Staplers for obstructed defecation syndrome

Regadas, Francisco Sérgio Pinheiro; Filho, Francisco L. de Caldas

doi:10.1007/s10151-017-1743-4

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…Therefore, surgery should not be the first or the only therapeutic strategy. A multimodal approach is recommended ( 43 ). Patients' preoperatory evaluation should include a dynamic defecography ( 44 ) and an endoscopic study such as colonoscopy or proctoscopy.…”

Section: Discussionmentioning

confidence: 99%

Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

et al. 2022

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Obstructed defecation syndrome (ODS) is a form of constipation that influences the quality of life in most patients and is an important health care issue. In 2004 Longo introduced a minimal invasive trans-anal approach known as Stapled Trans-Anal Rectal Resection (STARR) in order to correct mechanical disorders such as rectocele or rectal intussusception, two conditions present in more than 90% of patients with ODS. Considering the lack of a common view around ODS and STARR procedure. the aim of our study is to review the literature about preoperative assessment, operative features and outcomes of the STARR technique for the treatment of ODS. We performed a systematic search of literature, between January 2008 and December 2020 and 24 studies were included in this review. The total number of patients treated with STARR procedure was 4,464. In conclusion STARR surgical procedure has been proven to be safe and effective in treating symptoms of ODS and improving patients Quality of Life (QoL) and should be taken in consideration in the context of a holistic and multi modal approach to this complex condition. International guidelines are needed in order to optimize the diagnostic and therapeutic process and to improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

et al. 2022

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Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancers—Reply

2021

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The recommendation for omission of SLNB in elderly patients is based on the CALGB 9343 study 2 in which only about one-third of patients underwent axillary surgical staging. Without axillary dissection, only 3% (6 of 200) treated with lumpectomy and tamoxifen experienced axillary recurrence. 2 There was no difference in overall survival between treatments with or without radiation therapy (RT), which is the basis for another Choosing Wisely campaign recommendation-omission of RT in elderly patients with stage I ER+BC. What is often overlooked is the characteristics of the patients in CALGB 9343. With a median age of 75 years in both treatment groups, more than 50% in each group had died, most often from non-BC-related causes, on long-term follow-up. 3 Therefore, we agree that omitting SLNB (and RT) is reasonable for patients in their mid-70s and older with significant comorbidities, but it is difficult to broadly apply these recommendations to all patients 70 years and older with stage I ER+BC.Furthermore, axillary staging affects RT recommendations. For fit septuagenarians, accelerated partial breast irradiation (APBI) over 1 week is an excellent way to de-escalate therapy compared with the 5 weeks of RT that was performed in CALGB 9343. However, randomized studies comparing APBI and whole-breast RT required axillary surgical staging. 4 It gives us substantial pause to recommend APBI in the absence of known pN0 status by SLNB, particularly when a patient is hesitant about adjuvant hormonal therapy (HT).This leads to another important assumption when omitting SLNB: that patients will take adjuvant HT. The patientreported HT-related adverse events are not insignificant. Adverse events, such as joint pain and vaginal dryness, can be especially debilitating in elderly patients. The adherence to HT is suboptimal and there is trend for higher likelihood for discontinuing HT early with increasing age. 5 Thus, until better strategies are developed to reduce early discontinuation of HT, understanding the surgical axillary stage in this population will continue to be of importance.

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Anorectal Disorders

Rao

Tetangco

2020

Journal of Clinical Gastroenterology

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Anorectal disorders encompass structural, neuromuscular, and functional disorders. They are common, often distressing, and in some cases debilitating, and significantly add to the health care burden. They present with multiple, overlapping symptoms that can often obscure the underlying pathology and can pose significant diagnostic and management dilemmas. A meticulous history and comprehensive digital rectal examination can provide clarity on the diagnosis, appropriate testing, and management of these conditions. Today, with the development of sophisticated diagnostic tools such as high-resolution and high-definition (3-D) anorectal manometry, 3-D anal ultrasonography, magnetic resonance defecography and imaging, and neurophysiological tests such as translumbosacral anorectal magnetic stimulation, it is possible to more accurately define and characterize the underlying structural and functional abnormalities. In this review, we present a succinct update on the latest knowledge with regards to the pathophysiology, diagnosis and management of anal fissure, hemorrhoids, rectal prolapse, intussusception, rectocele, solitary rectal ulcer syndrome, levator ani syndrome, dyssynergic defecation and fecal incontinence.

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Staplers for obstructed defecation syndrome

Cited by 3 publications

References 8 publications

Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review

Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancers—Reply

Anorectal Disorders

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