Outcomes of Stapled Transanal Rectal Resection vs . Biofeedback for the Treatment of Outlet Obstruction Associated with Rectal Intussusception and Rectocele: A Multicenter, Randomized, Controlled Trial

Lehur, P.‐A.; Stuto, Angelo; Fantoli, Michel; Villani, Roberto Dino; Queralto, M.; Lazorthes, F; Hershman, M. J.; Carriero, A.; Pigot, F.; Meurette, G.; Narisetty, Prashanthi; Villet, R.

doi:10.1007/s10350-008-9378-1

Cited by 111 publications

(38 citation statements)

References 17 publications

(21 reference statements)

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“…In the literature, minor complications have been reported for stapled transanal resection (3,7) . In this respect, our results compare favorably to those of other series (21) . Thus, we suggest considering the criteria for surgical indication and surgical training carefully.…”

Section: Discussionsupporting

confidence: 84%

“…Many forms of treatment have been proposed with varying results, including fiber ingestion, laxatives, biofeedback therapy, electrostimulation, sacral nerve stimulation and surgical repair (8,9,12,13,21,23,27) . A total of 175 patients with obstructed defecation syndrome and a Wexner's constipation score ≥6.0 were assessed with 3-D dynamic anorectal ultrasonography (echodefecography) to identify pelvic floor dysfunctions in the posterior compartment (rectocele, intussusception, mucosal prolapse and anismus) and the middle compartment (Grade-III enterocele/sigmoidocele).…”

Section: Discussionmentioning

confidence: 99%

“…Different techniques have been used to treat patients with obstructed defecation associated with anatomical abnormalities such as rectocele, rectal intussusception and mucosal prolapse (18,21,36) . Successful outcomes have been reported in 62%-85% of cases, but the available data are difficult to analyze due to differences in indications (symptoms and laboratory findings) and criteria for the evaluation of results.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, results have so far been conflicting and no clear consensus has been reached (13,21,27) . The purpose of the present study was to analyze the efficacy of clinical, biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography.…”

Section: Introductionmentioning

confidence: 99%

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Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Murad-Regadas

Regadas

Rodrigues

et al. 2012

Arq. Gastroenterol.

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-Context -Management of patients with obstructed defecation syndrome is still controversial. Objective -To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. Methods -The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. Results -Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associa ted with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. Conclusions -Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts. HEADINGS -Rectocele. Constipation. Pelvic floor. Imaging, three-dimensional.None disclosure.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Murad-Regadas

Regadas

Rodrigues

et al. 2012

Arq. Gastroenterol.

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“…Once conservative treatment has failed in patients with ODS leading to a worsening of QOL, patients should be considered for surgery [18,19]. For the surgical treatment of the underlying disease of ODS, different transabdominal and perineal approaches are described [20].…”

Section: Discussionmentioning

confidence: 99%

Changes in Dynamic Pelvic Floor Magnet Resonance Imaging and Patient Satisfaction after Resection Rectopexy for Obstructed Defecation Syndrome

Reichert

Busse

Hecker

et al. 2015

Fortschr Röntgenstr

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, fecal behavior and defecation-associated pain were investigated before and after surgical treatment using anamnesis and clinical examination, Rand 36-idem health survey (SF-36), Cleveland-Clinic Incontinence Score (CCIS) and the visual analog scale for defecation-associated pain (VAS). Dynamic pelvic floor magnet resonance imaging (dPF-MRI) was used for the investigation of changes in pelvic floor anatomy and function before and after surgery. Results: RR improved the rate of fecal incontinence (p < 0.01) and CCIS (p = 0.01). The use of laxatives (p = 0.01), the need for self-digitation (p = 0.02) and VAS (p < 0.01) were decreased, leading to improvements in QOL (overall p < 0.01). RR led to shortening of the H-line but not of the M-line under rest (p < 0.01) and during defecation (p = 0.04). A rectocele was co-incident in all patients in dPF-MRI before surgery. RR led to a reduction (p < 0.01) and declined protrusion (p = 0.03) of the rectocele. This results in a decreased rate of culde-sac (p < 0.01) and increased rate of complete defecation (p < 0.01) after surgery. At the 36-month follow-up no recurrence was observed. Conclusion: RR promises high rates of patient satisfaction and improvement in pelvic floor anatomy in select patients.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Biofeedback for treatment of chronic idiopathic constipation in adults

Woodward

Norton

Chiarelli

2014

Cochrane Database of Systematic Reviews

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Outcomes of Stapled Transanal Rectal Resection vs . Biofeedback for the Treatment of Outlet Obstruction Associated with Rectal Intussusception and Rectocele: A Multicenter, Randomized, Controlled Trial

Cited by 111 publications

References 17 publications

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Changes in Dynamic Pelvic Floor Magnet Resonance Imaging and Patient Satisfaction after Resection Rectopexy for Obstructed Defecation Syndrome

Biofeedback for treatment of chronic idiopathic constipation in adults

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