Systematic Characterization of Defecographic Abnormalities in a Consecutive Series of 827 Patients With Chronic Constipation

Grossi, Ugo; Heinrich, Henriette; Tanna, Gian Luca Di; Taylor, Stuart A.; Vollebregt, Paul F.; Knowles, Charles H.; Scott, S. M.

doi:10.1097/dcr.0000000000001923

Cited by 10 publications

(16 citation statements)

References 40 publications

(80 reference statements)

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“…In clinical practice, the prevalence of patients with functional and/or anatomical abnormalities is much higher than that of patients with normal defaecography (85 versus 15%) [10]. We hypothesize that CFD modelling should help to find the origins of defaecation disorders for patients showing anatomical and/or functional abnormalities, as it can measure simultaneously flow and pressure during defaecation.…”

Section: Discussionmentioning

confidence: 99%

“…Once applied to a large cohort of different types of patients, it should help physicians to better characterize the anorectal function and, therefore, refresh our understanding of normal and pathologic defaecation. In regard to the large overlap between functional and structural abnormalities in patients with defaecation disorders [10], patient-specific fluid mechanical simulations should help to identify the origin of these disorders. Specifically, they could help to identify rectoanal discoordination during excessive straining [36].…”

Section: Discussionmentioning

confidence: 99%

“…It is also worth highlighting that a significant proportion of patients with impaired defaecation do not have a well-defined anatomic disorder [8,9]. Moreover, recent systematic characterization of defaecographic abnormalities showed a strong overlap of structural and functional abnormalities in a large cohort of patients [10].…”

Section: Introductionmentioning

confidence: 99%

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Flow simulations of rectal evacuation: towards a quantitative evaluation from video defaecography

Ahmad

Tanguy

et al. 2022

Interface Focus.

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Mechanistic understanding of anorectal (patho)physiology is missing to improve the medical care of patients suffering from defaecation disorders. Our objective is to show that complex fluid dynamics modelling of video defaecography may open new perspectives in the diagnosis of defaecation disorders. Based on standard X-ray video defaecographies, we developed a bi-dimensional patient-specific simulation of the expulsion of soft materials, the faeces, by the rectum. The model quantified velocity, pressure and stress fields during the defaecation of a neostool with soft stool-like rheology for patients showing normal and pathological defaecatory function. In normal defaecation, the proximal–distal pressure gradient resulted from both the anorectal junction which formed a converging channel and the anal canal. The flow of the neostool through these anatomical parts was dominated by its shear-thinning viscous properties, rather than its yield stress. Consequently, the evacuation flow rate was significantly affected by variations in pressure applied by the rectum, and much less by the geometry of the anorectal junction. Lastly, we simulated impaired defaecations in the absence of obvious obstructive phenomena. Comparison with normal defaecation allowed us to discuss critical elements which should lead to effective medical management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Flow simulations of rectal evacuation: towards a quantitative evaluation from video defaecography

Ahmad

Tanguy

et al. 2022

Interface Focus.

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“…Rectoceles may be identified by physical examination, barium or magnetic resonance defecography, and translabial ultrasound. 2,10,17 Expert physical examination usually includes estimation of rectocele stage using the Pelvic Organ Prolapse Quantification System. 18 Stages 0 (none) to 4 (vaginal eversion) are defined as degrees of vaginal descent of the rectocele during maximum Valsalva maneuver or cough.…”

Section: Iag Nos Is and CL A Ss Ifi C Ati Onmentioning

confidence: 99%

Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era

Bharucha

Knowles

2022

Neurogastroenterology Motil

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Background More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (<2 cm), medium (2–4 cm), or large (>4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (e.g., difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (e.g., bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful. Purpose We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by three colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable with historical data predominantly derived from retrospective series in which patients had a good outcome (67%–78%), symptoms of difficult defecation improved (30%–50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary.

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“…Dynamic structural abnormalities of the anorectum and pelvic floor can cause symptoms of obstructed defecation and fecal incontinence [ 1 ], and are found in an important subgroup of patients with chronic constipation [ 2 , 3 ]. The most common abnormalities (either singly or together) are rectocele and intussusception [ 3 , 4 ]. While parameters for diagnosis and intervention vary [ 1 , 5 , 6 ], structurally significant rectoceles and high-grade intussusception (i.e.…”

Section: Introductionmentioning

confidence: 99%

Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation

et al. 2022

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Background The effectiveness of laparoscopic ventral mesh rectopexy (LVMR) in patients with defecatory disorders secondary to internal rectal prolapse is poorly evidenced. A UK-based multicenter randomized controlled trial was designed to determine the clinical efficacy of LVMR compared to controls at medium-term follow-up. Methods The randomized controlled trial was conducted from March 1, 2015 TO January 31, 2019. A stepped-wedge RCT design permitted observer-masked data comparisons between patients awaiting LVMR (controls) with those who had undergone surgery. Adult participants with radiologically confirmed IRP refractory to conservative treatment were randomized to three arms with different delays before surgery. Efficacy outcome data were collected at equally stepped time points (12, 24, 36, 48, 60, and 72 weeks). Clinical efficacy of LVMR compared to controls was defined as ≥ 1.0-point reduction in Patient Assessment of Constipation-Quality of Life and/or Symptoms (PAC-QOL and/or PAC-SYM) scores at 24 weeks. Secondary outcome measures included 14-day diary data, the Generalized Anxiety Disorder scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), St Marks incontinence score, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), the chronic constipation Behavioral Response to Illness Questionnaire (CC-BRQ), and the Brief Illness Perception Questionnaire (BIPQ). Results Of a calculated sample size of 114, only 28 patients (100% female) were randomized from 6 institutions (due mainly to national pause on mesh-related surgery). Nine were assigned to the T0 arm, 10 to T12, and 9 to T24. There were no substantial differences in baseline characteristics between the three arms. Compared to baseline, significant reduction (improvement) in PAC-QOL and PAC-SYM scores were observed at 24 weeks post-surgery (– 1.09 [95% CI – 1.76, – 0.41], p = 0.0019, and – 0.92 [– 1.52, – 0.32], p = 0.0029, respectively) in the 19 patients available for analysis (9 were excluded for dropout [n = 2] or missing primary outcome [n = 7]). There was a clinically significant long-term reduction in PAC-QOL scores (− 1.38 [− 2.94, 0.19], p = 0.0840 at 72 weeks). Statistically significant improvements in PAC-SYM scores persisted to 72 weeks (− 1.51 [− 2.87, − 0.16], p = 0.0289). Compared to baseline, no differences were found in secondary outcomes, except for significant improvements at 24 and 48 weeks on CC-BRQ avoidance behavior (− 14.3 [95% CI − 23.3, − 5.4], and − 0.92 [− 1.52, − 0.32], respectively), CC-BRQ safety behavior (− 13.7 [95% CI − 20.5, − 7.0], and − 13.0 [− 19.8, − 6.1], respectively), and BIPQ negative perceptions (− 16.3 [95% CI − 23.5, − 9.0], and − 10.5 [− 17.9, − 3.2], respectively). Conclusions With the caveat of under-powering due to poor recruitment, the study presents the first randomized trial evidence of short-term benefit of LVMR for internal rectal prolapse. Trial registration ISRCTN Registry (ISRCTN11747152).

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Systematic Characterization of Defecographic Abnormalities in a Consecutive Series of 827 Patients With Chronic Constipation

Abstract: BACKGROUND: Barium defecography can assess structural and functional abnormalities in patients with chronic constipation.

Cited by 10 publications

References 40 publications

Flow simulations of rectal evacuation: towards a quantitative evaluation from video defaecography

Flow simulations of rectal evacuation: towards a quantitative evaluation from video defaecography

Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era

Stepped-wedge randomized controlled trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation

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