The aim of the paper — is to present the results of the consensus on the terminology used to describe data of high-resolution anorectal manometry.Methods: Online survey was conducted with the help of the public platform “Google forms” with the aim to harmonize the terms, which are used to conduct high-resolution anorectal manometry (HRAM), to agree the conformity of the proposed Russian-language terms to those used in English-language literature, and their abbreviations.Results: According to the aim, 56 specialists of different medical specialties who perform and use the results of HRAM in clinical practice and research were invited to participate in the survey. We received 45 answers from the respondents (42.2% coloproctologists, 22.2% gastroenterologists, 15.6% surgeons, 20% — representatives of other specialties). The response rate was 80.3%. According to the survey, 95.6% of respondents supported the need for harmonization of terms. Ten out of the 11 terms reached consensus level C1 (excellent), 1 term level of consistency was C2 (moderate). 90.9% of respondents (consensus level C1) were in favor of the appropriateness of using common abbreviations. However, the proposed abbreviations of the terms used in the conduct and description of the results of the HRAM can be accepted with reservations (in 10 cases out of 11 consensus level was C2).Conclusions: The agreed in interdisciplinary consensus terms can be approved and recommended for the use in clinical practice and when research data are published in Russian-language scientific literature.
Rectosacropexy may be preferred in rectal prolapse. However, further highly significant studies are necessary to optimize rectal prolapse management.
90 patients (female 72 (80%), male 18 (20%), mean age 43,6±16,5 y.o.) with functional disorders of defecation (dyssynergic defecation and inadequate propulsion) were included in the study. All the patients conformed the Rome III (2006) criteria for functional constipation. Highresolution anorectal manometry (HRAM) procedures (London protocol) were performed using Solar GI system (MMS, The Netherland) with 8-channel water-perfusion catheters. All the patients underwent a course of biofeedback therapy for obstructive defecation (Urostim, Laborie, Canada). The course consisted of 10 daily 30-minutes long sessions. Treatment efficacy was evaluated after the completion of biofeedback therapy according to the control HRAM. CONCLUSIONS. Biofeedback is the method of choice for treatment of patients with obstructive defecation syndrome with pelvic floor dyssynergia and spasm of m.puborectalis. At the same time biofeedback therapy is ineffective in patients with type III of manometry pattern and in patients with an inadequate propulsion.
Введение. В патогенезе расстройств дефекации у больных с ректоцеле могут участвовать как анатомические, так и функциональные нарушения. Однако до настоящего времени о возможности консервативной терапии, направленной на коррекцию функциональных расстройств дефекации, изучены недостаточно. Цель: изучение эффективности использования методов включающих БОС-терапию (терапия биологической обратной связью, biofeedback терапия) и тибиальной нейромодуляции в лечении больных с функциональными расстройствами дефекации на фоне пролапса тазовых органов. Методика. Материалом исследования служили результаты обследования пациенток в возрасте от 18 до 75 лет с наличием функционального расстройства дефекации (ФРД) в сочетании с ректоцеле без ранее проводившихся попыток хирургической коррекции. Проведены оценка общеклинических данных, опрос при помощи специализированного опросника выраженности расстройств эвакуаторной функции толстой кишки, рентгеновская дефектография, аноректальная манометрия высокого разрешения до и после комплекса консервативной реабилитации при помощи БОС-терапии и тибиальной нейромодуляции. Результаты. Конечному анализу были доступны данные 60 пациенток. Ректоцеле 1-й степени выявлено у 3 человек (5%), 2-й - у 37 (61,7%), 3-й степени - у 20 (33,3%) участниц исследования. Средний балл по симптомному опроснику составил 11,4±3,7. ФРД I типа выявлено у 41 (68,3%), II типа - у 6 (10%), III - у 10 (16,7%) и IV - у 3 (5%) участниц. После проведенной БОС-терапии признаки ФРД полностью устранены у 36,7% (22/60) женщин с ректоцеле. Неэффективной БОС-терапия оказалась у 11/41 (26,8 %) пациенток с I типом манометрического паттерна, 2/6 (33,3 %) со II типом и 4/10 (40,0 %) пациенток с III типом ФРД; (всего у 17/60 (28,3 %). У пациенток с IV типом паттерна неэффективные результаты лечения отсутствовали. Заключение. БОС-терапия и тибиальная нейромодуляция приводят к устранению симптомов в 36,7% случаев и положительной динамике у 35,0% больных. Методы могут быть рекомендованы к использованию в комплексной терапии эвакуаторных расстройств дефекации у больных с ректоцеле Aim. To assess the efficacy of conservative methods like biofeedback therapy (BFB) and tibial neuromodulation (TNM) for treatment of patients with functional FDD and rectocele. Methods. Information collected during examinations of female patients with FDD and rectocele and with no previous surgery served as source data. Before and after conservative treatment with BFB and TNM, symptoms were assessed, responses to a specialized questionnaire on the severity of rectal evacuatory function impairment were analyzed, and X-ray defecography and high-resolution anorectal manometry were performed. Data before and after treatment were compared with non-parametric statistics (Wilcoxon matched pairs test). Results. The data of 60 women (mean age 48.2±13.4 years) were analyzed. Rectocele grade 1 was detected in 3 (5%), grade 2 in 37 (61.7%), and grade 3 in 20 (33.3%) patients. Mean symptom score on the specialized questionnaire was 11.4±3.7. FDD type 1 manometric pattern was found in 41 (68.3%), type II in 6 (10%), type III in 10 (16.7%), and IV in 3 (5%) participants. Complete resolution of FDD after BFB and TNM therapy was found in 22/60 (36.7%) of women. BFB and TNM therapy was ineffective in 11/41 (26.8%) patients with FDD type I, in 2/6 (33.3%) with type II, and in 4/10 (40.0%) patients with type III FDD. This conservative treatment was effective in 100% patients with type IV pattern of FDD. Based on the results, we suggest further actions to improve the outcomes of conservative treatment. Conclusion. Conservative treatment with combined biofeedback therapy and tibial neuromodulation may help improve symptoms in 35% of patients and lead to complete resolution of functional component in 37% of patients with functional defecatory disorders and rectocele. This treatment was not effective in 28% of patients.
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