Relief of Obstructed Defecation Syndrome after Stapled Transanal Rectal Resection (STARR): a Meta-analysis

B, Van Geluwe; Stuto, Angelo; F, Da Pozzo; Fieuws, Steffen; Meurette, G.; Pa, Lehur; D’Hoore, André

doi:10.1080/00015458.2014.11681007

Cited by 25 publications

(16 citation statements)

References 34 publications

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“…However, true biofeedback (as opposed to bowel habit‐training) therapy is not widely available; hence accurate diagnosis is essential. Similarly, accurate diagnosis of clinically relevant obstructive anatomical phenomena can guide appropriate surgical corrective intervention …”

Section: Discussionmentioning

confidence: 57%

“…Similarly, accurate diagnosis of clinically relevant obstructive anatomical phenomena can guide appropriate surgical corrective intervention. [36][37][38] Prior recommendations suggest that abnormal ARM and BE tests, or an abnormal ARM alone, suffice to diagnose FDD and DD subtypes. 21,39 This study, however, suggests that ARM has a disproportionately high yield of identifying FDD and agrees poorly with other tests.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic disagreement between tests of evacuatory function: a prospective study of 100 constipated patients

Palit

Thin

Knowles

et al. 2016

Neurogastroenterology Motil

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Diagnostic disagreement between tests of evacuatory function: a prospective study of 100 constipated patients

Palit

Thin

Knowles

et al. 2016

Neurogastroenterology Motil

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“…In this procedure, a medical device is inserted rectally and is used to circumferentially excise the rectal mucosa/area of rectocele and reanastomose the edges. A meta-analysis suggest this technique effectively corrects the anatomic defect but has a high rate of associated complications including rectovaginal fistula, painful defecation, and stricture[36, 37]. No studies comparing this approach to the more generally accepted vaginal approaches of the traditional posterior colporrhaphy and site-specific repair exist, and at this point we would caution gynecologists against a transanal approach.…”

Section: Introductionmentioning

confidence: 99%

Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence

Brown

Grimes

2016

Curr Obstet Gynecol Rep

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While it would be our hope to report that there have been significant gains in the understanding of the correlation between the posterior vaginal compartment and defecatory dysfunction in the last year, this is not the case. Instead, we review the highlights of management of posterior vaginal compartment and defecatory dysfunction including 1) defining and understanding the patient's symptoms; 2) considering systemic disorders, motility dysfunction, and mechanical causes that may be contributing; 3) encouraging conservative management as first-line therapy; and 4) recognizing which surgical options are likely to improve specific symptoms. This is then followed by an update on treatment options for fecal incontinence, which we now prefer to refer to as accidental bowel leakage. We are able to report on five exciting and innovative treatment approaches for accidental bowel leakage. As the scientific community increases focus on patient-centered outcomes, we are likely on the verge of having a greater understanding of how treatment options for posterior compartment prolapse and defecatory dysfunction can improve patient symptoms. This year, we can report that strong evidence based recommendations simply do not exist, and this area is ripe for future investigation.

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“…It is not possible to advise which excisional technique is superior from the point of view of efficacy, peri-operative variables, or harms. Future study is required.One previous meta-analysis including 26 studies [7] addressed the outcome of rectal excisional procedures for constipation.…”

mentioning

confidence: 99%

Surgery for constipation: systematic review and practice recommendations

et al. 2017

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Aim To assess the outcomes of rectal excisional procedures in adults with chronic constipation.Method Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level.Results Forty-seven studies were identified, providing data on outcomes in 8340 patients. Average length of procedures was 44 min and length of stay (LOS) was 3 days. There was inadequate evidence to determine variations in procedural duration or LOS by type of procedure. Overall morbidity rate was 16.9% (0-61%), with lower rates observed after Contour Transtar procedure (8.9%). No mortality was reported after any procedures in a total of 5896 patients. Although inconsistently reported, good or satisfactory outcome occurred in 73-80% of patients; a reduction of 53-91% in Longo scoring system for obstructive defecation syndrome (ODS) occurred in about 68-76% of patients. The most common long-term adverse outcome is faecal urgency, typically occurring in up to 10% of patients. Recurrent prolapse occurred in 4.3% of patients. Patients with at least 3 ODS symptoms together with a rectocoele with or without an intussusception, who have failed conservative management, may benefit from a rectal excisional procedure.Conclusion Rectal excisional procedures are safe with little major morbidity. It is not possible to advise which excisional technique is superior from the point of view of efficacy, peri-operative variables, or harms. Future study is required.

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Relief of Obstructed Defecation Syndrome after Stapled Transanal Rectal Resection (STARR): a Meta-analysis

Cited by 25 publications

References 34 publications

Diagnostic disagreement between tests of evacuatory function: a prospective study of 100 constipated patients

Diagnostic disagreement between tests of evacuatory function: a prospective study of 100 constipated patients

Current Trends in Management of Defecatory Dysfunction, Posterior Compartment Prolapse, and Fecal Incontinence

Surgery for constipation: systematic review and practice recommendations

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