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Bolia R, Goel A, Thapar N. Transanal irrigation in children with functional constipation: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 2024; 78:1108-1115. [PMID: 38558090 DOI: 10.1002/jpn3.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/19/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Refractory functional constipation is a challenging condition to manage in children. The use of transanal irrigation (TAI) is well reported in children with neurological disorders as well as anorectal malformations but less so in children with functional disorders of defecation. The objective of our study was to evaluate the effectiveness, safety and outcomes of TAI in children with functional constipation. METHODS PubMed, Scopus and Google Scholar were searched for publications related to the use of TAI in functional constipation. Data regarding the study design, sample size, patient characteristics, investigator-reported response to TAI and adverse effects were extracted from studies that met the selection criteria. The inverse variance heterogeneity model was used for ascertaining the summary effect in this meta-analysis. RESULTS The search strategy yielded 279 articles of which five studies were included in the final review. The studies were from the United Kingdom (n = 2), Netherlands (n = 2) and Denmark (n = 1). These studies included 192 children with a median age ranging from 7 to 12.2 years old. The TAI systems used in these studies were: Peristeen (n = 2), Peristeen or Qufora (n = 1), Alterna (n = 1) and Navina (n = 1). The follow-up duration ranged from 5.5 months to 3 years. Eleven (5.7%) children did not tolerate TAI and withdrew from treatment soon after initiation. The pooled investigator-reported success of TAI was 62% (95% CI: 52%-71%). The most common adverse event was pain which was experienced by 21.7% of children. A total of 27 (14%) were successfully weaned off TAI at the last follow-up. CONCLUSIONS TAI is reported to be successful in 62% of children with refractory functional constipation. There is a need for well-designed prospective trials to evaluate this treatment option in children with refractory functional constipation.
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Affiliation(s)
- Rishi Bolia
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, South Brisbane, Australia
| | - Akhil Goel
- Departement of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, South Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
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Bazzocchi G, Corazziari ES, Staiano A, Bassotti G, Bellini M, Chiarioni G, D'Alba L, Scarpato E. Position paper on transanal irrigation in chronic non-organic constipation. Dig Liver Dis 2024; 56:770-777. [PMID: 38461046 DOI: 10.1016/j.dld.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/11/2024]
Abstract
The practice of recto-colonic water irrigation to treat constipation has been used since ancient times with different, uncontrolled, and variably performing methods which have been considered interchangeably all alike. The use of better-performing devices with a standardized methodology is relatively recent, and the term Trans Anal Irrigation (TAI) defines a methodology performed with devices able to control the timing, volume, and pressure of the water introduced into the rectum and colon utilizing a catheter or a cone through the anus. Such practice has been implemented with favorable responses in patients with refractory chronic constipation secondary to neurological diseases. However, since the role of Trans Anal Irrigation as a therapeutic aid in chronic functional constipation and functional evacuation disorders is not yet fully clarified and standardized, a group of clinical investigators with recognized expertise in these clinical conditions intends to clarify the elements that characterize a TAI procedure that can benefit patients with functional constipation and functional defecation disorders defined according to the lastly updated Rome Diagnostic Criteria. Finally, the paper deals with adherence and practical implementation of TAI.
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Affiliation(s)
- G Bazzocchi
- Montecatone Rehabilitation Institute, Imola - University of Bologna, Italy
| | - E S Corazziari
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy.
| | - A Staiano
- Department of Translational Medical Science - Section Of Pediatrics, University Federico II, Naples, Italy
| | - G Bassotti
- Gastroenterology & Hepatology Section, Department of Medicine & Surgery, University of Perugia, Perugia, Italy
| | - M Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G Chiarioni
- Il Centro Med Healthcare, Verona Center, Verona, Italy & UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L D'Alba
- Gastroenterology and Endoscopy Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - E Scarpato
- Department of Translational Medical Science - Section Of Pediatrics, University Federico II, Naples, Italy
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Zhang R, Luo W, Qiu Y, Chen F, Luo D, Yang Y, He W, Li Q, Li X. Clinical Management of Low Anterior Resection Syndrome: Review of the Current Diagnosis and Treatment. Cancers (Basel) 2023; 15:5011. [PMID: 37894378 PMCID: PMC10605930 DOI: 10.3390/cancers15205011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Low anterior resection syndrome (LARS) is a series of bowel dysfunction symptoms, including altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation. LARS occurs in 80% of patients undergoing sphincter-preserving surgery, affecting patients' quality of life along with social avoidance. Different measurements and treatments have been raised to deal with LARS, but no systematic standard has been developed. OBJECTIVE AND METHODS To promote the standardization of clinical trials and clinical management of LARS, this review summarizes the latest findings up until 2023 regarding the diagnostic criteria, assessment protocols, and treatment modalities for postoperative LARS in rectal cancer. RESULTS The diagnostic criteria for LARS need to be updated to the definition proposed by the LARS International Collaborative Group, replacing the current application of the LARS score. In both clinical trials and clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire, the LARS score or MSKCC BFI, and at least one scale related to quality of life. Anorectal manometry, fecoflowmetry, endoscopic ultrasonography, and pelvic floor muscle strength testing are recommended to be adopted only in clinical trials. After analysis of the latest literature on LARS treatment, a stepwise classification model is established for the standardized clinical management of LARS. Patients with minor LARS can start with first-line treatment, including management of self-behavior with an emphasis on diet modification and medication. Lamosetron, colesevelam hydrochloride, and loperamide are common antidiarrheal agents. Second-line management indicates multi-mode pelvic floor rehabilitation and transanal irrigation. Patients with major LARS should select single or several treatments in second-line management. Refractory LARS can choose antegrade enema, neuromodulation, or colostomy. CONCLUSIONS In clinical trials of LARS treatment between 2020 and 2022, the eligibility criteria and evaluation system have been variable. Therefore, it is urgent to create a standard for the diagnosis, assessment, and treatment of LARS. Failure to set placebos and differentiate subgroups are limitations of many current LARS studies. Randomized controlled trials comparing diverse therapies and long-term outcomes are absent, as well. Moreover, a new scale needs to be developed to incorporate the patient's perspective and facilitate outpatient follow-up. Though the establishment of a stepwise classification model for LARS treatment here is indispensable, the refinement of the guidelines may be improved by more standardized studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Qingguo Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; (R.Z.); (W.L.); (Y.Q.); (F.C.); (D.L.); (Y.Y.); (W.H.)
| | - Xinxiang Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; (R.Z.); (W.L.); (Y.Q.); (F.C.); (D.L.); (Y.Y.); (W.H.)
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Valero Soriano M, Carrasco Prats MM, Perán Fernández C, Calero García P, López Morales P, Giménez Francés C, Jiménez Moreno IM, Albarracín Marín-Blázquez A. Transanal irrigation as a therapeutic option for patients with incontinence and severe chronic constipation refractory to first-line treatment. Cir Esp 2023; 101:587-593. [PMID: 36464105 DOI: 10.1016/j.cireng.2022.11.013] [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] [Received: 07/26/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The aim is to evaluate the utility of transanal irrigation such as treatment of incontinence and severe chronic constipation which is refractory to first-line therapy, and to assess its impact into the symptomatology and quality of life. METHODS Observational retrospective study of patients with incontinence and chronic constipation that had initiated transanal irrigation in two hospitals of the region. We collect sociodemographic variables, comorbidity, previous treatments, tests, parameters and incidences during the irrigation, and punctuation in the Cleveland Clinic Incontinence and Constipation Scores and EuroQol-5D Quality Of Life Scale before and after the treatment. RESULTS 40 patients, 20 with incontinence and 20 with chronic constipation. After an average period of 9 months of treatment, in 14 patients with incontinence we have observed a mean clinical improvement of 7,45 points before-after treatment measured with Cleveland Clinic Incontinence Score, and a mean improvement of 23 points in their quality of life before-after treatment measured with EQ5D Scale (P < .001); and in 16 patients with constipation a mean clinical improvement of 7,6 points before-after treatment measured with Cleveland Clinic Constipation Score, and a mean improvement of 31,5 points in their quality of life before-after treatment measured with EQ5D Scale (P < .001). CONCLUSIONS Transanal irrigation is an effective therapy for patients with incontinence and chronic constipation that are refractory to first-line therapies. It's an easy, self-administered and safe procedure. When the patient learns how to use it, the symptomatology and quality of life are improved.
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Affiliation(s)
- María Valero Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain.
| | | | - Cristóbal Perán Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Purificación Calero García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Pedro López Morales
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Clara Giménez Francés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Isabel María Jiménez Moreno
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
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Vollebregt PF, Dekker L, Han-Geurts IJM, Felt-Bersma RJF. Prospective cohort study of high-volume transanal irrigation in patients with constipation and/or faecal incontinence. Colorectal Dis 2023; 25:1658-1670. [PMID: 37259692 DOI: 10.1111/codi.16628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
AIM The aim of this work was to determine the clinical efficacy of high-volume transanal irrigation (TAI) in patients with constipation and/or faecal incontinence using validated symptom and quality of life questionnaires. METHOD This was a prospective cohort study of 114 consecutive patients with constipation and/or faecal incontinence (Rome IV defined) who started TAI. A comprehensive questionnaire was completed at baseline and 4, 12, 26 and 52 weeks' follow-up. The primary objective was significant symptom reduction [≥30%; Cleveland Clinic Constipation Score (CCCS) and St Marks Incontinence Score (SMIS)] in those who continued TAI at 52 weeks. Secondary objectives were (1) continuation rates of TAI, (2) effect on quality of life (QoL) and (3) identification of predictors for continuation. RESULTS A total of 59 (51.8%) patients with constipation, 26 (22.8%) with faecal incontinence and 29 (25.4%) with coexistent symptoms were included. At 52 weeks, 41 (36.0%) patients continued TAI, 63 (55.2%) stopped and 10 (8.8%) patients were lost to follow-up. In those who continued TAI at 52 weeks (n = 41), no reduction of constipation symptoms was observed. Median Patient Assessment of Constipation Quality of Life scores decreased on most domains, indicating QoL improvement. Reduction of faecal incontinence occurred in 5/9 (55.6%) patients with faecal incontinence and in 3/10 (30.0%) patients with coexistent symptoms. The median SMIS per-individual decreased in patients with coexistent symptoms (2; interquartile range 0-4; p = 0.023). Median Fecal Incontinence Quality of Life scores increased in most domains, indicating improved QoL. No clinical characteristics predicted continuation. CONCLUSION One-third (n = 41) of patients continued TAI at 52 weeks. In those who continued TAI at 52 weeks, symptoms of faecal incontinence (SMIS) were reduced but not constipation (CCCS). QoL related to both constipation and faecal incontinence improved. No clinical characteristics predicted continuation.
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Affiliation(s)
- Paul F Vollebregt
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Lisette Dekker
- Proctos Kliniek, Bilthoven, The Netherlands
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Richelle J F Felt-Bersma
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Proctos Kliniek, Bilthoven, The Netherlands
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Xavier TDS, Duarte LMR, Martins G. Transanal irrigation to manage neurogenic bowel in the pediatric population with spina bifida: a scoping review. J Pediatr (Rio J) 2023; 99:322-334. [PMID: 36852756 PMCID: PMC10373142 DOI: 10.1016/j.jped.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE To map available scientific evidence about the pediatric population with spina bifida submitted to transanal irrigation to manage signs and symptoms of neurogenic bowel. SOURCE OF DATA This research was developed according to recommendations from the Joanna Briggs Institute Reviewers' Manual and the PRISMA Extension for Scoping Reviews. Searches were carried out in the databases: CINAHL, Medline/Pubmed, Scielo, Scopus, Web of Science, Embase, LILACS, Proquest, and the CAPES catalog of theses and dissertations. Quantitative and qualitative studies on the topic were included, as long as they dealt with this population. There was no predetermined time frame. SUMMARY OF THE FINDINGS The authors found 1.020 studies, selected 130 for close reading, and included 23 in the review, all of which had been published from 1989 to 2021. The authors mapped the characteristics of the studies, including their definitions of concepts and use of scales, criteria for the indication of transanal irrigation, training to carry out the procedure, devices and solutions used, number and frequency of transanal irrigations, health care actions, time spent, associated complications, complementary exams, adherence rate, follow-up, and outcomes, focusing on the benefits for bowel management. CONCLUSIONS Despite the variability of evaluation parameters and term definitions, evidence suggests that transanal irrigation is a safe and effective method to manage fecal incontinence. Studies in the field are likely to grow, using standardized scales and longitudinal follow-ups. The authors suggest further research on transanal irrigation in the pediatric population with spina bifida in the Latin American context.
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Affiliation(s)
- Thayane de Souza Xavier
- Universidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Enfermagem, Brasília/DF, Brasil; Rede SARAH de Hospitais de Reabilitação, Programa de Reabilitação Infantil, Brasília/DF, Brasil.
| | - Lenamaris Mendes Rocha Duarte
- Rede SARAH de Hospitais de Reabilitação, Departamento de Pediatria e Escola Superior de Ciências da Saúde (ESCS), Brasília/DF, Brasil
| | - Gisele Martins
- Universidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Enfermagem, Brasília/DF, Brasil
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Tamvakeras P, Horrobin C, Chang J, Chapman M. Long-Term Outcomes of Transanal Irrigation for Bowel Dysfunction. Cureus 2023; 15:e42507. [PMID: 37502470 PMCID: PMC10371390 DOI: 10.7759/cureus.42507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Transanal irrigation (TAI) improves bowel function and quality of life in patients with neurogenic bowel disease compared to conservative bowel care. Its use has been extended to a range of defecatory disorders. However, data on long-term benefits and compliance are lacking. We aim to evaluate the long-term efficacy of TAI by examining compliance and patient outcomes over a five-year period. METHODS This study is a five-year retrospective review of patients practising TAI in a district general hospital. Patient demographics, indications, long-term compliance, adverse events, and patient-reported Qufora bowel symptom bother scores were analysed. RESULTS A cohort of 18 patients had a median age of 61 (range 23-91) and were predominantly female (83.5%). The reasons for bowel dysfunction were diverse: low anterior resection syndrome, neurogenic bowel, congenital anorectal malformations, obstructed defecation, and functional disorders. Predominant symptoms were constipation (9), faecal incontinence (7), and mixed (2). Both high-volume (catheter and cone) and low-volume (mini cone) irrigation devices were used. Fourteen patients continued regular irrigation at a median follow-up of 27.7 months (range 5.1-72.3), while four had discontinued at a median follow-up of 4.8 months. The reasons for discontinuation were inadequate rectal evacuation and spontaneous improvement of symptoms. In the compliant group, there was a significant improvement in bowel symptom scores (p=0.003). No major adverse events, such as significant rectal bleeding or perforation, were noted. CONCLUSION In this small cohort, TAI was safe and effective for long-term use; however, a fifth of patients discontinued treatment. Further work needs to be done to identify those patients who will benefit from TAI.
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Affiliation(s)
- Panagiotis Tamvakeras
- Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
| | - Clare Horrobin
- Lower GI Physiology, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
| | - Jessica Chang
- Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
| | - Mark Chapman
- Colorectal Surgery, University Hospitals Birmingham NHS Foundation Trust, The Royal Town of Sutton Coldfield, GBR
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Falletto E, Martellucci J, Rossitti P, Bondurri A, Zaffaroni G, Ascanelli S, Chimisso L, Lauretta A, Mirafiori M, Clementi I, Ripetti V, Lufarelli P, Cestaro G, Bottini C, Bellini M, Lambiase C, Di Candido F, Zattoni D, Cornaglia S, Tonello P, Zucchi E. Transanal irrigation in functional bowel disorders and LARS: short-term results from an Italian national study. Tech Coloproctol 2023; 27:481-490. [PMID: 37160596 DOI: 10.1007/s10151-023-02800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To evaluate the potential benefits associated with the short-term (6 months) treatment with transanal irrigation (TAI) in patients suffering from functional constipation (FC), functional fecal incontinence (FI), and low anterior resection syndrome (LARS). METHODS A multicenter observational study (12 centers; 369 patients) was conducted to assess the following primary and secondary objectives: to evaluate the level of satisfaction regarding bowel control and quality of life (QoL); to evaluate bowel symptoms severity and dropout frequency and reason. To this aim, validated questionnaires were provided to the patients at baseline (T0) and after 6 months of TAI treatment (T6) performed with the medical device Peristeen® Plus (Coloplast A/S, Denmark). Statistical analyses were conducted to compare the outcomes obtained at T0 and T6. RESULTS A 6-month treatment with TAI enabled a statistically significant (p < 0.05) improvement of QoL scores, satisfaction scores regarding bowel control, and severity indexes of disorder-related symptoms in patients suffering from FC, FI, and LARS. Globally, 8.0% of patients discontinued the treatment after 6 months as a result of occurrence of symptoms (2.4%) or other justifications (3.8%) such as personal reasons. None of the dropouts were due to treatment inefficacy. CONCLUSION Results of the present study suggest that short-term TAI treatment is beneficial for patients suffering from functional bowel disorders and LARS. Future analysis of prospective data will focus on the clinical outcomes associated with the long-term use (up to 24 months) of TAI when dealing with these types of medical conditions.
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Affiliation(s)
- E Falletto
- Department of Surgical Sciences, Città Della Salute e Della Scienza, University of Torino, Turin, Italy.
| | - J Martellucci
- Unit of Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - P Rossitti
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - A Bondurri
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - G Zaffaroni
- Department of General Surgery, Department of Biomedical and Clinical Sciences, "Luigi Sacco", "Luigi Sacco" University Hospital, Milan, Italy
| | - S Ascanelli
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - L Chimisso
- Department of Morphology, Surgery and Experimental Medicine, General Surgery Unit, University of Ferrara, Ferrara, Italy
| | - A Lauretta
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - M Mirafiori
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - I Clementi
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I "Sapienza", University of Rome, Rome, Italy
| | - V Ripetti
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - P Lufarelli
- Department of Pelvic Floor Surgery and Proctology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - G Cestaro
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - C Bottini
- General Surgery Unit, Sant'Antonio Abate Hospital in Gallarate, ASST Valle Olona, Varese, Italy
| | - M Bellini
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - C Lambiase
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | - F Di Candido
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - D Zattoni
- Colorectal Surgery Unit, AUSL Romagna, Ospedale per gli Infermi, Faenza, Italy
| | - S Cornaglia
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - P Tonello
- General Surgery Division, Koelliker Hospital, Turin, Italy
| | - E Zucchi
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
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9
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Rosen H. Transanale Irrigation als Geheimtipp. COLOPROCTOLOGY 2023. [DOI: 10.1007/s00053-022-00670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ZusammenfassungFunktionelle Störungen nach Rektumresektion, die unter der Definition „low anterior resection syndrome“ (LARS) zusammengefasst werden, beeinträchtigen bei vielen operierten Patienten zum Teil massiv die Lebensqualität. Nachdem die transanale Irrigation (TAI) bei ähnlicher Problematik anderer Genese als erfolgreiche Option zum Einsatz gekommen ist, wurde sie auch bei Patienten mit bereits länger bestehendem LARS angewandt. Als Folge der deutlichen Verbesserung der Rektumfunktion durch diese Therapie wurde auch eine prophylaktische Anwendung unmittelbar nach Verschluss der protektiven Ileostomie diskutiert und im Rahmen einer kontrollierten, randomisierten Studie untersucht. Dabei zeigte sich eine signifikante Reduktion der Anzahl der Defäkationsepisoden (bei Tag und Nacht), des LARS-Scores sowie des Wexner-Inkontinenz-Scores in den ersten 3 Monaten. Obwohl der positive Effekt der TAI eine Empfehlung als Therapieoption bei LARS nahelegt, verbleiben noch offene Fragen (notwendiges Irrigationsvolumen, Intervalle zwischen den Irrigationen, Behandlungsdauer) als Basis für zukünftige Untersuchungen.
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10
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Rectal Intussusception: Medical management and timing of the decision to operate. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Valero Soriano M, Carrasco Prats MM, Perán Fernández C, Calero García P, López Morales P, Giménez Francés C, Jiménez Moreno IM, Albarracín Marín-Blázquez A. La irrigación transanal como opción terapéutica para los pacientes con incontinencia y estreñimiento crónico severo refractarios a primera línea. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Boman E, Nylander M, Oja J, Olofsson B. Transanal Irrigation for People With Neurogenic Bowel Dysfunction: An Integrative Literature Review. Gastroenterol Nurs 2022; 45:211-230. [PMID: 35833736 DOI: 10.1097/sga.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
Transanal irrigation has been introduced as a complement to standard bowel care for people with neurogenic bowel dysfunction. There is no contemporary integrative review of the effectiveness and feasibility of transanal irrigation from a holistic nursing perspective, only fragments of evidence to date. The aim was to investigate the effectiveness and feasibility of transanal irrigation for people with neurogenic bowel dysfunction. An integrative literature review was conducted. Nineteen studies were included. According to the results, transanal irrigation can reduce difficulties associated with defecation, episodes of incontinence, and the time needed for evacuation and bowel care. Transanal irrigation can increase general satisfaction with bowel habits and quality of life and decrease level of dependency. However, there are practical problems to overcome and adverse effects to manage. Discontinuation is relatively common. The results support the effectiveness of transanal irrigation, but feasibility is inconclusive. Users, including caregivers, report practical problems, and compliance was not always easy to achieve. It is important that users, including caregivers, are well informed and supported during transanal irrigation treatment, especially during introduction. The quality of the studies found was generally weak; therefore, high-quality quantitative and qualitative studies are needed on the topic.
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Affiliation(s)
- Erika Boman
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Malin Nylander
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Josefine Oja
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Evolving Evidence Supporting Use of Rectal Irrigation in the Management of Bowel Dysfunction: An Integrative Literature Review. J Wound Ostomy Continence Nurs 2021; 48:553-559. [PMID: 34781312 DOI: 10.1097/won.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Disorders of bowel function are prevalent, particularly among patients with spinal cord injuries and other neurological disorders. An individual's bowel control significantly impacts quality of life, as predictable bowel function is necessary to actively and independently participate in everyday activities. For many patients with bowel dysfunction, initial lifestyle adjustments and other conservative therapeutic interventions (eg, digital stimulation, oral laxatives, suppositories) are insufficient to reestablish regular bowel function. In addition to these options, rectal irrigation (RI) is a safe and effective method of standard bowel care that has been used for several decades in adults and children suffering from bowel dysfunction associated with neurogenic or functional bowel etiologies. Rectal irrigation is an appropriate option when conservative bowel treatments are inadequate. Unlike surgical options, RI can be initiated or discontinued at any time. This report summarizes the clinical, humanistic, and economic evidence supporting the use of RI in clinical practice, noting features (eg, practical considerations, patient education) that can improve patients' success with RI treatment.
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Chesnel C, Hentzen C, Haddad R, Charlanes A, Le Breton F, Turmel N, Amarenco G. Adherence to transanal irrigation in older adults: first-year assessment. Tech Coloproctol 2021; 25:1055-1063. [PMID: 34185193 DOI: 10.1007/s10151-021-02479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND While the prevalence of chronic constipation and fecal incontinence increases with age, few data on transanal irrigation in older adults are available. The aim of this study was to assess the adherence and predictive factors for adherence to transanal irrigation during the first year of use in older adults. METHODS This retrospective study included all patients over 65 years old, who had therapeutic education for transanal irrigation with the Peristeen® device between January 2010 and July 2019 in a neuro-urology department of a university hospital in France. The adherence rate was assessed at 1, 3, 6, and 12 months. Predictive factors for adherence were looked for by comparing persistent population and non-persistent population at 1, 3, 6, and 12 months. RESULTS Sixty-nine patients over 65 years old were included. The adherence rate was 73.9% at 1 month, 55.1% at 3 months, 46.4% at 6 months, and 40.1% at 1 year. No predictive factor for adherence to transanal irrigation was identified. CONCLUSIONS Adherence to transanal irrigation during the first year in older adults remains close to that in the adult general population. Predictive factors of adherence remain unclear.
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Affiliation(s)
- C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France. .,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France. .,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France.
| | - C Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - R Haddad
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - A Charlanes
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - F Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France
| | - N Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Department of Neuro-Urology, Tenon Hospital, 4, rue de la Chine, 75020, Paris, France.,GRAPPPA (Clinical Research Group of Perineal Dysfunctions in Older Adults), Department of Neuro-Urology, Tenon Hospital, Paris, France
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15
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Why and when does an enema provoke abdominal pain? Reaction to the article by Peña et al. J Pediatr Surg 2021; 56:1252-1253. [PMID: 33549305 DOI: 10.1016/j.jpedsurg.2021.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/21/2022]
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16
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Assessment and management of low anterior resection syndrome after sphincter preserving surgery for rectal cancer. Chin Med J (Engl) 2021; 133:1824-1833. [PMID: 32604174 PMCID: PMC7469998 DOI: 10.1097/cm9.0000000000000852] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients’ quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.
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Li Q, Shen YL, Jiang YL, Li DS, Jin S. The effect of the therapy of "combination 3 methods progression" in patients with neurogenic bowel dysfunction (constipated type): Study protocol for a randomized controlled trial. Medicine (Baltimore) 2021; 100:e24662. [PMID: 33607803 PMCID: PMC7899824 DOI: 10.1097/md.0000000000024662] [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: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND As one of the important manifestations of neurogenic bowel dysfunction, constipation is characterized by high incidence and harmful effects. It has a negative impact on both physical and psychological health of patients. And there are no effective treatment options for this type of disease clinically. Therefore, this study is designed to examine the effect of the therapy of "combination 3 methods progression" in patients with neurogenic bowel dysfunction (constipated type). METHODS This is a randomized, controlled, parallel-design clinical trial. A total of 60 patients with neurogenic bowel dysfunction (constipated type) will be randomly assigned to intervention group and control group. The control group will receive 4 weeks of usual rehabilitation care, the intervention group will receive 4 weeks of the therapy of "combination 3 methods progression" in addition to usual rehabilitation care. The primary outcome is the number of spontaneous bowel movement per week. Secondary outcomes are stool characteristics, degree of difficulty in defecation, level of anxiety, level of depression, and level of self-efficacy. DISCUSSION The interventions of this protocol have been programmed to alleviate constipation in patients with neurogenic bowel dysfunction. Findings may provide preliminary evidence for clinical efficacy of the therapy of "combination 3 methods progression." TRIAL REGISTRATION Chinese Clinical Trial Registry, IDF: ChiCTR2000041463. Registered on December 26, 2020.
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Affiliation(s)
- Qing Li
- Nursing School, Chengdu University of Traditional Chinese Medicine
| | - Yin-Li Shen
- Department of Rehabilitation, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yun-Lan Jiang
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Dong-Shuang Li
- Nursing School, Chengdu University of Traditional Chinese Medicine
| | - Song Jin
- Department of Rehabilitation, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine
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18
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Mekhael M, Kristensen HØ, Larsen HM, Juul T, Emmanuel A, Krogh K, Christensen P. Transanal Irrigation for Neurogenic Bowel Disease, Low Anterior Resection Syndrome, Faecal Incontinence and Chronic Constipation: A Systematic Review. J Clin Med 2021; 10:jcm10040753. [PMID: 33668658 PMCID: PMC7918662 DOI: 10.3390/jcm10040753] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Transanal irrigation (TAI) has received increasing attention as a treatment option in patients with bowel dysfunction. This systematic review was conducted according to the PRISMA guidelines and evaluates the effect of TAI in neurogenic bowel dysfunction (NBD), low anterior resection syndrome (LARS), faecal incontinence (FI) and chronic constipation (CC). The primary outcome was the effect of TAI on bowel function. Secondary outcomes included details on TAI, quality of life (QoL), the discontinuation rate, adverse events, predictive factors for a successful outcome, and health economics. A systematic search for articles reporting original data on the effect of TAI on bowel function was performed, and 27 eligible studies including 1435 individuals were included. Three randomised controlled trials, one non-randomised trial, and 23 observational studies were included; 70% of the studies were assessed to be of excellent or good methodological quality. Results showed an improvement in bowel function among patients with NBD, LARS, FI, and CC with some studies showing improvement in QoL. However, discontinuation rates were high. Side effects were common, but equally prevalent among comparative treatments. No consistent predictive factors for a successful outcome were identified. Results from this review show that TAI improves bowel function and potentially QoL; however, evidence remains limited.
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Affiliation(s)
- Mira Mekhael
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
- Correspondence:
| | - Helle Ø Kristensen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
| | - Helene Mathilde Larsen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
| | - Therese Juul
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
| | - Anton Emmanuel
- GI Physiology Unit, University College London Hospital, London NW1 2BU, UK;
| | - Klaus Krogh
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK8200 Aarhus, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, DK8200 Aarhus, Denmark; (H.Ø.K.); (H.M.L.); (T.J.); (P.C.)
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic Organs, DK8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, DK8200 Aarhus, Denmark
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19
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Christensen P, IM Baeten C, Espín‐Basany E, Martellucci J, Nugent KP, Zerbib F, Pellino G, Rosen H. Management guidelines for low anterior resection syndrome - the MANUEL project. Colorectal Dis 2021; 23:461-475. [PMID: 33411977 PMCID: PMC7986060 DOI: 10.1111/codi.15517] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
AIM Little is known about the pathophysiology of low anterior resection syndrome (LARS), and evidence concerning the management of patients diagnosed with this condition is scarce. The aim of the LARS Expert Advisory Panel was to develop practical guidance for healthcare professionals dealing with LARS. METHOD The 'Management guidelines for low anterior resection syndrome' (MANUEL) project was promoted by a team of eight experts in the assessment and management of patients with LARS. After a face-to-face meeting, a strategy was agreed to create a comprehensive, practical guide covering all aspects that were felt to be clinically relevant. Eight themes were decided upon and working groups established. Each working group generated a draft; these were collated by another collaborator into a manuscript, after a conference call. This was circulated among the collaborators, and it was revised following the comments received. A lay patient revised the manuscript, and contributed to a section containing a patient's perspective. The manuscript was again circulated and finalized. A final teleconference was held at the end of the project. RESULTS The guidance covers all aspects of LARS management, from pathophysiology, to assessment and management. Given the lack of sound evidence and the often poor quality of the studies, most of the recommendations and conclusions are based on the opinions of the experts. CONCLUSIONS The MANUEL project provides an up-to-date practical summary of the available evidence concerning LARS, with useful directions for healthcare professional and patients suffering from this debilitating condition.
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Affiliation(s)
- Peter Christensen
- Department of SurgeryDanish Cancer Society Centre for Research on Survivorship and Late Adverse Effects after Cancer in the Pelvic OrgansAarhus University HospitalAarhusDenmark
| | - Coen IM Baeten
- Department of SurgeryGroene Hart ZiekenhuisGoudaThe Netherlands
| | | | | | | | - Frank Zerbib
- Gastroenterology DepartmentCHU de BordeauxCentre Medico‐Chirurgical MagellanHôpital Haut‐LévêqueUniversité de BordeauxBordeauxFrance
| | - Gianluca Pellino
- Colorectal SurgeryVall d'Hebron University HospitalBarcelonaSpain,Department of Advanced Medical and Surgical SciencesUniversitá degli Studi della Campania ‘Luigi Vanvitelli’NaplesItaly
| | - Harald Rosen
- Department of Surgical OncologySigmund Freud UniversityViennaAustria
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20
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Peña A, De La Torre L, Belkind-Gerson J, Lovell M, Ketzer J, Bealer J, Bischoff A. Enema-Induced spastic left colon syndrome: An unintended consequence of chronic enema use. J Pediatr Surg 2021; 56:424-428. [PMID: 33199058 DOI: 10.1016/j.jpedsurg.2020.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE Enemas have become a common practice for treating fecal incontinence and severe constipation. Several patients receiving enemas complained of severe, colicky, abdominal pain during enema administration and complained that the duration for fluid to pass was progressively increasing. Contrast studies showed a startling picture of severe right colon dilatation and a spastic, narrow, left colon. An investigation was started to seek the origin and possible management of this condition. METHODS Medical and radiologic records were reviewed retrospectively, with emphasis on the type and ingredients of enemas used, the duration the patients had been receiving enemas, and their original diagnosis. A literature review was done on previous reports of this condition and publications related to long-term use of enemas. RESULTS This series included 22 patients (average age, 19.6 years; range, 8-54) with fecal incontinence due to anorectal malformations (10 cases), myelomeningocele (5), cloaca (2), severe colonic dysmotility (2), Hirschsprung's disease (2), and sacrococcygeal teratoma (1). The average duration of enema use was 13.7 years (range, 4-45). The composition of the enemas included saline/glycerin (six cases), only saline solution (five), saline/glycerin/soap (four), plain water (three), and one case each of molasses/milk, saline/glycerin/soap/phosphate, saline/phosphate, and only phosphate. The enemas were performed in an antegrade fashion in 21 cases and rectally in 1. All patients had a dilated right colon and a narrow, spastic, left, transverse, and descending colon. Four patients underwent colonoscopy, colonic manometry, and mucosal biopsies, which did not help in explaining the etiology of the problem. In the literature, 43 reports mentioned a "long-term follow-up" for the administration of enemas, but we could not find a description of symptoms, such as in our cases. CONCLUSIONS An intriguing and, to our knowledge, previously unreported complication of chronic enema use is presented. We call attention to an overly concerning complication and report our findings in the hope that they will aid and stimulate more investigations into this condition. Several hypotheses to explain the cause are presented, as well as potential treatment options.
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Affiliation(s)
- Alberto Peña
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States.
| | - Luis De La Torre
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
| | - Jaime Belkind-Gerson
- Digestive Health Institute, Children's Hospital Colorado, Aurora, CO, United States
| | - Mark Lovell
- Department of Pathology, Children's Hospital Colorado, Aurora, CO, United States
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
| | - John Bealer
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, United States
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21
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Musco S, Bazzocchi G, Martellucci J, Amato MP, Manassero A, Putignano D, Lopatriello S, Cafiero D, Paoloni F, Del Popolo G. Treatments in neurogenic bowel dysfunctions: evidence reviews and clinical recommendations in adults. Eur J Phys Rehabil Med 2020; 56:741-755. [PMID: 32935955 DOI: 10.23736/s1973-9087.20.06412-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Neurogenic bowel dysfunction (NBD) is an impairment of defecation control due to any nervous system lesion negatively affecting physical health status and quality of life. We aimed at systematically assessing all available evidence on NBD treatment in adults and providing clinical management guidance and recommendations. EVIDENCE ACQUISITION PICOs and questions (N.=7) were identified by an expert panel. We searched for and retrieved evidence from the PUBMED and EMBASE databases, limited to the English language and the Western countries context, related to any type of setting and published from 2009 to 2019. Health effects, patient values, preferences and resource use were assessed. Of all, only RCTs, observational studies and systematic reviews on adult population (≥18 years) were analyzed. The study was conducted according to PRISMA guidelines and Cochrane recommendations. The effect size, if possible, was calculated for the interpretation of the outcomes, and evidence was assessed through the GRADE method. EVIDENCE SYNTHESIS Thirty-one studies were included in our qualitative synthesis. Evidence is generally scarce. Most of the outcomes are narratively described and therefore defined by imprecision. Besides, most of the included studies are affected by risk of bias. Digital stimulation was found to be effective in short term follow-up. The pharmacological treatment choice, combined or alone, needs to be balanced case by case considering clinical history, setting of use and bowel management protocol. According to only one RCT supporting evidence mainly in persons affected by spinal cord injury (SCI), trans-anal irrigation (TAI) improves QoL and patient independency with a significant reduction of time spent for defecation and daily bowel program. History of urinary infections predicts the choice of using TAI. Patient-reported efficacy of colostomy alone or in combination with other surgeries appears evident in terms of patient's satisfaction and QoL over time. Nonetheless, perioperative and late complications can occur and may result in reduced acceptability over time. CONCLUSIONS Evidence is somehow weak and mainly reported in SCI. The systematic use of assistive interventions does not reduce the need of conservative or invasive approaches. Studies are needed on the role of bowel management in protecting patients from complications secondary to NBD in long term follow-ups.
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Affiliation(s)
- Stefania Musco
- SOD of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Gabriele Bazzocchi
- Technical and Scientific Committee, Montecatone Rehabilitation Institute S.p.A, Imola, Bologna, Italy
| | | | - Maria P Amato
- Department of Neurology, Careggi University Hospital, Florence, Italy
| | - Alberto Manassero
- Unit of Neuro-Urology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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Impact of Transanal Irrigation Device in the Management of Children With Fecal Incontinence and Constipation. J Pediatr Gastroenterol Nutr 2020; 71:292-297. [PMID: 32404764 DOI: 10.1097/mpg.0000000000002785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Children with fecal incontinence and constipation can be classified into 3 groups: neurogenic bowel dysfunction (NBD) related to spinal cord defects (NBD), refractory constipation (RC), or anorectal malformations (ARMs). The transanal irrigation (TAI) device (Peristeen) was approved in 2012 by the Food and Drug Administration. This system uses a pump rather than gravity to instill water as a colonic irrigant and uses balloon occlusion of the rectum. Our aim was to evaluate the effectiveness of TAI (Peristeen) in children who failed to respond to conservative measures for stool incontinence and constipation. METHODS Retrospective study of 147 patients prescribed TAI between January 2014 and January 2020. Data collected included demographics, prior bowel regimen, symptoms before and after, patient satisfaction scores, and NBD scores. RESULTS Of the 147 patients initiated, 114 remain active users (13 lost to follow-up and 20 discontinued use). Multiple bowel regimens including laxatives (n = 139), cone enema (n = 40), and cecostomy (n = 7) were tried previously. The majority of our patients (n = 85) have NBD, primarily spina bifida, followed by RC (n = 43), and ARM (n = 19). For all patient groups, there was significant improvement in symptoms of fecal incontinence and constipation (P ≤ 0.001). Abdominal pain was improved in the NBD and RC group, but not significantly in the ARM group. CONCLUSIONS We provide a single-center review of a large pediatric cohort using TAI (Peristeen) for management of fecal incontinence and constipation. Peristeen offered significant improvement in patients with NBD, RC, and ARM.
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Use of a new transanal irrigation device for bowel disorder management by patients familiar with the irrigation technique: a prospective, interventional, multicenter pilot study. Tech Coloproctol 2020; 24:731-740. [PMID: 32318989 PMCID: PMC7297826 DOI: 10.1007/s10151-020-02212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/06/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility of transanal irrigation (TAI) with a new medical device incorporating an electric pump, the IryPump®R Set. METHODS An interventional, prospective, open-label, non-comparative, multicenter pilot study on TAI was conducted at three French university hospitals. Patients with experience of TAI were enrolled for a 1-month period during which 5 consecutive TAIs were performed using the IryPump®R Set (B.Braun Melsungen AG Melsungen, Germany). The study's primary efficacy criterion was successful TAI, defined as (i) use of the patient's usual irrigation volume of water, (ii) stool evacuation, and (iii) the absence of leakage between TAIs. The first two TAIs were not taken into account in the main analysis. The secondary outcome measures were device acceptability, bowel dysfunction scores, tolerability, and safety. RESULTS Fifteen patients were included between November 2016 and May 2017, and 14 were assessed in the main analysis. The TAI success rate was 72.4% (21 out of 29 procedures). The bowel dysfunction scores at the end of the study did not differ significantly from those recorded on inclusion. A high proportion of patients (> 70%) reported that TAI was feasible with the new medical device. There were no serious adverse events or device-related adverse events. At the end of the study, 50% of the participants were willing to consider further use of the new device. CONCLUSIONS In patients familiar with TAI, using a new medical device incorporating an electric pump was feasible. Levels of patient satisfaction were high, especially with regard to comfort of use and a feeling of security during TAI.
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Lallemant-Dudek P, Cretolle C, Hameury F, Lemelle JL, Ranke A, Louis-Borrione C, Forin V. Multicentric evaluation of the adherence to Peristeen® transanal irrigation system in children. Ann Phys Rehabil Med 2019; 63:28-32. [PMID: 31051275 DOI: 10.1016/j.rehab.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since 2009 in France, the Peristeen® transanal irrigation (TAI) device has represented an alternative treatment of faecal incontinence (FI). OBJECTIVE The primary objective of this study was to assess the mid-term adherence to TAI in paediatric patients. The secondary objective was to identify factors determining TAI continuation. METHODS This observational study conducted in 5 French paediatric centres prospectively reviewed from March to May 2012 all children educated in TAI for at least 9months. RESULTS We included 149 children (mean [SD] age 10.6 [4.1] years) educated in TAI. Children mainly had neurogenic disorders (52.3%) or congenital malformations (30.9%). The main symptoms motivating TAI initiation were recurring faecaloma (59.7%) and daily FI (65.1%). At last follow-up (mean 14 [7.4] months), 129 (86.6%) children continued the TAI procedure, independent of pathology or age. The main motivation was resolution of FI and/or constipation (77.3%). In total, 107 (82.9%) children fulfilled the initial therapeutic contract established with their healthcare professional before TAI initiation was met. Twenty children had stopped the TAI when they answered the questionnaire, at a mean duration of 16 (8.4) months. The reasons were mainly "lack of motivation" (45%), "poor tolerance" (35%), "difficulties" performing the procedure (35%) and "inefficacy" (30%). Factors related to continuation were performing at least one TAI procedure under a nurse's supervision during the initial training and prescribing TAI at a daily frequency (P=0.014 and P=0.04). Continuing constipation treatment after the training session was a factor in discontinuation (P=0.024). CONCLUSION This study reports a very high mid-term adherence to TAI in a paediatric cohort, provided that the training is pragmatic, personalized and repeated.
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Affiliation(s)
- P Lallemant-Dudek
- Reference center for vertebral and spinal cord malformations, pediatric department of physical medicine and rehabilitation, university hospital Trousseau, Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
| | - C Cretolle
- Reference center for anorectal malformations and rare pelvic anomalies, NeuroSphinx National Network, pediatric surgery department, university hospital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
| | - F Hameury
- Pediatric surgery department, Femme-Mère-Enfant university hospital, 59, boulevard Pinel, 69677 Bron, France.
| | - J L Lemelle
- Pediatric surgery department, university hospital Nancy, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - A Ranke
- Pediatric surgery department, university hospital Nancy, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - C Louis-Borrione
- Pediatric surgery department, university hospital Marseille, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - V Forin
- Reference center for vertebral and spinal cord malformations, pediatric department of physical medicine and rehabilitation, university hospital Trousseau, Sorbonne Université, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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Rosen HR, Kneist W, Fürst A, Krämer G, Hebenstreit J, Schiemer JF. Randomized clinical trial of prophylactic transanal irrigation versus supportive therapy to prevent symptoms of low anterior resection syndrome after rectal resection. BJS Open 2019; 3:461-465. [PMID: 31388638 PMCID: PMC6677104 DOI: 10.1002/bjs5.50160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background Low anterior resection syndrome (LARS) is a frequent problem after rectal resection. Transanal irrigation (TAI) has been suggested as an effective treatment in patients who have developed LARS. This prospective RCT was undertaken to evaluate the effect of TAI as a prophylactic treatment to prevent symptoms of LARS. Methods Patients who had undergone ultralow rectal resection were randomized to start TAI on a daily basis, or to serve as a control with supportive therapy only after ileostomy closure. All patients were seen after 1 week, 1 month and 3 months, and the maximum number of defaecation episodes per day and night documented during follow‐up. Wexner score, LARS score and Short Form 36 questionnaire responses were evaluated in both groups. Results Thirty‐seven patients could be evaluated according to protocol (TAI 18, control 19). The maximum number of stool episodes per day and per night was significantly lower among patients who underwent TAI at 1 month (median 3 versus 7 episodes/day in TAI versus control group, P = 0·003; 0 versus 3 episodes/night, P = 0·001) and 3 months (3 versus 5 episodes per day, P = 0·006; 0 versus 1 episodes/night, P = 0·002). LARS scores were significantly better in the TAI group after 1 month (median 16 versus 32 in control group; P = 0·044) and 3 months (9 versus 31; P = 0·001). A significantly better result in terms of Wexner score was seen in the TAI group after 3 months (median 2 versus 6 in controls; P = 0·046). Conclusion Prophylactic TAI led to a significantly better functional outcome compared with supportive therapy for up to 3 months. Registration number: DRKS00011752 (
http://apps.who.int/trialsearch/).
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Affiliation(s)
- H R Rosen
- Faculty of Surgical Oncology, Sigmund Freud University Vienna Austria
| | - W Kneist
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Mainz Germany
| | - A Fürst
- Department of Surgery, Caritas-Hospital St Josef Regensburg Germany
| | - G Krämer
- Department of Surgery, Caritas-Hospital St Josef Regensburg Germany
| | - J Hebenstreit
- Department of Surgery, Hospital St John of God Graz Austria
| | - J F Schiemer
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Mainz Germany
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Ausili E, Marte A, Brisighelli G, Midrio P, Mosiello G, La Pergola E, Lombardi L, Iacobelli BD, Caponcelli E, Meroni M, Leva E, Rendeli C. Short versus mid-long-term outcome of transanal irrigation in children with spina bifida and anorectal malformations. Childs Nerv Syst 2018; 34:2471-2479. [PMID: 29948136 DOI: 10.1007/s00381-018-3860-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE We assessed short- and mid-long-term clinical efficacy of transanal irrigation (TAI) and its effect on the quality of life of children with spina bifida (SB) and anorectal malformations (ARM). METHODS Seventy-four pediatric patients (age 6-17 years) with SB and ARM with neurogenic bowel dysfunction were enrolled for a prospective and multicentric study. Patients were evaluated before the beginning of TAI (T0), after 3 months (T1) and after at least 2 years (range 24-32 months) (T2) using a questionnaire assessing bowel function, the Bristol scale, and two validated questionnaires on quality of life: the CHQ-PF50 questionnaire for the parents of patients aged 6-11 years and the SF36 questionnaires for patients aged between 12 and 18 years. RESULTS Seventy-two patients completed TAI program in T1, and 67 continued into T2. Bowel outcomes (constipation and fecal incontinence) improved in both the SB and the ARM groups in the short and mid-long term. In both groups at T1 and T2, parents and children reported an improvement in quality of life and there was a significant increase of stool form types 4 and 5 as described by the Bristol scale. Common adverse effects during the study were similar at T1 and T2 without serious complications. CONCLUSIONS We observed a sustained improvement in bowel management and quality of life in SB and ARM children during the study, more significant in the short term than in mid-long term. To maintain success rates in the mid-long term and to reduce the dropout rate, we propose patient training and careful follow-ups.
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Affiliation(s)
- Emanuele Ausili
- Spina Bifida Center, Department of Science of the Health of Women and Children, Catholic University Medical School, Rome, Italy. .,Spina Bifida Center-Pediatric Department, Catholic University of Sacred Heart, Largo Gemelli 8, 00168, Rome, Italy.
| | - A Marte
- Pediatric Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - G Brisighelli
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - P Midrio
- Mother and Child Department, Cà Foncello Regional Hospital, Treviso, Italy
| | - G Mosiello
- Neuro-Urology Unit/Spina Bifida Center and Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - E La Pergola
- Mother and Child Department, Cà Foncello Regional Hospital, Treviso, Italy
| | - L Lombardi
- Pediatric Surgery Unit, Pediatric Hospital, Parma, Italy
| | - B D Iacobelli
- Neuro-Urology Unit/Spina Bifida Center and Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital and Research Institute, Rome, Italy
| | - E Caponcelli
- Pediatric Surgery Unit, Vittore Buzzi Pediatric Hospital, Milan, Italy
| | - M Meroni
- Pediatric Surgery Unit, Vittore Buzzi Pediatric Hospital, Milan, Italy
| | - E Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - C Rendeli
- Spina Bifida Center, Department of Science of the Health of Women and Children, Catholic University Medical School, Rome, Italy
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Wilkinson-Smith V, Bharucha AE, Emmanuel A, Knowles C, Yiannakou Y, Corsetti M. When all seems lost: management of refractory constipation-Surgery, rectal irrigation, percutaneous endoscopic colostomy, and more. Neurogastroenterol Motil 2018; 30:e13352. [PMID: 29700961 DOI: 10.1111/nmo.13352] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022]
Abstract
While the pharmacological armamentarium for chronic constipation has expanded over the past few years, a substantial proportion of constipated patients do not respond to these medications. This review summarizes the pharmacological and behavioral options for managing constipation and details the management of refractory constipation. Refractory constipation is defined as an inadequate improvement in constipation symptoms evaluated with an objective scale despite adequate therapy (ie, pharmacological and/or behavioral) that is based on the underlying pathophysiology of constipation. Minimally invasive (ie, rectal irrigation and percutaneous endoscopic colostomy) and surgical therapies are used to manage refractory constipation. This review appraises these options, and in particular, percutaneous endoscopic colostomy, which as detailed by an article in this issue, is a less invasive option for managing refractory constipation than surgery. While these options benefit some patients, the evidence of the risk: benefit profile for these therapies is limited.
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Affiliation(s)
- V Wilkinson-Smith
- National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - A E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - A Emmanuel
- GI Physiology Unit, University College London Hospital, London, UK
| | - C Knowles
- Blizard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Y Yiannakou
- University Hospital of North Durham, Durham, UK
| | - M Corsetti
- National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Woodward S. Treating chronic constipation and faecal incontinence using transanal irrigation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:1220-1222. [PMID: 29240487 DOI: 10.12968/bjon.2017.26.22.1220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sue Woodward
- Head of Clinical Education, Florence Nightingale Faculty of Nursing, King's College London
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