AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with r...AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.展开更多
The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yog...The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectoceleand/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.展开更多
Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The a...Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.展开更多
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal proced...External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.展开更多
Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and ...Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.展开更多
AIM: To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training.
BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has...BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele展开更多
A biofluid dynamics mathematical model is developed to study peristaltic flow of non-Newtonian physiological liquid in a two-dimensional asymmetric channel containing porous media as a simulation of obstructed digesti...A biofluid dynamics mathematical model is developed to study peristaltic flow of non-Newtonian physiological liquid in a two-dimensional asymmetric channel containing porous media as a simulation of obstructed digestive （intestinal） transport. The fractional Oldroyd-B viscoelastic rheological model is utilized. The biophysical flow regime is constructed as a wave-like motion and porous medium is simulated with a modified Darcy-Brinkman model. This model is aimed at describing the diges- tive transport in intestinal tract containing deposits which induce impedance. A low Reynolds number approximation is em- ployed to eliminate inertial effects and the wavelength to diameter ratio is assumed to be large. The differential transform method （DTM）, a semi-computational technique is employed to obtain approximate analytical solutions to the boundary value problem. The influences of fractional （rheological material） parameters, relaxation time, retardation time, amplitude of the wave, and permeability parameter on peristaltic flow characteristics such as volumetric flow rate, pressure difference and wall friction force are computed. The present model is relevant to flow in diseased intestines.展开更多
AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography an...AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up.METHODS:From January to December 2007,we have treated 30 patients.Fifteen treated with double PPH-01 staplers and 15 treated using new CCS 30 contour.Resected specimen were measured with respect to average surface and volume.All patients have been evaluated at 24 mo with clinical examination,anorectal manometry and endoanal ultrasonography.RESULTS:Average surface in the CCS 30 group was 54.5 cm2 statistically different when compared to the STARR group (36.92 cm2).The average volume in the CCS 30 group was 29.8 cc,while in the PPH-01 it was23.8 cc and difference was statistically significant.The mean hospital stay in the CCS 30 group was 3.1 d,while in the PPH-01 group the median hospital stay was 3.4 d.As regards the long-term follow-up,an overall satisfactory rate of 83.3% (25/30) was achieved.Endoanal ultrasonography performed 1 year following surgery was considered normal in both of the studied groups.Mean resting pressure was higher than the preoperative value (67.2 mmHg in the STARR group and 65.7 mmHg in the CCS30 group vs 54.7 mmHg and 55.3 mmHg,respectively).Resting and squeezing pressures were lower in those patients not satisfied,but data are not statistically significant.CONCLUSION:The STARR procedure with two PPH-01 is a safe surgical procedure to correct ODS.The new Contour CCS 30 could help to increase the amount of the resected tissue without differences in early complications,post-operative pain and in hospital stay compared to the STARR with two PPH-01 technique.展开更多
Based on the elementary band representations(EBR),many topologically trivial materials are classified as unconventional ones(obstructed atomic limit),where the EBR decomposition for a set of electronic states is not c...Based on the elementary band representations(EBR),many topologically trivial materials are classified as unconventional ones(obstructed atomic limit),where the EBR decomposition for a set of electronic states is not consistent with atomic valenceelectron band representations.In the work,we identify that the unconventional nature can also exist in phonon spectra,where the EBR decomposition for a set of well-separated phonon modes is not consistent with atomic vibration band representations(ABR).The unconventionality has two types:typeⅠis on an empty site;and typeⅡis on an atom site with non-atomic vibration orbitals.The unconventionality is described by the nonzero real-space invariant at the site.Our detailed calculations show that the black phosphorus(BP)has the typeⅠunconventional phonon spectrum,while 1H-Mo Se_(2)has the typeⅡone,although their electronic structures are also unconventional.Accordingly,the obstructed phonon modes are obtained for two types of unconventional phonon spectra.展开更多
Transperineal ultrasound is an inexpensive,safe and painless technique that dynamically and non-invasively evaluates the anorectal area.It has multiple indications,mainly in urology,gynaecology,surgery and gastroenter...Transperineal ultrasound is an inexpensive,safe and painless technique that dynamically and non-invasively evaluates the anorectal area.It has multiple indications,mainly in urology,gynaecology,surgery and gastroenterology,with increased use in the last decade.It is performed with conventional probes,positioned directly above the anus,and may capture images of the anal canal,rectum,puborectalis muscle(posterior compartment),vagina,uterus,(central compartment),urethra and urinary bladder(anterior compartment).Evacuatory disorders and pelvic floor dysfunction,like rectoceles,enteroceles,rectoanal intussusception,pelvic floor dyssynergy can be diagnosed using this technique.It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature,with images obtained at rest,straining and sustained squeezing.This technique is an accurate examination for detecting,classifying and following of perianal inflammatory disease.It can also be used to sonographically guide drainage of deep pelvic abscesses,mainly in patients who cannot undergo conventional drainage.Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence,postpartum and also following surgical repair of obstetric tears.There are also some studies referring to its role in anal stenosis,for the measurement of the anal cushions in haemorrhoids and in chronic anal pain.展开更多
AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 me...AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.展开更多
A rare case of a severely constipated patient with rectal aganglionosis is herein reported.The patient,who had no megacolon/megarectum,underwent a STARR,i.e.,stapled transanal rectal resection,for obstructed defecatio...A rare case of a severely constipated patient with rectal aganglionosis is herein reported.The patient,who had no megacolon/megarectum,underwent a STARR,i.e.,stapled transanal rectal resection,for obstructed defecation,but her symptoms were not relieved.She started suffering from severe chronic proctalgia possibly due to peri-retained staples fibrosis.Intestinal transit times were normal and no megarectum/megacolon was found at barium enema.A diverting sigmoidostomy was then carried out,which was complicated by an early parastomal hernia,which affected stoma emptying.She also had a severe diverting proctitis,causing rectal bleeding,and still complained of both proctalgia and tenesmus.A deep rectal biopsy under anesthesia showed no ganglia in the rectum,whereas ganglia were present and normal in the sigmoid at the stoma site.As she refused a Duhamel procedure,an intersphincteric rectal resection and a refashioning of the stoma was scheduled.This case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure.展开更多
Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Met...Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%;p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.展开更多
BACKGROUND The most common causes of outlet obstructive constipation(OOC)are rectocele and internal rectal prolapse.The surgical methods for OOC are diverse and difficult,and the postoperative complications and recurr...BACKGROUND The most common causes of outlet obstructive constipation(OOC)are rectocele and internal rectal prolapse.The surgical methods for OOC are diverse and difficult,and the postoperative complications and recurrence rate are high,which results in both physical and mental pain in patients.With the continuous deepening of the surgeon’s concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC,the treatment concepts and surgical methods are continuously improved.AIM To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.METHODS From January 2017 to July 2019,49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.RESULTS Forty-five patients were cured,4 patients improved,and the cure rate was 92%.The postoperative obstructed defecation syndrome score,the defecation frequency score,time/straining intensity,and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment,and the differences were statistically significant(P<0.05).The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment,and the differences were statistically significant(P<0.05).The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment,and the differences were statistically significant(P<0.05).The postoperative ratings of rectocele,resting phase,and defecation phase in these patients were significantly decreased compared with those before treatment,and the differences were statistically significant(P<0.05).CONCLUSION The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.展开更多
Background:There are persistent controversies about the outcomes and benefits of drainage of malignant ureteral obstruction by percutaneous nephrostomy(PCN).This study aimed to assess the predictors of the time-to-nad...Background:There are persistent controversies about the outcomes and benefits of drainage of malignant ureteral obstruction by percutaneous nephrostomy(PCN).This study aimed to assess the predictors of the time-to-nadir(TTN)of serum creatinine(SCr)levels after drainage of bilaterally obstructed kidneys(BOKs)due to bladder cancer(BC)by PCN.Materials and methods:This prospective nonrandomized study included patients with BOKs due to BC treated by PCN between April 2019 and March 2022.The primary outcome measure was TTN.Results:Of the 55 patients with a median age(range)of 66 years(47-86 years),32(58.2%)had a normal nadir SCr and 23(41.8%)had a high nadir SCr within 21 days after drainage of BOKs due to BC.High nadir SCr was associated with a higher mean age(p=0.011)and lower body mass index(BMI,p=0.043).However,patients with normal nadir SCr had a significantly shorter TTN(p=0.023)and an increased mean SCr trajectory(p<0.001)during TTN.In multivariate analysis,low urine output at presentation(p=0.021)and high BMI(p=0.006)were associated with longer TTN.However,the mean parenchymal thickness(p=0.428)and laterality of drainage(p=0.466)were not associated with the mean TTN and SCr normalization rates.According to the modified Clavien-Dindo classification,8 cases of hematuria were managed conservatively(grade 2),and 2 cases of PCN slippage were repositioned using local anesthesia(grade 3).Conclusions:Despite the safety of PCN for drainage of BOKs due to BC,more than 41%of the patients failed to have a normal nadir SCr.Predrainage low urine output and high BMI were associated with longer TTN.Laterality of drainage had no significant effects on the TTN and SCr trajectory.展开更多
Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶12...Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶125 and 1∶2000.Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in patho-logical outcomes.The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging.In ad-dition,a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery.Affected pregnancies are conservatively managed;however,1 in 4 requires surgical intervention.Indications for surgi-cal interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy.Therefore,a multi-disciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex.We reviewed the role,safety,advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.展开更多
Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous in...Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women. These included cervical retraction (42.2%), obstetric nerve palsy (30.4%), vaginal scarring (29.8%), partial urethral loss (16.1%), anal sphincter injury (3.1%), cervical stenos展开更多
Aim: To evaluate an innovative sonopelvimetry method for early prediction of obstructed labour. Methods: A prospective study was conducted in two centers.GPS-based sonopelvimetry, laborProTM?(Trig Medical Inc., Yoqnea...Aim: To evaluate an innovative sonopelvimetry method for early prediction of obstructed labour. Methods: A prospective study was conducted in two centers.GPS-based sonopelvimetry, laborProTM?(Trig Medical Inc., Yoqneam Ilit, Israel) devise, was used prior to labour in nulliparous women at 39 - 42 weeks gestation remote from labor. Maternal pelvic parameters, including inter-iliac transverse diameter, obstetric conjugate and interspinous diameter were evaluated. Fetal parameters included head station, biparietal diameter and occipitofrontal diameter. Data on delivery and outcome were collected from the electronic files. Results: The innovative use of sonopelvimetry was applied to 154 consecutive women, none of the participants complained of discomfort or complications observed. The mean time of examination was 15 + 2 minutes. Mean time of examination to delivery interval was 4.8 days (range 0 - 16 days). Small interspinous diameter and high head station were the best predictors for obstructed labour. Analysis indicated 87% sensitivity and 61% specificity for birth weight fetal head station and ISD combined in predicting obstructed labour with an area under the curve of 0.77. Conclusions: Our results indicate that GPS-based?sonopelvimetry combined with fetal estimated weight is a valuable tool in the risk assessment of obstructed labour. Parameters obtained by sonopelvimetry combined with birth weight may be useful.展开更多
文摘AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.
文摘The management of obstructed defecation syndrome(ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectoceleand/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.
基金Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri via N Colajanni,4-00191 Roma,ItalySocietà Italiana di Chirurgia Colo-Rettale via Medici,23-10143Torino,Italy
文摘Chronic constipation is a common and extremely troublesome disorder that significantly reduces the quality of life,and this fact is consistent with the high rate at which health care is sought for this condition.The aim of this project was to develop a consensus for the diagnosis and treatment of chronic constipation and obstructed defecation.The commission presents its results in a "Question-Answer" format,including a set of graded recommendations based on a systematic review of the literature and evidence-based medicine.This section represents the consensus for the diagnosis.The history includes information relating to the onset and duration of symptoms and may reveal secondary causes of constipation.The presence of alarm symptoms and risk factors requires investigation.The physical examination should assess the presence of lesions in the anal and perianal region.The evidence does not support the routine use of blood testing and colonoscopy or barium enema for constipation.Various scoring systems are available to quantify the severity of constipation;the Constipation Severity Instrument for constipation and the obstructed defecation syndrome score for obstructed defecation are the most reliable.The Constipation-Related Quality of Life is an excellent tool for evaluating the patient's quality of life.No single test provides a pathophysiological basis for constipation.Colonic transit and anorectal manometry define the pathophysiologic subtypes.Balloon expulsion is a simple screening test for defecatory disorders,but it does not define the mechanisms.Defecography detects structural abnormalities and assesses functional parameters.Magnetic resonance imaging and/or pelvic floor sonography can further complement defecography by providing information on the movement of the pelvic floor and the organs that it supports.All these investigations are indicated to differentiate between slow transit constipation and obstructed defecation because the treatments differ between these conditions.
文摘External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
文摘Obstructed defecation （OD） and fecal incontinence （FI） are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders sodally and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical, and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories （ARP）, radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.
基金Supported by Foundation of Science and Technology Plan Projects of Shenyang,No.P112238
文摘AIM: To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training.
文摘BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele
文摘A biofluid dynamics mathematical model is developed to study peristaltic flow of non-Newtonian physiological liquid in a two-dimensional asymmetric channel containing porous media as a simulation of obstructed digestive （intestinal） transport. The fractional Oldroyd-B viscoelastic rheological model is utilized. The biophysical flow regime is constructed as a wave-like motion and porous medium is simulated with a modified Darcy-Brinkman model. This model is aimed at describing the diges- tive transport in intestinal tract containing deposits which induce impedance. A low Reynolds number approximation is em- ployed to eliminate inertial effects and the wavelength to diameter ratio is assumed to be large. The differential transform method （DTM）, a semi-computational technique is employed to obtain approximate analytical solutions to the boundary value problem. The influences of fractional （rheological material） parameters, relaxation time, retardation time, amplitude of the wave, and permeability parameter on peristaltic flow characteristics such as volumetric flow rate, pressure difference and wall friction force are computed. The present model is relevant to flow in diseased intestines.
文摘AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up.METHODS:From January to December 2007,we have treated 30 patients.Fifteen treated with double PPH-01 staplers and 15 treated using new CCS 30 contour.Resected specimen were measured with respect to average surface and volume.All patients have been evaluated at 24 mo with clinical examination,anorectal manometry and endoanal ultrasonography.RESULTS:Average surface in the CCS 30 group was 54.5 cm2 statistically different when compared to the STARR group (36.92 cm2).The average volume in the CCS 30 group was 29.8 cc,while in the PPH-01 it was23.8 cc and difference was statistically significant.The mean hospital stay in the CCS 30 group was 3.1 d,while in the PPH-01 group the median hospital stay was 3.4 d.As regards the long-term follow-up,an overall satisfactory rate of 83.3% (25/30) was achieved.Endoanal ultrasonography performed 1 year following surgery was considered normal in both of the studied groups.Mean resting pressure was higher than the preoperative value (67.2 mmHg in the STARR group and 65.7 mmHg in the CCS30 group vs 54.7 mmHg and 55.3 mmHg,respectively).Resting and squeezing pressures were lower in those patients not satisfied,but data are not statistically significant.CONCLUSION:The STARR procedure with two PPH-01 is a safe surgical procedure to correct ODS.The new Contour CCS 30 could help to increase the amount of the resected tissue without differences in early complications,post-operative pain and in hospital stay compared to the STARR with two PPH-01 technique.
基金supported by the National Natural Science Foundation of China(Grant Nos.11974395,and 12188101)the Strategic Priority Research Program of Chinese Academy of Sciences(Grant No.XDB33000000)+1 种基金the National Key R&D Program of Chain(Grant No.2022YFA1403800)the Center for Materials Genome。
文摘Based on the elementary band representations(EBR),many topologically trivial materials are classified as unconventional ones(obstructed atomic limit),where the EBR decomposition for a set of electronic states is not consistent with atomic valenceelectron band representations.In the work,we identify that the unconventional nature can also exist in phonon spectra,where the EBR decomposition for a set of well-separated phonon modes is not consistent with atomic vibration band representations(ABR).The unconventionality has two types:typeⅠis on an empty site;and typeⅡis on an atom site with non-atomic vibration orbitals.The unconventionality is described by the nonzero real-space invariant at the site.Our detailed calculations show that the black phosphorus(BP)has the typeⅠunconventional phonon spectrum,while 1H-Mo Se_(2)has the typeⅡone,although their electronic structures are also unconventional.Accordingly,the obstructed phonon modes are obtained for two types of unconventional phonon spectra.
文摘Transperineal ultrasound is an inexpensive,safe and painless technique that dynamically and non-invasively evaluates the anorectal area.It has multiple indications,mainly in urology,gynaecology,surgery and gastroenterology,with increased use in the last decade.It is performed with conventional probes,positioned directly above the anus,and may capture images of the anal canal,rectum,puborectalis muscle(posterior compartment),vagina,uterus,(central compartment),urethra and urinary bladder(anterior compartment).Evacuatory disorders and pelvic floor dysfunction,like rectoceles,enteroceles,rectoanal intussusception,pelvic floor dyssynergy can be diagnosed using this technique.It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature,with images obtained at rest,straining and sustained squeezing.This technique is an accurate examination for detecting,classifying and following of perianal inflammatory disease.It can also be used to sonographically guide drainage of deep pelvic abscesses,mainly in patients who cannot undergo conventional drainage.Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence,postpartum and also following surgical repair of obstetric tears.There are also some studies referring to its role in anal stenosis,for the measurement of the anal cushions in haemorrhoids and in chronic anal pain.
文摘AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for compliance.METHODS The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.RESULTS Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.
文摘A rare case of a severely constipated patient with rectal aganglionosis is herein reported.The patient,who had no megacolon/megarectum,underwent a STARR,i.e.,stapled transanal rectal resection,for obstructed defecation,but her symptoms were not relieved.She started suffering from severe chronic proctalgia possibly due to peri-retained staples fibrosis.Intestinal transit times were normal and no megarectum/megacolon was found at barium enema.A diverting sigmoidostomy was then carried out,which was complicated by an early parastomal hernia,which affected stoma emptying.She also had a severe diverting proctitis,causing rectal bleeding,and still complained of both proctalgia and tenesmus.A deep rectal biopsy under anesthesia showed no ganglia in the rectum,whereas ganglia were present and normal in the sigmoid at the stoma site.As she refused a Duhamel procedure,an intersphincteric rectal resection and a refashioning of the stoma was scheduled.This case report shows that a complete assessment of the potential causes of constipation should be carried out prior to any surgical procedure.
文摘Objective: To compare maternal and fetal outcome associated with two methods Reverse breech extraction versus Head pushing to deliver the impacted fetal head in advanced labor requiring emergency Cesarean section. Method: A prospective comparative study was conducted on 80 pregnant women at term with cephalic presentation in advanced labour, requiring emergency Cesarean Section. Reverse breech extraction technique (pull method) was used in 40 cases (group I) and pushing the head up through the vagina (“push” method) was tried in (group II) 40 cases. The maternal outcome was assessed by extension of the uterine Incision, bladder injury, intra and postoperative blood transfusion, Postpartum hemorrhage, wound infection and duration of hospital stay. Fetal outcome was Apgar score and admission to neonatal intensive care unit. Results: Extension of the uterine incision was significantly lower in women undergoing reverse breech extraction compared to cephalic delivery (20% versus 50%;p = 0.001). The mean operative time (pull group) was lower than that in the (push group) 59.7 ± 4.2, versus 75.2 ± 6.1 p = 0.001 and blood loss was significantly lower in the (pull group) than that in the (push group) 878 ± 67 ml, versus 1321 ± 57 ml, p = 0.001. No significant difference between groups regarding maternal and neonatal outcome. Conclusion: Reverse breech extraction (pull) is safer than pushing head up through vagina (push) for delivery of a deeply impacted fetal head in advanced labour sensitizing emergency Cesarean Section and is associated with the least maternal complications.
基金The Natural Science Foundation of Liaoning Province,No.20170540840.
文摘BACKGROUND The most common causes of outlet obstructive constipation(OOC)are rectocele and internal rectal prolapse.The surgical methods for OOC are diverse and difficult,and the postoperative complications and recurrence rate are high,which results in both physical and mental pain in patients.With the continuous deepening of the surgeon’s concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC,the treatment concepts and surgical methods are continuously improved.AIM To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.METHODS From January 2017 to July 2019,49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.RESULTS Forty-five patients were cured,4 patients improved,and the cure rate was 92%.The postoperative obstructed defecation syndrome score,the defecation frequency score,time/straining intensity,and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment,and the differences were statistically significant(P<0.05).The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment,and the differences were statistically significant(P<0.05).The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment,and the differences were statistically significant(P<0.05).The postoperative ratings of rectocele,resting phase,and defecation phase in these patients were significantly decreased compared with those before treatment,and the differences were statistically significant(P<0.05).CONCLUSION The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.
文摘Background:There are persistent controversies about the outcomes and benefits of drainage of malignant ureteral obstruction by percutaneous nephrostomy(PCN).This study aimed to assess the predictors of the time-to-nadir(TTN)of serum creatinine(SCr)levels after drainage of bilaterally obstructed kidneys(BOKs)due to bladder cancer(BC)by PCN.Materials and methods:This prospective nonrandomized study included patients with BOKs due to BC treated by PCN between April 2019 and March 2022.The primary outcome measure was TTN.Results:Of the 55 patients with a median age(range)of 66 years(47-86 years),32(58.2%)had a normal nadir SCr and 23(41.8%)had a high nadir SCr within 21 days after drainage of BOKs due to BC.High nadir SCr was associated with a higher mean age(p=0.011)and lower body mass index(BMI,p=0.043).However,patients with normal nadir SCr had a significantly shorter TTN(p=0.023)and an increased mean SCr trajectory(p<0.001)during TTN.In multivariate analysis,low urine output at presentation(p=0.021)and high BMI(p=0.006)were associated with longer TTN.However,the mean parenchymal thickness(p=0.428)and laterality of drainage(p=0.466)were not associated with the mean TTN and SCr normalization rates.According to the modified Clavien-Dindo classification,8 cases of hematuria were managed conservatively(grade 2),and 2 cases of PCN slippage were repositioned using local anesthesia(grade 3).Conclusions:Despite the safety of PCN for drainage of BOKs due to BC,more than 41%of the patients failed to have a normal nadir SCr.Predrainage low urine output and high BMI were associated with longer TTN.Laterality of drainage had no significant effects on the TTN and SCr trajectory.
文摘Urolithiasis is the most common cause of nonobstetric abdominal pain,resulting in 1.7 admissions per 1000 deliveries.Urolithiasis most commonly occurs in the second and third trimesters,with an incidence between 1∶125 and 1∶2000.Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in patho-logical outcomes.The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging.In ad-dition,a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery.Affected pregnancies are conservatively managed;however,1 in 4 requires surgical intervention.Indications for surgi-cal interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy.Therefore,a multi-disciplinary approach is required to optimize patient care.The diagnosis and management of urolithiasis in pregnancy are complex.We reviewed the role,safety,advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
文摘Background: Long-term complications of prolonged obstructed labour are multisystemic, obstetric fistula about the most devastating. Efforts at controlling obstetric fistula pay little attention to the non-fistulous injuries which reduce the quality of life of the affected women even after a successful fistula repair. The objectives of this study were to determine the burden of the non-fistulous complications among fistula patients, identify these injuries and the factors associated with them. Methods: This cross-sectional study was conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria from July to December 2016. The hospital has performed over 2600 free fistula repairs. This study was approved by the Research and Ethics Committee of the hospital. The study population comprised of women who developed obstetric fistula following prolonged obstructed labour. Direct questioning, examination findings, operation findings and laboratory results, using a pre-tested, semi-structured and interviewer-administered proforma were used to collect data. Informed consent was obtained from the subjects. Data were analyzed using the Statistical Package for Social Sciences [SPSS] version 21. Frequency and proportions were used to describe categorical variables while means and standard deviation were used to describe continuous variables. Association between categorical variables and direct obstructed labour injuries was tested using chi-square test and predictors of obstructed labour injuries were determined using logistic regression. A P-value 0.05 was considered statistically significant. Results: One hundred and sixty one (161) women participated in the study. The mean age of the women was 33.4 years while the mean parity was 3.2. Non-fistulous complications of prolonged obstructed labour were found in 96.9% (156) of the women. These included cervical retraction (42.2%), obstetric nerve palsy (30.4%), vaginal scarring (29.8%), partial urethral loss (16.1%), anal sphincter injury (3.1%), cervical stenos
文摘Aim: To evaluate an innovative sonopelvimetry method for early prediction of obstructed labour. Methods: A prospective study was conducted in two centers.GPS-based sonopelvimetry, laborProTM?(Trig Medical Inc., Yoqneam Ilit, Israel) devise, was used prior to labour in nulliparous women at 39 - 42 weeks gestation remote from labor. Maternal pelvic parameters, including inter-iliac transverse diameter, obstetric conjugate and interspinous diameter were evaluated. Fetal parameters included head station, biparietal diameter and occipitofrontal diameter. Data on delivery and outcome were collected from the electronic files. Results: The innovative use of sonopelvimetry was applied to 154 consecutive women, none of the participants complained of discomfort or complications observed. The mean time of examination was 15 + 2 minutes. Mean time of examination to delivery interval was 4.8 days (range 0 - 16 days). Small interspinous diameter and high head station were the best predictors for obstructed labour. Analysis indicated 87% sensitivity and 61% specificity for birth weight fetal head station and ISD combined in predicting obstructed labour with an area under the curve of 0.77. Conclusions: Our results indicate that GPS-based?sonopelvimetry combined with fetal estimated weight is a valuable tool in the risk assessment of obstructed labour. Parameters obtained by sonopelvimetry combined with birth weight may be useful.
