Short-term results after STARR versus internal Delorme for obstructed defecation: a non-randomized prospective study

Ohazuruike, Nnawuihe Luca; Martellucci, Jacopo; Menconi, Claudia; Panicucci, Sonia; Toniolo, G. Chechile; Naldini, Gabriele

doi:10.1007/s13304-014-0247-2

Cited by 14 publications

(15 citation statements)

References 29 publications

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“…The STARR procedure was developed specifically for patients with ODS attributable to internal intussusception or rectocele. In the recent STARR literature, there is a trend toward omitting this distinction, referring to the STARR procedure simply as a "treatment for ODS," [79][80][81][82][83] with ODS regarded as a single entity caused by mechanical obstruction of stool by internally prolapsing tissue. 84 Even if the studies themselves have more stringent inclusion criteria, the description of STARR as an "operation for ODS" is problematic.…”

Section: Transanal Resectionmentioning

confidence: 99%

Functional Disorders: Rectocele

2016

Clinics in Colon and Rectal Surgery

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Rectoceles are a very common finding in patients, and symptoms most commonly include pelvic pain, pressure, or difficulty with passing stool. However, there are often other associated pelvic floor disorders that accompany rectoceles, making the clinical significance of it in an individual patient often hard to determine. When evaluating a patient with a rectocele, a thorough history and physical exam must be conducted to help delineate other causes of these symptoms. Treatment consists of addressing other defecatory disorders through various methods, with surgery reserved for select cases in which obstructed defecation is well documented.

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Section: Transanal Resectionmentioning

confidence: 99%

Functional Disorders: Rectocele

2016

Clinics in Colon and Rectal Surgery

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“…Both procedures significantly lowered the Wexner constipation score (from 17 to 4.7 after STARR and from 15.3 to 3.3 after Delorme). 47 A retrospective study of 52 patients compared STARR to laparoscopic ventral rectopexy (LVR) and found that there was a shorter length of stay for STARR 5.6 versus 7.1 days. Other outcomes were similar.…”

Section: Comparative Studiesmentioning

confidence: 99%

Functional Disorders: Rectoanal Intussusception

Blaker

Anandam

2016

Clinics in Colon and Rectal Surgery

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HistoryRectoanal intussusception (RI), also known as internal intussusception, occult rectal prolapse, intrarectal prolapse, and internal procidentia, is a telescoping of the rectal wall during fecal evacuation. 1 Allingham, in the late 1800s, first described what we label today as rectoanal intussusception as the third variety of procidentia recti in which "the upper part of the rectum descends through the lower part, but does not appear outside the anus." 2,3 He diagnosed this with physical exam and symptoms included "obstinate constipation unrelieved by purgatives; a sensation of burning and fullness in the bowel attended with tenesmus, straining, and difficulty in defecation with occasional discharges of blood and mucus." He postulated that the intussusception was caused by a redundant sigmoid or rectal mesentery. Treatment options at that time included cauterizing portions of the intussusception or a sort of rectopexy via a left lower quadrant incision in which a silk suture is passed through the mesentery and secured it to the abdominal wall. 3 Since its first description, advances have been made in the diagnosis and treatment of rectal intussusception. However, there are many unanswered questions and the best treatment option remains unclear. EtiologyThe pathophysiology and etiology of RI is not well elucidated. Existing theories of etiology fall along two general lines of thought: RI is a dynamic anomaly which may progress to rectal prolapse; or RI is secondary to other abnormalities of pelvic floor function. 1,2 Loose fixation of the rectum to the sacrum or connective tissue disorders may contribute to RI. 4 It is hypothesized that symptoms of obstructed defecation due to RI occur owing to the circular infolding of the rectal wall with subsequent occlusion of the rectal lumen.Several studies have examined whether RI progresses to rectal prolapse. Wijffels et al found a positive correlation between grade of prolapse and age, supporting this postulation. 5 However, other studies do not support this hypothesis. Choi et al found that only 1 in 26 patients treated with dietary therapy or biofeedback for large RI ( 10 mm) developed fullthickness rectal prolapse during 45 months of follow-up (range: 12-118 months). 1 Similarly, Mellgren et al studied 38 patients with rectal intussusception on defecography who were treated nonsurgically, and found that only 2 developed rectal prolapse during the follow-up period. 6 A much larger study of 1,014 women with fecal incontinence and/or obstructive defecation found that of the 26 patients with initial rectorectal intussusception, 1 progressed to external rectal AbstractRectoanal intussusception is an invagination of the rectal wall into the lumen of the rectum. Patients may present with constipation, incomplete evacuation, incontinence, or may be asymptomatic. Defecography has been the gold standard for detection. Magnetic resonance imaging defecography and dynamic anal endosonography are alternatives to conventional defecography. However, both methods are not as sens...

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“…As a most commonly used transanal manual procedure, internal Delorme’s transanal excision was supposed to be a relatively cheap and pathophysiologically appropriate procedure for many patients with ODS[ 39 ].…”

Section: Current Options For Ods Treatmentmentioning

confidence: 99%

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

Liu

Wan

Yaseen

et al. 2016

WJG

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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.

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Short-term results after STARR versus internal Delorme for obstructed defecation: a non-randomized prospective study

Cited by 14 publications

References 29 publications

Functional Disorders: Rectocele

Functional Disorders: Rectocele

Functional Disorders: Rectoanal Intussusception

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

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