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BONDURRI A, CAVALLO D, MAFFIOLI A, GUERCI C, DANELLI P. STARR vs. internal Delorme procedure for obstructed defecation: functional and QoL long-term results. Chirurgia (Bucur) 2023. [DOI: 10.23736/s0394-9508.22.05394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Picciariello A, Rinaldi M, Grossi U, Trompetto M, Graziano G, Altomare DF, Gallo G. Time trend in the surgical management of obstructed defecation syndrome: a multicenter experience on behalf of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2022; 26:963-971. [PMID: 36104607 DOI: 10.1007/s10151-022-02705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Surgical management of obstructed defecation syndrome (ODS) is challenging, with several surgical options showing inconsistent functional results over time. The aim of this study was to evaluate the trend in surgical management of ODS in a 10-year timeframe across Italian referral centers.
Methods
Surgeons from referral centers for the management of pelvic floor disorders and affiliated to the Italian Society of Colorectal Surgery provided data on the yearly volume of procedures for ODS from 2010 to 2019. Six common clinical scenarios of ODS were captured, including details on patient’s anal sphincter function and presence of rectocele and/or rectal intussusception. Perineal repair, ventral rectopexy (VRP), transanal repair (internal Delorme), stapled transanal rectal resection (STARR), Contour Transtar, and transvaginal repair were considered in each clinical scenario.
Results
Twenty-five centers were included providing data on 2943 surgical patients. Procedure volumes ranged from 10–20 (54%) to 21–50 (46%) per year across centers. The most performed techniques in patients with good sphincter function were transanal repair for isolated rectocele (243/716 [34%]), transanal repair for isolated rectal intussusception (287/677 [42%]) and VRP for combined abnormalities (464/976 [48%]). When considering poor sphincter function, these were perineal repair (112/194 [57.8%]) for isolated rectocele, and VRP for the other two scenarios (60/120 [50%] and 97/260 [37%], respectively). The use of STARR and Contour Transtar decreased over time in patients with impaired sphincter function.
Conclusions
The complexity of ODS treatment is confirmed by the variety of clinical scenarios that can occur and by the changing trend of surgical management over the last 10 years.
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Ripamonti L, Guttadauro A, Lo Bianco G, Rennis M, Maternini M, Cioffi G, Chiarelli M, De Simone M, Cioffi U, Gabrielli F. Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review. Front Surg 2022; 9:790287. [PMID: 35237648 PMCID: PMC8882820 DOI: 10.3389/fsurg.2022.790287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo introduced a minimal invasive trans-anal approach known as Stapled Trans-Anal Rectal Resection (STARR) in order to correct mechanical disorders such as rectocele or rectal intussusception, two conditions present in more than 90% of patients with ODS. Considering the lack of a common view around ODS and STARR procedure. the aim of our study is to review the literature about preoperative assessment, operative features and outcomes of the STARR technique for the treatment of ODS. We performed a systematic search of literature, between January 2008 and December 2020 and 24 studies were included in this review. The total number of patients treated with STARR procedure was 4,464. In conclusion STARR surgical procedure has been proven to be safe and effective in treating symptoms of ODS and improving patients Quality of Life (QoL) and should be taken in consideration in the context of a holistic and multi modal approach to this complex condition. International guidelines are needed in order to optimize the diagnostic and therapeutic process and to improve outcomes.
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Affiliation(s)
- Lorenzo Ripamonti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
| | - Giulia Lo Bianco
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Maria Rennis
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Maternini
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
| | - Gerardo Cioffi
- Department of Sciences and Technologies, University of Sannio RCOST, Benevento, Italy
| | - Marco Chiarelli
- Department of Surgery, Ospedale Alessandro Manzoni, ASST Lecco, Lecco, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Francesco Gabrielli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- General Surgery Department, Istituti Clinici Zucchi Monza, Monza, Italy
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A step-by-step approach to endorectal proctopexy (ERPP): how we do it. Tech Coloproctol 2021; 25:879-886. [PMID: 34046758 DOI: 10.1007/s10151-021-02467-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
There are many surgical treatments aimed at correcting internal mucosal prolapse and rectocele associated with obstructed defecation syndrome (ODS). Perineal procedures can be considered as first options in young men in whom an abdominal approach poses risks of sexual dysfunction and in selected women with isolated posterior compartment prolapse who failed conservative treatment. About 20 years ago, we described endorectal proctopexy (ERPP) also known as internal Delorme procedure. The aim of the present study was to describe, with attention to technical details and the aid of a video, the different steps of ERPP for the treatment of ODS. A retrospective analysis of our last 100 cases confirms our initial good results. Complications included suture line dehiscence with consequent stricture in four patients (4%). Bleeding occurred in four (4%) patients and was conservatively treated. Transient anal continence impairment consisting of urgency and soiling occurred in 12 (12%) and 6 (6%) patients, respectively. At 6-month follow-up the Cleveland Clinic Constipation Score and ODS score improved from a median preoperative value of 18.9 and 18.5 to 5 and 5, respectively (p < 0.0001). The mean follow-up was 36.05 ± 13.3 (range 12-58) months and anatomical recurrence rate was 6 (%). Due to its excellent safety profile and the ability to tailor the procedure to different disease presentations, we think that ERPP should be part of the basic armamentarium of all colorectal surgeons operating on the pelvic floor.
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Picciariello A, O'Connell PR, Hahnloser D, Gallo G, Munoz-Duyos A, Schwandner O, Sileri P, Milito G, Riss S, Boccasanta PA, Naldini G, Arroyo A, de laPortilla F, Tsarkov P, Roche B, Isbert C, Trompetto M, d'Hoore A, Matzel K, Xynos E, Lundby L, Ratto C, Consten E, Infantino A, Panis Y, Terrosu G, Espin E, Faucheron JL, Guttadauro A, Adamina M, Lehur PA, Altomare DF. Obstructed defaecation syndrome: European consensus guidelines on the surgical management. Br J Surg 2021; 108:1149-1153. [PMID: 33864061 DOI: 10.1093/bjs/znab123] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
Management of obstructed defaecation is challenging and remains controversial. No international guidelines have been published.
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Affiliation(s)
- A Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - P R O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - D Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - A Munoz-Duyos
- Department of General Surgery, Colorectal Unit, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - O Schwandner
- Department of Proctology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - P Sileri
- Department of Surgery, Università Vita Salute San Raffaele, Milano, Italy
| | - G Milito
- Department of Surgery, Tor Vergata University, Rome, Italy
| | - S Riss
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - P A Boccasanta
- Istituto Humanitas Gavazzeni & Castelli, Proctology and Perineology Surgical Unit, Bergamo, Italy
| | - G Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - A Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Alicante, Spain
| | - F de laPortilla
- Gastrointestinal Surgery Department, Coloproctology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - P Tsarkov
- I. M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia
| | - B Roche
- Division of Digestive Surgery, Proctology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - C Isbert
- Department of General, Gastrointestinal and Colorectal Surgery, Amalie Sieveking Hospital, Hamburg, Germany
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - A d'Hoore
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
| | - K Matzel
- Chirurgische Klinik, Universität Erlangen, Erlangen, Germany
| | - E Xynos
- Department of Surgery, Creta Interclinic Hospital of Heraklion, Heraklion, Greece
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - C Ratto
- Proctology Unit, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - E Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Infantino
- Department of Surgery, General Surgery Unit, Santa Maria dei Battuti Hospital, Pordenone, Italy
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - G Terrosu
- General Surgery and Transplantation Unit, Department of Medicine, University of Udine, Udine, Italy
| | - E Espin
- Department of Surgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France
| | - A Guttadauro
- General Surgery Department, University of Milano-Bicocca, Istituti Clinici Zucchi, Monza, Italy
| | - M Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - P A Lehur
- Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Management of patients with rectal prolapse: the 2017 Dutch guidelines. Tech Coloproctol 2018; 22:589-596. [DOI: 10.1007/s10151-018-1830-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
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Liu W, Sturiale A, Fabiani B, Giani I, Menconi C, Naldini G. Internal Delorme's Procedure for Treating ODS Associated With Impaired Anal Continence. Surg Innov 2017; 24:566-573. [PMID: 28778136 DOI: 10.1177/1553350617723771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the medium-term outcomes of internal Delorme's procedure for treating obstructed defecation syndrome (ODS) patients with impaired anal continence. PATIENTS AND METHODS In a retrospective study, 41 ODS patients who underwent internal Delorme's procedure between 2011 and 2015 were divided into 3 subgroups according to their associated symptoms of impaired continence, as urgency, passive fecal incontinence and both, before study. Then the patients' preoperative statuses, perioperative complications, and postoperative outcomes were investigated and collected from standardized questionnaires, including Altomare ODS score, Fecal Incontinence Severity Index (FISI), Patient Assessment of Constipation-Quality of Life Questionnaire (PAC-QoL), and Fecal Incontinence Quality of Life Scale (FIQLS). All results with a 2-tailed P < .05 were considered statistically significant. RESULTS At an average 2.8 years of follow-up, there were significant improvements ( P < .01) in Altomare ODS score, FISI, PAC-QoL, and FIQLS in all patients when comparing scores from before the operation with those at the final follow-up. Similar results were also observed in both the urgency subgroup and passive fecal incontinence subgroup, but there were no statistically significant improvements ( P > .05) in Altomare ODS score, FISI, PAC-QoL, or FIQLS in the urgency and passive fecal incontinence subgroups. Anorectal manometry showed the mean value of anal resting pressure increased 20%. Additionally, no major complications occurred. CONCLUSION Internal Delorme's procedure is effective without major morbidity for treating ODS associated with urgency or passive fecal incontinence, but it may be less effective for treating ODS associated with both urgency and passive fecal incontinence.
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Affiliation(s)
- Weicheng Liu
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
| | | | | | - Iacopo Giani
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Claudia Menconi
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Gabriele Naldini
- 1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy
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Abstract
Rectoanal intussusception is an invagination of the rectal wall into the lumen of the rectum. Patients may present with constipation, incomplete evacuation, incontinence, or may be asymptomatic. Defecography has been the gold standard for detection. Magnetic resonance imaging defecography and dynamic anal endosonography are alternatives to conventional defecography. However, both methods are not as sensitive as conventional defecography. Treatment options range from conservative/medical treatment such as biofeedback to surgical procedures such as Delorme, rectopexy, and stapled transanal rectal resection. Recent studies conducted after a trial of failed nonoperative management show adequate results with operations performed for rectal intussusception with or without rectocele if other causes of constipation are not present.
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Affiliation(s)
- Kristen Blaker
- Department of Surgery, Division of General Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joselin L Anandam
- Department of Surgery, Division of General Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
Rectoceles are a very common finding in patients, and symptoms most commonly include pelvic pain, pressure, or difficulty with passing stool. However, there are often other associated pelvic floor disorders that accompany rectoceles, making the clinical significance of it in an individual patient often hard to determine. When evaluating a patient with a rectocele, a thorough history and physical exam must be conducted to help delineate other causes of these symptoms. Treatment consists of addressing other defecatory disorders through various methods, with surgery reserved for select cases in which obstructed defecation is well documented.
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Affiliation(s)
- W Conan Mustain
- Division of Colon and Rectal Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Liu WC, Wan SL, Yaseen SM, Ren XH, Tian CP, Ding Z, Zheng KY, Wu YH, Jiang CQ, Qian Q. Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience. World J Gastroenterol 2016; 22:7983-7998. [PMID: 27672293 PMCID: PMC5028812 DOI: 10.3748/wjg.v22.i35.7983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/23/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented.
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Giannakaki V, Bordeianou L. Surgical management of severe constipation due to slow transit and obstructed defecation syndrome. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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