved more by rye bread than wheat bread or laxatives without increased adverse gastrointestinal effects. J Nutr 2010; 140:534-41. [PMID: 20089780 DOI: 10.3945/jn.109.118570] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rye bread and lactobacilli modify the colonic environment and have the potential to relieve constipation and could be a safe and convenient alternative to laxatives. The effects of rye bread and cultured buttermilk with Lactobacillus rhamnosus GG (LGG) on bowel function and colon metabolism were investigated and compared with laxatives in 51 constipated adults. They were randomized to receive whole-grain rye bread (minimum 240 g/d), LGG (2 x 10(10) colony-forming units/d), whole-grain rye bread (minimum 240 g/d) + LGG (2 x 10(10) colony-forming units/d), white wheat bread (maximum 192 g/d), or laxatives (as usual for a participant) for 3 wk. Participants recorded their dietary habits, bowel function, and gastrointestinal symptoms. Fecal weight, pH, SCFA and bacterial enzyme activities, total intestinal transit time (TITT), and breath hydrogen were determined. Rye bread, compared with white wheat bread, shortened TITT by 23% (P = 0.040), increased weekly defecations by 1.4 (P = 0.014), softened feces [odds ratio (OR) 3.98; P = 0.037], eased defecation (OR 5.08; P = 0.018), increased fecal acetic acid and butyric acid contents by 24% (P = 0.044) and 63% (P <0.001), respectively, and reduced fecal beta-glucuronidase activity by 23% (P = 0.014). Compared with laxatives, rye bread reduced TITT by 41% (P = 0.006), fecal beta-glucuronidase activity by 38% (P = 0.033), and fecal pH by 0.31 units (P = 0.006). LGG did not relieve constipation or significantly affect colonic metabolism. Gastrointestinal adverse effects did not significantly differ among the study groups. In conclusion, rye bread relieves mild constipation and improves colonic metabolism compared with white wheat bread and commonly used laxatives without increasing gastrointestinal adverse effects.
Collapse
Affiliation(s)
- Reetta Holma
- Institute of Biomedicine, FIN-00014 University of Helsinki, Finland.
| | | | | | | |
Collapse
|
47
|
Ostaszkiewicz J, Hornby L, Millar L, Ockerby C. The Effects of Conservative Treatment for Constipation on Symptom Severity and Quality of Life in Community-Dwelling Adults. J Wound Ostomy Continence Nurs 2010; 37:193-8. [DOI: 10.1097/won.0b013e3181cf7206] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report. Int J Colorectal Dis 2008; 23:1251-6. [PMID: 18696088 DOI: 10.1007/s00384-008-0552-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Total abdominal colectomy with ileorectal anastomosis (TAC-IRA) is recommended widely for the patients with severe, refractory slow transit constipation (STC). Subtotal colectomy with end-to-end antiperistaltic cecorectal anastomosis (Sarli procedure), an alternative for STC, has been paid particular attention. The purpose of this study was to retrospectively compare alterations of clinical functions and qualities of life between TAC-IRA and Sarli procedure. METHODS Seventeen patients with STC who underwent Sarli procedure and 20 patients with STC who underwent TAC-IRA were chosen for this study. Patient characteristics, operative data, postoperative data, alterations of clinical function, and quality of life were compared. The gastrointestinal quality of life index (GIQLI) survey was used to evaluate postoperative qualities of life. RESULTS At the mean 4-year follow-up (range 2-6 years), the frequency of daily bowel movement in the Sarli group was significantly less than that in the TAC-IRA group (2.4 +/- 0.9 vs. 3.4 +/- 0.8; P = 0.0014), and the Wexner continence scores were significantly lower in the Sarli group compared to the TAC-IRA group (4.3 +/- 1.8 vs. 5.8 +/- 1.9; P = 0.0223). However, the GIQLI score in Sarli group was higher than the TAC-IRA group (119.8 +/- 7.5 vs. 111.1 +/- 12.0, P = 0.0455). Post subtotal colectomy barium enema showed a sign of "reservoir" at the residual ascending colon and cecum. CONCLUSIONS Compared to the TAC-IRA, subtotal colectomy with end-to-end antiperistaltic cecoproctostomy for appropriately selected patients with STC resulted in relief of constipation, satisfactory functional outcome, and improved qualities of life.
Collapse
|