Defecographic functional evaluation of rectal akinesia

Morandi, C; Martellucci, Jacopo; Genovese, Maurilio; Torricelli, Pietro

doi:10.1007/s10151-015-1310-9

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…In conclusion, the main limiting factor for this patient was an excessively weak applied pressure/force. This is in line with the concept of 'rectal akinesia', the pathogenesis of which is a problem of rectal wall contractility [8,9,34]. Extending CFD simulations to video defaecographies of patients showing impaired defaecation in the absence of obvious obstructive phenomena should lead to a much better description of 'rectal akinesia'.…”

Section: Towards a Quantitative Evaluation Of Pathophysiology Of Defa...supporting

confidence: 74%

“…Patient P1, as a significant proportion of patients with impaired defaecation [8,9], had no well-defined anatomic disorders, figure 4 a . Simulated maximal pressure and forces were about 15 kPa and 300 N m −1 , almost twice smaller than in normal patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1,7]. 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: Towards a Quantitative Evaluation Of Pathophysiology Of Defa...supporting

confidence: 74%

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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“…In fact, rectal akinesia was often found after surgical procedures (rectopexy, rectosigmoid resection, etc. ), due to the potential limitation of the physiological movements of the rectum during defecation maneuvers [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Sacral Neuromodulation for defecation disorders after non oncologic pelvic surgery

Martellucci,

Annicchiarico,

Scheiterle

et al. 2023

Int J Colorectal Dis

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Purpose Defecation disorders (DD) can sometimes affect the outcomes of pelvic or colorectal surgery. The aim of the present study is to evaluate the role of sacral neuromodulation for the treatment of constipation and other evacuation disorders after surgery. Methods A retrospective analysis in all the consecutive patients that underwent sacral nerve modulation (SNM) for DD arisen or worsened after pelvic or colorectal surgery was performed from January 2010 to December 2020. DD were defined starting from Rome IV Criteria, and according to manometric results, all patients were further divided into the two subgroups: inadequate defecatory propulsion and dyssynergic defecation. Cleveland Clinic Constipations Score (CCCS) and SF-36 have been evaluated in the time. Results Thirty-seven patients have been included in the study. Twenty-seven out of thirty-seven (73.3%) patients had experienced sufficient benefits to implant the definitive device, and 22 patients (59.4% of tested and 81.5% of permanently implanted) still had the device functioning after a mean follow-up of 6.3 years. The most represented manometric pattern was inadequate propulsive function (59% of patients). CCCS at preoperative assessment for all patients was 17.5 with a reduction to 10.4 at the first year of follow-up (p < 0.001). Conclusion SNM appears to be a feasible, safe, and well-tolerated procedure with durable benefit in the long-term treatment of defecatory dysfunction after pelvic or colorectal surgery for benign diseases.

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“…Despite extensive resections of the entire left colon, the altered colonic transit could not be corrected, while some patients developed new-onset constipation [ 35 ]. In a defecographic study of rectal motility, obstructed defecation persisted after rectopexy, apparently due to the fixity of the rectum preventing effective expulsive contraction [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation

et al. 2022

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Background Ventral mesh rectopexy (VMR) is widely accepted for the treatment of rectal prolapse or obstructed defecation. However, despite good anatomical results, the improvement of functional symptoms (constipation or incontinence) cannot always be obtained and in some cases these symptoms may even worsen. The aim of the present study was to identify possible predictors of functional failure after VMR. Methods Data of all consecutive patients who had VMR for the treatment of rectal prolapse and/or obstructed defecation between January 2017 and December 2020 in three different pelvic floor surgical centres in Italy were analysed to identify possible predictors of functional failure, intended as persistence, worsening or new onset of constipation or faecal incontinence. Symptom severity was assessed pre- and postoperatively with the Wexner Constipation score and Obstructed Defecation Syndrome score. Quality of life was assessed, also before and after treatment, with the Patients Assessment of Constipation Quality of Life questionnaire, the Pelvic Floor Disability Index and the Pelvic Floor Impact Questionnaire. Faecal incontinence was evaluated with the Cleveland Clinic Incontinence Score. The functional outcomes before and after surgery were compared. Results Sixty-one patients were included (M:F ratio 3:60, median age 64 years [range 33–88 years]). Forty-two patients (68.9%) had obstructed defecation syndrome, 12(19.7%) had faecal incontinence and 7 patients (11.5%) had both. A statistically significant reduction between pre- and postoperative Obstructed Defecation Syndrome and Wexner scores was reported (p < 0.0001 in both cases). However, the postoperative presence of constipation occurred in 22 patients (36.1%) (this included 3 cases of new-onset constipation). The presence of redundant colon and the pre-existent constipation were associated with an increased risk of persistence of constipation postoperatively or new-onset constipation (p = 0.004 and p < 0.0001, respectively). The use of postoperative pelvic floor rehabilitation (p = 0.034) may reduce the risk of postoperative constipation. Conclusions VMR is a safe and effective intervention for correcting the anatomical defect of rectal prolapse. The degree of prolapse, the presence of dolichocolon and pre-existing constipation are risk factors for the persistence or new onset of postoperative constipation. Postoperative rehabilitation treatment may reduce this risk.

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Defecographic functional evaluation of rectal akinesia

Abstract: N

Cited by 3 publications

References 6 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

Sacral Neuromodulation for defecation disorders after non oncologic pelvic surgery

Predictive factors for functional failure of ventral mesh rectopexy in the treatment of rectal prolapse and obstructed defecation

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