Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience

Abstract

Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented.

An exploring study of defecography, digital rectal examination, and balloon expulsion test for screening and predicting of symptoms with defecation disorders

“…It is found that DF could be used as a much more accessible diagnostic method for patients with obstruction and an index combining DF and DRE can further assess for the screening and diagnosis of the cause(s) of their symptoms, to guide treatment in clinics [30]. The treatment of constipation includes drug therapy, anorectal myectomy, biofeedbac� or surgery, but in general these treat� ments have poor efficacy due to various etiology [31,32]. Thus treatment decisions should not depend solely on this type of feedbac�.…”

Khubchandani’s procedure combined with stapled posterior rectal wall resection for rectocele

“…Moreover, it effectively rebuilds the rectal volume by resection of the prolapsed tissue. However, there is an ongoing debate between the supporters and the opponents of STARR as multiple postoperative complications have been reported[ 31 , 33 - 37 ] after STARR. Some long-term follow-up studies[ 11 , 38 ] revealed that the ODS score of patients who underwent the STARR procedure had a smooth increase after operation.…”

Internal Delorme’s Procedure for Treating ODS Associated With Impaired Anal Continence

“…From June 2011 to June 2015, 41 (35 female) patients with a mean age ± SD of 62.3 ± 15.3 (range = 31-82) years underwent internal Delorme's procedure for rectocele and/ or internal rectal prolapse-induced ODS with impaired anal continence. Clinical assessment of constipation and incontinence was performed according to the Rome III criteria, 20 and all patients underwent surgical procedures only after experiencing failure of medical therapy. All candidates should have a complete diagnostic evaluation, including the following items, before undergoing the operation: (1) digital examination and anoscopy, (2) magnetic resonance defecography or enterocolpocystodefecography, (3) colonoscopy (patients with age ≥45 years or who have a familial history of colon cancer), (4) tridimensional 360° transanal ultrasonography, (5) anorectal manometry, and (6) neurophysiological tests (when indicated).…”